Preventing Childhood Obesity Health in the Balance (2005) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-20
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From page 1... ...
At a time when we have learned that excess weight has significant and troublesome health consequences, we nevertheless see our population, in general, and our children, in particular, gaining weight to a dangerous degree and at an alarmmg rate. The increasing prevalence of childhood obesityl throughout the United States has led policy makers to rank it as a critical public health threat.
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The national health care expenditures related to obesity and overweight in adults alone have been estimated to range from approximately $98 billion to $129 billion after adjusting for inflation and converting estimates to 2004 dollars. Understanding the causes of childhood obesity, determining what to do about them, and taking appropriate action require attention to what influences eating behaviors and physical activity levels because obesity prevention involves a focus on energy balance (calories consumed versus calories expended)
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Therefore, evaluation should be a critical component of any implemented intervention or change. Childhood obesity prevention involves maintaining energy balance at a healthy weight while protecting overall health, growth and development, and nutritional status.
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Examples include Increased number of children who safely walk and bike to school Improved access to and affordability of fruits and vegetables for low-income populations Increased availability and use of community recreational facilities Increased play and physical activity opportunities Increased number of new industry products and advertising messages that promote energy balance at a healthy weight Increased availability and affordability of healthful foods and beverages at supemmarkets, grocery stores, and fammers markets located within walking distance of the communities they se ve Changes in institutional and environmental policies that promote energy balance Thus, changes at many levels and in numerous environments will require the involvement of multiple stakeholders from diverse segments of society. In the home environment, for example, incremental changes such as improving the nutritional quality of family dinners or increasing the time and frequency that children spend outside playing can make a difference.
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Across the country, obesity prevention efforts have already begun, and although the ultimate solutions are still far off, there is great potential at present for pursuing innovative approaches and creating linkages that permit the cross-fertilization of ideas. Current efforts range from new school board policies and state legislation regarding school physical education requirements and nutrition standards for beverages and foods sold in schools to community initiatives to expand bike paths and improve recreational facilities.
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From page 6... ...
An increased level and sustained commitment of federal and state funds and resources are needed. To implement this recommendation, the federal government should: · Strengthen research and program efforts addressing obesity prevention, with a focus on experimental behavioral research and community-based intervention research and on the rigorous evaluation of the effectiveness, cost-effectiveness, sustainability, and scaling up of effective prevention interventions · Support extensive program and research efforts to prevent childhood obesity in high-iisk populations with health disparities, with a focus both on behavioral and envirommerltal approaches · Support nutrition and physical activity giant programs, particularly in states with the highest prevalence of childhood obesity · Strengthen support for relevant surveillance and monitoring efforts, particularly the National Health and Nutrition Examination Survey (NHANES)
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From page 7... ...
They often make immediate trade-offs in taste, cost, and convenience for longer term health. The food, beverage, restaurant, entertainment, leisure, and recreation industries share in the responsibilities for childhood obesity prevention and can be instrumental in supporting this goal.
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Public education messages in multiple types of media are needed to generate support for policy changes and provide messages to the general public, parents, children, and adolescents. Recommendation 2: industry Industly should make obesity prevention in children and youth a priority by developing and promoting products, opportunities, and infolmation that will encourage healthful eating behaviors and regular physical activity.
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· The Federal Trade Commission should have the authority mud resources to momtor compliance widh She food and beverage mud sedentary entertainment advertising practices. Recommendation 5: Mv.ltimedia and Public Relations Campaign The DHHS should develop and evaluate a long-term national multimedia and public relations campaign focused on obesity prevention in children and youHh.
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Recommendation 6: Community Programs Local governments, public health agencies, schools, and community organizations should collaboratively develop and promote programs that encourage healthful eating behaviors and regular- physical activity, particularly for populations at high risk of childhood obesity. Community coalitions should be formed to facilitate and promote a-oss-cutting programs amd community-wide efforts.
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· Communities should improve access to supermarkets, farmers' mal* ets, and commumity gardens to expand healthful food options, particularly in low-income and undersel-ved areas Recommendation 7: Built Environment Local governments, private developers, and community groups should expand oppoltumities for physical activity including recreational facilities, parks, playgrounds, sidewalks, bike paths, routes for walking or bicycling to school, and safe streets and neighborhoods, especially for populations at high risk of childhood obesity.
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Health-care professional orgamizations, insurers, amd accrediting groups should support individual amd population-based obesity prevention efforts. To implement this recommendation: · Health-care professionals should routinely track Bull, offer relevant evidence-based counseling amd guidance, serve as role models, and provide leadership in their commumties for obesity prevention efforts.
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Schools offer many other opportunities for learning and practicing healthful eating and physical activity behaviors. Coordinated changes in the curriculum, the in-school advertising environment, school health services, and after-school programs all offer the potential to advance obesity prevention.
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have a profound influence on their children by fostering certain values and attitudes, by rewarding or reinforcing specific behaviors, and by serving as role models. A child's health and well-being are thus enhanced by a home environment with engaged and skillful parenting that models, values, and encourages healthful eating habits and a physically active lifestyle.
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To implement this recommendation parents can: · Choose exclusive breastfeeding as the method for feeding infants for the first four to six months of life · Provide healthful food and beverage choices for children by carefully considering nutrient quality and energy density · Assist and educate children in making healthful decisions regarding types of foods and beverages to consume, how often, and in what portion size · Encourage and support regular physical activity · Limit children's television viewing and other recreational screen time to less than two hours per day · Discuss weight status with their child's health-care provider and momtor age- and gender-specific BMI percentile · Serve as positive role models for their children regarding eating and physical-activity behaviors CONFRONTING THE CHILDHOOD OBESITY EPIDEMIC The committee acknowledges, as have many other similar efforts, that obesity prevention is a complex issue, that a thorough understanding of the causes and determinants of the obesity epidemic is lacking, and that progress will require changes not only in individual and family behaviors but also in the marketplace and the social and built environments (Box ES-2)
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Therefore, the committee used the best scientific evidence available—including studies with obesity as the outcome measure and studies on improving dietary behaviors, increasing physical activity levels, and reducing sedentary behaviors, as well as years of experience and study on what has worked in addressing similar public health challenges—to develop the recommendations presented in this report. As evidence was limited, yet the health concerns are immediate and warrant preventive action, it is an explicit part of the committee's recommendations that all the actions and initiatives include evaluation efforts to help build the evidence base that continues to be needed to more effectively fight this epidemic.
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· Community-based population-level research—The committee encourages experimental and observational research examining the most important established and novel factors that drive changes in population health, how they are embedded in the socioeconomic and built environments, how they impact obesity prevention, and how they affect society at large with regard to improving nutritional health, increasing physical activity, decreasing sedentary behaviors, and reducing obesity prevalence. The recommendations that constitute this report's action plan to prevent childhood obesity commence what is anticipated to be an energetic and sustained effort.
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18 PREVENTING CHILDHOOD OBESITY longer term, while others will prove unsuccessful. Knowing that it is impossible to produce an optimal solution a priori, we more appropriately adopt surveillance, trial, measurement, error, success, alteration, and dissemination as our course, to be embarked on immediately.
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From page 19... ...
EXECUTIVE SUMMARY TABLE ES-1 immediate Steps 19 Federal government Industry and media Health-care professionals Community and nonprofit organization State and local education authorities and schools Parents and families Establish an interdepartmental task force and coordinate federal actions Develop nutrition standards for foods and beverages sold in schools Fund state-based nutrition and physical-activity grants with strong evaluation components Develop guidelines regarding advertising and marketing to children and youth by convening a national conference Expand funding for prevention intervention research, experimental behavioral research, and communitybased population research; strengthen support for surveillance, monitoring, and evaluation efforts Develop healthier food and beverage product and packaging innovations Expand consumer nutrition information Provide clear and consistent media messages Expand and promote opportunities for physical activity in the community through changes to ordinances, capital improvement prog ams, and other planning practices Work with communities to support partnerships and networks that expand the availabi ity of and access to healthful foods Routinely track BMI in children and youth and offer appropriate counseling and guidance to children and their families Provide opportunities for healthful eating and physical activity in existing and new community prog ams, particularly for high-risk populations Improve the nutritional quality of foods and beverages served and sold in schools and as part of school-related activities Increase opportunities for frequent, more intensive and engaging physical activity during and after school Implement school-based interventions to reduce children's screen time Develop, implement, and evaluate innovative pilot programs for both staffing and teaching about wellness, healthful eating, and physical activity Engage in and promote more healthful dietary intakes and active lifestyles (e.g., increased physical activity, reduced television and other screen time, more healthful dietary behaviors)
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