Progress in Preventing Childhood Obesity How Do We Measure Up? (2007) / Chapter Skim
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4 Government
4 Government
Pages 109-166
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From page 109... ...
. In responding to the obesity epidemic, federal, state, and local government agencies across the nation share in the core public health responsibilities listed in Box 4-1 (IOM, 1988, 2003; NACCHO, 2005)
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From page 110... ...
Additionally, the report recommended that state and local government should "provide coordinated leadership and support for childhood obesity efforts, particularly for populations at high risk of childhood obesity, by increasing resources and strengthening policies that promote opportunities for physical activity and healthful eating" (IOM, 2005a, p.
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From page 111... ...
In order to continue to focus attention on the childhood obesity epidemic and encourage sustained efforts from all sectors of society, government will need to consistently acknowledge the importance of preventing childhood obesity. In addition to implementing and sustaining new programs, governmental agencies at all levels need to reexamine their existing policies and initia
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From page 112... ...
agricultural policies including marketing practices, nutrition standards, agricultural subsidies, and procurement policies for agricultural commodity programs that affect the types and quantities of foods and beverages available in schools, communities, and through federal food assistance programs; land use policies that do not encourage mixed use of residential and business space and that subsequently discourage walking to neighborhood stores or businesses; and school policies that shorten the length of time in the school day devoted to healthy school meals and physical activity. This chapter provides an overview of the role of government at all levels in the response to the childhood obesity epidemic.
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From page 113... ...
However, a selected list of recent federal agency programs, initiatives, and surveillance systems relevant to childhood obesity prevention is compiled in Appendix D FEDERAL GOVERNMENT The federal government has a responsibility to address public health crises including the childhood obesity epidemic through ensuring sufficient capacity to provide essential public health services; responding when a health threat is apparent across the entire country, region, or many states; providing assistance when the responses are beyond the jurisdictions of individual states; helping to formulate the public health goals of state and
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From page 114... ...
• Develop and evaluate pilot programs within the nutrition assistance programs that would promote healthful dietary intake and physical activity and scale up those found to be successful. To implement this recommendation, state and local governments should: • Provide coordinated leadership and support for childhood obesity prevention efforts, particularly those focused on high-risk populations, by increasing re sources and strengthening policies that promote opportunities for physical ac tivity and healthful eating in communities, neighborhoods, and schools.
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From page 115... ...
Department of Health and Human Services and the U.S. Department of Transportation should: • Fund community-based research to examine the impact of changes to the built environment on the levels of physical activity in the relevant communities and populations.
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To implement this recommendation: Federal and state departments of education and health and professional or ganizations should • Develop, implement, and evaluate pilot programs to explore innovative approaches to both staffing and teaching about wellness, healthful choices, nutrition, physical activity, and reducing sedentary behaviors. Innovative ap proaches to recruiting and training appropriate teachers are also needed.
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The U.S. Congress and several federal executive branch departments have become actively engaged in obesity prevention.
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From page 118... ...
Joint efforts by USDA and DHHS resulted in the release of the sixth edition of the Dietary Guidelines for Americans 2005, which provide specific recommendations on the consumption of foods in different food groups, fats, carbohydrates, sodium and potassium, and alcoholic beverages; food safety; and physical activity (DHHS and USDA, 2005)
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From page 119... ...
. As outlined in the legislation, the school wellness policies should include goals for nutrition education, physical activity, guidelines for foods and beverages served throughout school campuses, and other school-based activities that are designed to promote student wellness in a manner that the local educational agency determines is appropriate.
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From page 120... ...
Discretionary or competitive project grants, which target particular federal efforts such as obesity prevention, fund states on the basis of the merits of their grant applications, and are awarded for a specific time frame (e.g., CDC's Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases; USDA's Special Supplemental Nutrition Program for Women, Infants, and Children [WIC] and Fresh Fruit and Vegetable Program [FFVP]
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From page 121... ...
The Health in the Balance report (IOM, 2005a) recommended that the federal government undertake an independent assessment of federal nutrition assistance programs and agricultural policies to ensure that they promote healthful dietary intake and increase physical activity levels for all children and youth.
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. The committee recommends that Congress and USDA expeditiously complete the revision of the contents of the WIC food packages and thoroughly examine other relevant food and nutrition assistance programs so that they can be strengthened to fully address childhood obesity prevention goals and to monitor and evaluate relevant outcomes.
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From page 123... ...
The Health in the Balance report (IOM, 2005a) recommended that DHHS develop, implement, and evaluate a long-term national multimedia and public relations campaign focused on obesity prevention in children and youth.
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Formative Evaluation Before CDC launched the 5-year youth media campaign, VERB -- It's what you do. -- it used exploratory research techniques to gain insights into a variety of fac tors relevant to understanding how to increase and maintain physical activity levels in the multiethnic U.S. tweens.
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. Evaluation of VERB through FY 2006, monitored through the YMCLS, will allow continued comparison of physical activity levels in tweens who were exposed to the campaign and those who were not exposed (Huhman, 2006)
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. The termination of an adequately funded, well-designed, and effective program to increase physical activity and combat childhood obesity calls into question the commitment to obesity prevention within government and by multiple stakeholders who could have supported the continuity of the VERB campaign.
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From page 127... ...
An assessment is needed to identify the appropriate level of funding required to support all states and territories in capacity building and program implementation to prevent obesity. TABLE 4-2 CDC's Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases Number of Funding Fiscal Year States Funded ($ million)
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From page 128... ...
The Steps Program enables communities to develop an action plan, a community consortium, and an evaluation strategy that supports chronic disease prevention and health promotion to lower the prevalence of obesity, type 2 diabetes, and asthma through healthful eating, physical activity, and tobacco avoidance in disproportionately affected, at-risk and low-income populations including African Americans, Hispanics/Latinos, American Indians/Alaska Natives, Asian Americans, and Pacific Islanders (DHHS, 2005b,c)
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, and state nutrition action plans are now required for USDA food and nutrition assistance programs. The committee encourages further efforts to develop policies that foster opportunities for collaboration among USDA programs relevant to childhood obesity prevention.
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the Youth Media Campaign Longitudinal Survey (YMCLS) , which is used to track older children's physical activity levels and media use, and to evaluate the VERB campaign; and (5)
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Given the urgency of the childhood obesity epidemic, it is important to conduct frequent assessments of changes in the school environment. For example, USDA's School Nutrition Dietary Assessment Study (SNDA)
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. As noted earlier, both BRFSS and NHANES were the first surveillance systems to document the growing obesity epidemic in U.S.
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. Research helps provide an understanding of the fundamental and intermediate causes of childhood obesity and the determinants of and the relationships between eating and physical activity behaviors.
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. Its purpose is threefold: to facilitate constructive, coordinated research across diverse federal agencies and departments; identify areas in which interagency collaboration can extend progress in obesity prevention; and advise OSTP's Committee on Science about the research needs and opportunities related to overweight and obesity and associated adverse health effects (NSTC, 2006)
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From page 135... ...
. STATE AND LOCAL GOVERNMENTS The Health in the Balance report called for state and local governments to implement the report's recommendations through the provision of coordinated leadership and support for childhood obesity efforts, particularly those focused on high-risk populations, by increasing resources and strengthening policies that promote opportunities for healthful eating and physical activity
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From page 136... ...
Leadership Many states and communities throughout the nation are providing leadership through focused efforts to increase opportunities for physical activity and improve the dietary intake of children and youth. The National Governors Association made obesity prevention a priority as early as 2002 and has established a bipartisan task force of governors to provide further direction on this issue (NGA, 2003, 2006)
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9. Health insurers and health care providers will promote physical activity and healthful eating.
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Restrict Activity substitutions and waivers for PE. Promote physical activity in other classes.
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Walking/ Support (through appropriations and 17/46 2/2 Biking Paths regulations) physical activity through (37%)
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The obesity prevention efforts of local governments are complementary to those of the state and federal governments. In particular, local public health departments are involved in providing leadership for the horizontal integration of interventions, communications, and funding requirements, as well as developing an adequate infrastructure in which policies and programs can be implemented and evaluated at the local level.
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From page 141... ...
. Similar to other states, California has only recently begun to recognize the need to develop policies related to nutrition, physical activity, and food security and an infrastructure to enhance those provided by the federal government or to fill gaps where the federal government does not meet the state's needs in these areas.
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From page 142... ...
, a coalition-based organization supported by state and federal funds that provides technical assistance and resources for obesity prevention efforts and that serves as a communication clearinghouse. In 2005, PANA began the Keystone Healthy Zone Schools campaign, which recognizes schools that are working toward a healthier school environment (PANA, 2006)
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From page 143... ...
Surveillance of funding and resources, the implementation of programs and policies, the availability of foods and beverages that contribute to healthful diets, the availability of places for physical activity, and the mapping of advocacy activities and grassroots efforts are a few of the other actions and outcomes that need to be monitored. One area
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, and NetScan's Health Policy Tracking Services for state legislation related to school nutrition and physical activity (NetScan, 2005)
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Federal research efforts should emphasize intervention research, that is, scientific assessments of the values of policies, environments, programs, and other activities that are implemented to improve dietary and physical activity behaviors. Surveillance systems need to be expanded not only to include behavioral and health outcomes, but also to monitor levels of funding, research, public health capacity, programmatic activities, policy development and implementation, and structural, institutional, and systemic outcomes.
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Many of these federal agencies either currently support or have the potential to initiate or support childhood obesity prevention efforts. PART involves a review of evidence pertaining to the program purpose and design, strategic planning, program management, and results.
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The states receiving CDC grants for capacity building or implementation are identified by a star. SOURCES: Adapted from the University of Baltimore (2005a)
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Figure 4-2 highlights some of the strategies and actions to be considered when the extent to which government is demonstrating leadership and commitment in making childhood obesity prevention a national priority is evaluated. As discussed earlier in this chapter, federal and state high-level task forces could serve to coordinate and prioritize budgets, policies, and programs and serve as a basis for new initiatives.
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Population coordinate budgets, Home developing a plan of policies and research. action, establishing • Incorporate childhood obesity prevention into policies, and securing Reduce the strategic research plans of federal agencies State Government adequate financial and Obesity (e.g., NIH, CDC, USDA, Department of • State health human resources to Education)
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From page 150... ...
Training: assessments of whether state health departments have suf ficient numbers of adequately trained staff to provide leadership and statewide training and whether all states meet the minimum staffing requirements recommended by CDC's State-Based Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases; 3. Surveillance and monitoring: assessments of whether state and local health departments have adequate or improved surveillance systems to monitor trends in obesity, dietary patterns, and physical activity behaviors; and 4.
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From page 151... ...
outcomes. Morbidity • Implement in all states a mechanism to monitor childhood obesity prevalence, dietary factors, physical activity levels, and sedentary behaviors through a population-based sample over time.
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From page 152... ...
Department of Education, strengthen its leadership role by making childhood obesity prevention an urgent priority and reflecting this priority in the public statements, programs, research priorities, and budgets of federal departments and agencies. Furthermore, state and local governments should provide coordinated leadership and support for childhood obesity prevention efforts by increasing resources and strengthening policies that promote opportunities for physical activity and healthful eating in communities, neighborhoods, and schools.
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From page 153... ...
Although changes to the built environment in communities can be part of obesity prevention efforts, many of the current efforts at the state and local levels have focused on improving nutrition and physical activity opportunities in schools. It is incumbent on state and local governments to also focus attention and funding on community-based programs and evaluations of those efforts (Chapter 6)
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From page 154... ...
Surveillance of environmental and institutional changes that are being implemented to promote healthful eating and regular physical activity is particularly lacking. Furthermore, surveillance of state and local policies, regulations, and practices that pertain to the prevention of childhood obesity provide an inadequate assessment of status or progress.
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From page 155... ...
SUMMARY AND RECOMMENDATIONS Government is an integral part of the response to the childhood obesity epidemic. At the federal, state, and local levels, government has the authority and the resources to make childhood obesity prevention a public health priority and to act on that priority by authorizing and appropriating adequate funding, training personnel, and supporting technical capabilities directed to efforts that will increase opportunities for physical activity and improved diets for the population to engage in healthy lifestyles.
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From page 156... ...
• Local government agencies should convene community- or regional-level task forces to provide coordinated leadership in preventing childhood obesity by increasing resources, col laborating with community stakeholders, and developing or strengthening policies and programs that promote opportuni ties for physical activity and healthful eating in communities and neighborhoods.
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From page 157... ...
Recommendation 3: Government, industry, communities, and schools should expand or develop relevant surveillance and monitoring systems and, as applicable, should engage in research to examine the impact of childhood obesity prevention policies, interventions, and actions on relevant outcomes, paying particular attention to the unique needs of diverse groups and high-risk populations. Additionally, parents and caregivers should monitor changes in their family's food, beverage, and physical activity choices and their progress toward healthier lifestyles.
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• All states should have a mechanism in place to monitor child hood obesity prevalence, dietary factors, physical activity lev els, and sedentary behaviors through population-based sam pling over time.
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2006. Communities of Excellence in Nutrition, Physical Activity, and Obesity Prevention (CX3)
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2006. Improving Nutrition, Physical Activity, and Obesity Pre vention: Performance Report of the Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases: July 1 Through December 31, 2005.
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2004. Financing Childhood Obesity Prevention Programs: Federal Funding Sources and Other Strategies.
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2007. Evaluation of a national physical activity intervention for children: VERB campaign, 2002–2004.
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2005a. Preventing Childhood Obesity: Health in the Balance.
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2006. Physical Activity.
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2005. Does the Built Environment Influence Physical Activity?
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2006. The Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases: Monitor ing progress in funded states.
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