Accelerating Progress in Obesity Prevention Solving the Weight of the Nation (2012) / Chapter Skim
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3 Goals, Targets, and Strategies for Change
3 Goals, Targets, and Strategies for Change
Pages 79-114
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From page 79... ...
• An ecological model can be used to identify behavioral settings and sectors of influence in which and by which actions can be taken to improve envi ronments for physical activity and healthful eating. Strategies for taking action are multifaceted and interrelated and include policy and legislative approaches, approaches that change organizational policies and practices and environments in communities and neighborhoods, health communication and social marketing approaches, and interventions in health care settings.
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From page 80... ...
Progress in achieving obesity prevention can be assessed in the short term by indicators of change in the environments that influence physical activity and eating. I t is clear from the preceding chapters that tremendous strides have been made in addressing the obesity epidemic, given the sheer amount of attention to the problem and the number and coherence of efforts to address the epidemic and bolster the scientific underpinnings and policy basis for taking action.
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From page 81... ...
. For children and adolescents, obesity prevention means maintaining a healthy weight trajectory and preventing excess weight gain while growing, developing, and maturing (IOM, 2010)
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From page 82... ...
• Appropriate amounts and types of physical activity • Achievement of physical, psychosocial, and cognitive growth and developmental goals • A healthy body image and the absence of potentially adverse weight concern or restrictive eating behaviors Population of Children and Adolescents • Reduction in the incidence of childhood and adolescent obesity • Reduction in the prevalence of childhood and adolescent obesity • Reduction of mean population BMI levels • Improvement in the proportion of children and adolescents with dietary quality meeting the Dietary Guidelines for Americans • Improvement in the proportion of children and adolescents meeting physical activity guidelines • Achievement of physical, psychological, and cognitive growth and develop mental goals Accelerating Progress in Obesity Prevention 82
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From page 83... ...
Examples of Possible Intermediate Indexes of Progress Toward Obesity Prevention in Children and Adolescents • Increased number of children and adolescents who walk and bike to school safely • 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 pro mote energy balance at a healthy weight • Increased availability and affordability of healthful foods and beverages at supermarkets, grocery stores, and farmers' markets located within walking dis tance of the communities they serve • Changes in institutional and environmental policies that promote energy balance SOURCE: Adapted from IOM, 2005, 2007. 83 Goals, Targets, and Strategies for Change
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From page 84... ...
. This weight gain shift ed many people from the healthy weight range into the overweight range, from the overweight range into the obese range, or from a moderate to an extreme level of obesity.
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From page 85... ...
For eating behaviors, the focus is on overall dietary quality as well as appropriate caloric consumption, achieved by increasing plant-based dietary components; reducing the consumption of sugar-sweetened beverages and of highcalorie, energy-dense foods; increasing breastfeeding and responsive child feeding; and ensuring the intake of nutrients needed to promote optimal linear growth. In general terms, the types of environmental changes needed to motivate and support the indicated changes in individual behavior are directly related to the types of changes identified in the preceding chapters as having led to populationwide increases in weight gain and obesity and listed in Boxes 3-1 and 3-2 as 85 Goals, Targets, and Strategies for Change
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From page 86... ...
levels • Improvement in the proportion of adults with dietary quality meeting the Dietary Guidelines for Americans • Improvement in the proportion of adults meeting physical activity guidelines • A population with weight and fitness levels conducive to a productive society Accelerating Progress in Obesity Prevention 86
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From page 87... ...
Examples of Possible Intermediate Indexes of Progress Toward Obesity Prevention in Adults • Increased number of adults who routinely use active means of transportation, e.g., walking or cycling • Improved access to and affordability of fruits and vegetables for low-income populations • Increased availability, affordability, and use of community recreational facilities • Increased opportunities to be physically active at work • Increased number of new industry products and advertising messages that pro mote energy balance at a healthy weight • Increased availability and affordability of healthful foods and beverages at supermarkets, grocery stores, and farmers' markets located within walking dis tance of the communities they serve • Community designs and social characteristics that encourage being physically active outdoors • Changes in institutional and environmental policies that promote energy balance SOURCES: IOM, 1995; USDA/HHS, 2010. 87 Goals, Targets, and Strategies for Change
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From page 88... ...
• Adults aim for 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week. • Decrease television viewing.
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From page 89... ...
(IOM, 2007) use an ecological approach to identify leverage points for developing effective intervention strategies to promote energy balance, and specifically address individual factors, behavioral settings, sectors of society, and social norms and values that may constrain or reinforce regular physical activity and healthful eating as the accepted and encouraged standard.
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From page 90... ...
90 • Government • Public Health • Communities • Health Care • Worksites • Agriculture Social Norms and Values • Health Care • Education • Schools and Child • Media Care • Land Use and Transportation • Communities Sectors of Influence • Foundations • Demographic • Businesses ■ Factors Food and beverage (e.g., age, sex, SES, companies ■ race/ethnicity) Retail food stores Behavioral Settings • Psychosocial and restaurants ■ Factors Leisure and • Gene−Environment recreation ■ Interactions Entertainment ■ Individual, Home, • Other Factors Other businesses and Family Factors Food and Beverage Physical Activity Intake Energy Intake Energy Expenditure Energy Balance FIGURE 3-2 Various levels and sectors of influence on obesity in populations.
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From page 91... ...
indicate that the public expects businesses to contribute to health in a variety of ways in addition to providing health insurance coverage or worksite wellness programs, such as by educating people about the health risks of products or services, creating products and services that are conducive to good health, fostering a dialogue about public priorities related to health, and contributing funds or in-kind services to improve the health of the public. And the Partnership to Build a Healthier America, part of the First Lady's Let's Move campaign, works with food and beverage companies, as well as other companies, to generate meaningful sponsorship commitments that will increase physical activity and improve access to healthy, affordable foods (www.ahealthieramerica.org)
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From page 92... ...
A SUCCESSFUL MODEL OF COMPREHENSIVE CHANGE To date, obesity prevention has not fully employed the complex thinking that is required to address the obesity epidemic. Applying the social change strategies described in this chapter to the community environment in order to encourage increased levels of physical activity, decreased sedentary behaviors, and healthful Accelerating Progress in Obesity Prevention 92
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From page 93... ...
. Community-based obesity interventions (targeting policy and environmental changes)
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59) , is: focused on creating multilevel environmental change to support behavioral action and its maintenance and to prevent excessive weight gain among early elementary school aged children through community participation.
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The availability of less energy-dense foods, with an emphasis on fruits, vegetables, whole grains, and low-fat dairy products, was increased; foods high in fat and sugar were discouraged. Additional changes within the home and the community reinforced opportunities for increased physical activity and improved access to healthier food.
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From page 96... ...
Similarly, acknowledgment of the responsibility to address obesity in the pri vate and public sectors has been demonstrated globally. As reviewed in 2007, a number of countries and regions have been developing and implementing strategic plans to promote physical activity and healthful eating and to prevent obesity (IOM, 2007)
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From page 97... ...
. The probability of states enacting bills related to physical education, school nutrition, BMI screening, or health education differed according to adult obesity prevalence, the difference between self-reported and ideal weights 4 NationalProgramme on Diet and Physical Activity.
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Or, when policies are instituted without the need for public consultation or are not contro Accelerating Progress in Obesity Prevention 98
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At the level of social norms and consumer culture, ways to replace the use of cars as a status symbol also may be needed. Environmental and Policy-Level Intervention Versus Freedom of Choice Concern that intervening to change environments will inappropriately and unfairly constrain individual freedom of choice is a continuing part of the debate about how to address the obesity epidemic (Kersh, 2009)
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From page 100... ...
Many Apparent Choices Reflect Habitual or Natural Responses to Environmental Cues Theory and empirical data from the field of behavioral economics suggest that the majority of physical activity and eating behaviors are routine rather than choices made after deliberation about a set of options (Just and Payne, 2009; Just et al., 2008)
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From page 101... ...
Therefore, the school food environment is a logical focus for efforts to encourage healthy dietary behaviors. Today, school food service includes two competing arms -- the federally regulated reimbursable National School Lunch and School Breakfast programs and the competitive food and beverage marketplace, which has expanded substantially during recent decades.
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From page 102... ...
. Regulation of Food Marketing to Children and Adolescents Aggressive marketing of high-calorie foods to children and adolescents has been identified as one of the major contributors to childhood obesity (IOM, 2006)
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Effects on Children, Adolescents, and Adults Who Are Obese Efforts to address the obesity epidemic must consider the potential impact of actions taken on those children, adolescents, and adults who are already obese. Environmental and policy changes that will make it easier to achieve and maintain energy balance should have positive effects across the continuum of body weight.
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From page 104... ...
Policies and practices to address obesity must take this potential for harm into account and incorporate appropriate safeguards, including the institution of measures to track such outcomes. The case for addressing the obesity epidemic cannot be made at the expense of obese people.
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From page 105... ...
. Characteristics of physical activity or food marketing environments and the high prevalence of obesity itself may influence social norms about physical activity and healthy eating, making higher weight, consumption of high-calorie foods and beverages, and sedentary behavior seem normal and appropriate.
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From page 106... ...
, recommendations for improving the likelihood that ongoing policies and programs can be well evaluated (Leviton et al., 2010) , and the development of a detailed framework and process for assessing the strength of evidence for various policy and environmental change strategies undertaken to prevent childhood obesity (Brennan et al., 2011)
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From page 107... ...
Complex realities associated with the obesity epidemic include practical and policy considerations, some of which may impede progress or lead to unintended adverse consequences that must be addressed during the design, implementation, and evaluation of measures to accelerate obesity prevention. These considerations include the nature of modern lifestyles, uncertainty or ambivalence about whether or how governments or other decision makers should use policy strategies to shift population physical activity and eating behaviors, the tensions associated with attempts to regulate food marketing to children and adolescents, and the potential adverse effects of obesity prevention efforts on individuals and population subgroups that are most affected by obesity.
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From page 108... ...
2009. The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: A systematic review.
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2008. Correlates of state legislative action to prevent childhood obesity.
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2006. Inequality in the built environment underlies key health disparities in physical activity and obesity.
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From page 111... ...
2008. Population-based prevention of obesity: The need for comprehensive promo tion of healthful eating, physical activity, and energy balance: A scientific state ment from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the expert panel on popula tion and prevention science)
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2006. The role of built environments in physical activity, eat ing, and obesity in childhood.
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2006. Environmental jus tice: Obesity, physical activity, and healthy eating.
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1990. The 10-year incidence of overweight and major weight gain in US adults.
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