Evaluating Obesity Prevention Efforts A Plan for Measuring Progress (2013) / Chapter Skim
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6 National Obesity Evaluation Plan
6 National Obesity Evaluation Plan
Pages 133-182
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What: What is a National Obesity Evaluation Plan? A National Obesity Evaluation Plan is a framework for evaluating progress in achieving the strategies recommended in the Accelerating Progress in Obesity Prevention report (IOM, 2012a)
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National Obesity Evaluation Plan that can be used as a resource and model for state and regional evaluations. This chapter includes summaries of current international and national evaluation plans; an outline of a National Obesity Evaluation Plan to evaluate strategies identified in the APOP report; recommendations to adapt this plan at the state and regional levels; and considerations for how community and local level data, which will be discussed in Chapters 7 and 8, can be incorporated to enhance and support the National Obesity Evaluation Plan.
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to provide a logic model, including inputs, activities, outputs, outcomes, and impacts that can be easily applied to evaluation plans assuring timely and meaningful collection and analysis of data to inform and improve obesity prevention efforts at national, state, and community levels (Committee vision, Chapter 1)
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Activities: 1. Designate a federal obesity evaluation task force/entity to oversee the implementation of the National Obesity Evaluation Plan and coordinate with relevant federal, state, local, and private-sector entities.
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, Early Head Start, and Head Start into the National Obesity Evaluation Plan.
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. State objectives tend to be patterned after national obesity, diet, and physical activity objectives; many have been developed or adapted from the Healthy People 2020 template with Centers for Disease Control and Prevention (CDC)
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. National Obesity Evaluation PlanS International Examples Obesity is a worldwide problem, and, as such, world and regional organizations, as well as other c ountries, have proposed monitoring, surveillance, and evaluation plans for obesity prevention and control.
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also calls for a monitoring, surveillance, and evaluation plan. The WHO European Database on Nutrition, Obesity, and Physical Activity (WHO, 2011)
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provide data for participating states that are complementary to national data, but there is increasing interest in collecting state data to address local health and welfare concerns, as well as to collect data on state 2 Includesbut not limited to efforts in the following federal agencies: Corporation for National and Community Service; Departments of Agriculture, Commerce, Defense, Education, Health and Human Services, Interior, Labor, Transportation, and Veteran Affairs; Domestic Policy Council; Environmental Protection Agency; Federal Trade Commission; General Services Administration; and Office of Management and Budget. National Obesity Evaluation Plan 141
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. 142 Evaluating Obesity Prevention Efforts
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Along with the physical and policy environment, the behavioral environment should also be assessed, including social norms for diet, physical activity, and obesity. Components and Guidance for Implementing the National Obesity Evaluation Plan The National Obesity Evaluation Plan for assessing progress in obesity prevention builds on the current strengths and infrastructure of the existing monitoring and surveillance systems in the United States, including Healthy People 2020 (HHS, 2010b)
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-- -- Long-term objectives achievable in 5 years or longer. 144 Evaluating Obesity Prevention Efforts
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be collected at the state level. continued National Obesity Evaluation Plan 145
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innovative strategies to implement in the future. 146 Evaluating Obesity Prevention Efforts
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continued National Obesity Evaluation Plan 147
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148 Evaluating Obesity Prevention Efforts
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. Convening a federal obesity evaluation task force/entity to oversee the National Obesity Evaluation Plan would be an appropriate first step to guide its development.
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150 Evaluating Obesity Prevention Efforts
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. National Obesity Evaluation Plan 151
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guide the indicators and measurement systems proposed in the National Obesity Evaluation Plan. An initial assignment for the obesity evaluation task force would be to provide a process for priori tization of plan recommendations, accountability, and adaptability or revision, including a review of the existing national obesity reports and objectives.
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Therefore, much of the focus of the National Obesity Evaluation Plan is on existing and proposed surveillance activities, from which data can be derived for evaluation efforts, at the national level, and potentially at the state and local levels. The Committee's assessment of current monitoring and surveillance activities in the United States found that several potential components of a national evaluation plan for obesity prevention exist, but there are challenges and barriers to improving national gaps in indicators, methodology, and reach.
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154 Evaluating Obesity Prevention Efforts
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This lack of a designated task force to coordinate monitoring and surveillance data to evaluate obesity progress is a barrier to coordination of collecting data on new indicators, creating or expanding data systems, and reducing duplication of effort. The current nutrition monitoring system and activities provide a foundation to build on for the national obesity evaluation plan.
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. 156 Evaluating Obesity Prevention Efforts
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. In addition to the policy monitoring and surveillance systems, several organizations maintain billlevel tracking systems for monitoring the introduction, adoption, and/or repeal of individual-level bills and/or session laws across the 50 states and the District of Columbia: CDC's Chronic Disease State Policy Tracking System, the National Conference of State Legislatures, the School Nutrition Association, and the Rudd Center for Food Policy and Obesity (CDC, 2013c; National Conference of State Legislatures, 2013; National Obesity Evaluation Plan 157
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Related Monitoring Surveys/Systems in the United States In addition to previously described national and state surveys, other indicators drawn from current studies (see Appendix Table D-1) are proposed as part of the National Obesity Evaluation Plan based on the specific measures, target population, and level of the data desired (see Appendix Table F-2)
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The Committee recommends the addition of similar process-oriented indicators in the National Obesity Evaluation Plan and state plans, such as (1) establishment of a coordinating and oversight federal obesity evaluation task force; (2)
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24 hild/adolescent physical activity–related C NSCH NA attitudes and perceptions (supportive neighborhoods) 160 Evaluating Obesity Prevention Efforts
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; NHANES; Core YRBSS (adolescents) 41 onsumption of whole grains C NHANES NA 42 ealthy vending policies in federal buildings and H General Services NA worksites Administration 43 utrition standards in child care N National Resource Center for Core Health and Safety in Child Care and Early Education 44 ood retail incentive policies F CDC State Indicator Report on NA Fruits and Vegetables continued National Obesity Evaluation Plan 161
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TABLE 6-4 Continued WHO Data Source or National State Proposed Indicator Topica Documentationb Planc Plansc Indicatorsd 45 ast food outlet density F CZCBP NA 46 ealthy food outlet density H CZCBP NA 47 rice of fruit and vegetables P Quarterly Foods-at-Home Price NA Database Goal Area 3: Messaging Environment 48 unding for national social marketing program F Federal appropriations and Core HHS budgets; State budgets 49 elevision marketing of foods and beverages to T Nielson advertising data Core children and adolescents (Dietary Guidelines) 50 urchase of foods and beverages recommended P National Consumer Panel NA in Dietary Guidelines for Americans 51 utrition education policies for federal nutrition N State SNAP-Ed plans Expanded programs 52 urchase by SNAP participants of foods and P NHANES NA beverages recommended in Dietary Guidelines for Americans Goal Area 4: Health Care and Worksites 53 ommunity-based primary prevention nutrition C National Profile of Local NA related services Health Departments 54 ommunity-based primary prevention physical C National Profile of Local NA activity–related services Health Departments 55 MI measurement by physicians B National Survey on Energy NA Balance Related Care among Primary Care Physicians 56 utrition and weight counseling by physicians N NAMCS; National Survey on Core Energy Balance Related Care among Primary Care Physicians 57 hysical activity–related counseling by physicians NAMCS; National Survey on P Core Energy Balance Related Care among Primary Care Physicians 58 nsurance incentives for healthy lifestyles I NAMCS; National Survey on NA Energy Balance Related Care among Primary Care Physicians 59 besity screening and promotion strategies O NAMCS; National Survey on NA offered by health plans Energy Balance Related Care among Primary Care Physicians 60 besity screening and prevention reimbursement O NAMCS; National Survey on NA strategies by health plans Energy Balance Related Care among Primary Care Physicians 61 besity screening and prevention metrics O Healthcare Effectiveness Data NA and Information Set 162 Evaluating Obesity Prevention Efforts
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continued National Obesity Evaluation Plan 163
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Benchmarks for physi 11 The Department of Health and Human Services proposed changes to the birth certificates in 2003. 164 Evaluating Obesity Prevention Efforts
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The National Obesity Evaluation Plan includes trainings on standardized measurement protocols for anthropometric and other measures. It also calls for creation of a list of recommended measures for all indicators.
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Data from the National Obesity Evaluation Plan could help to further elucidate the evidence base for the APOP recommendations and suggest new environmental and policy strategies or directions for future obesity prevention efforts. Standardization of Key Indicators for Federally Funded Grants and Programs Federally funded grants, initiatives, and programs through NIH, CDC, USDA, and other govern mental agencies can provide additional data for the National Obesity Evaluation Plan.
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Develop and Test New, Alternative, and Emerging Methods of Data Collection An innovative and evolving National Obesity Evaluation Plan will need a provision for development, testing, and incorporation of new, alternative, and emerging methods of data collection that have the potential to capture data in real-time with greater precision. These contributions will necessarily, or at least most usefully, come from actual evaluations of national, state, and local programs as they attempt to use the existing surveillance systems and to adapt them to emerging programs and evaluation needs.
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. State Obesity Evaluation PlanS Almost all states have individual plans for obesity prevention and control, physical activity, and/or diet (see Appendix Table F-3)
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In Chapter 1, the Committee defines summative evaluation as detecting and attributing changes in output, outcomes, and impacts associated with obesity prevention interventions. In the case of TWOTN, such indicators of value include the following: viewers on the HBO platforms and streaming of content; media impressions; social media impressions; and "commitments." Where these events and activities have potential national significance, such evaluation relates to the National Obesity Evaluation Plan; where ollow-on activities are local in nature, summative evaluation pertains to Chapter 8, and suggested f approaches will be presented there.
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The 5-year objective is to measure progress toward obesity prevention in California by assessing overall health, health behaviors, and policy and environmental change. Ongoing efforts are focusing on identifying California- and county-specific data sources and indicators of progress in obesity prevention available since the late 1990s, such as the California Department of Education's FITNESSGRAM® data on BMI and physical fitness collected annually from 5th, 7th, and 9th grade students15 and the annual California Healthy Kids Survey on nutrition and physical activity behaviors collected from 5th, 7th, 9th, and 11th grade students,16 the biennially administered California Department of Public Health surveys17 on dietary practices and physical activity assessment in adults (California Dietary Practices Survey)
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. Gaps in Current State Obesity Evaluations The state-level evaluation plans have several disadvantages, including the cost, and consequent lack of objective data; a relative paucity of methods comparable to the National Obesity Evaluation Plan; and a relative lack of resources and infrastructure to develop and maintain state systems comparable to the national monitoring/surveillance systems.
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An assessment of current monitoring, surveillance, and other summative evaluation efforts at the state level would be the next step in the State Obesity Evaluation Plan; this is expected to be a less inten sive undertaking than detailed in the National Obesity Evaluation Plan. While conducting an inventory of state evaluation methods and systems, it is important to determine if state-level indicators are consistent with those at the federal level (see Table 6-4)
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. National Obesity Evaluation Plan 173
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sUMMARY Implementation of a National Obesity Evaluation Plan to assess the APOP strategies would enhance the ability of the United States to demonstrate progress in obesity prevention efforts, provide guidance on gaps in the extant programs and policies, and redirect use of resources. Elements of the National Obesity Evaluation Plan were developed to maximize existing monitoring/surveillance systems and incorporate metrics that are similar to those in other plans, such as the WHO framework.
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. National Obesity Evaluation Plan 175
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:38-43. National Obesity Evaluation Plan 177
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:512-515. 178 Evaluating Obesity Prevention Efforts
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33-42. National Obesity Evaluation Plan 179
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:3782-3783. National Obesity Evaluation Plan 181
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