Progress in Preventing Childhood Obesity: How Do We Measure Up?
INSTITUTE OF MEDICINE
Food and Nutrition Board
Sept. 13, 2006
Jeffrey P. Koplan, M.D., M.P.H.
Vice President for Academic Health Affairs, Emory University, Atlanta
Chair, Committee on Progress in Preventing Childhood Obesity
Good afternoon. I too would like to extend my thanks to all the committee members and IOM staff who worked on this report. In addition to the committee members with me on the panel, we also have another committee member who has been able to join us. Susan Foerster is chief of the cancer prevention and nutrition section of the California Department of Health Services.
As Clyde noted, this study was undertaken in 2005 at the request of The Robert Wood Johnson Foundation as a follow up to the IOM report Preventing Childhood Obesity: Health in the Balance, which was a congressionally mandated study that recommended ways for government, industry, schools, families, and other stakeholders to work together to prevent childhood obesity. The report being released today, Progress in Preventing Childhood Obesity: How Do We Measure Up?, assesses what is being done to address childhood obesity and makes recommendations for important actions across many sectors.
The remarkable and unexpected rise in obesity among our children and youth in a relatively short time span is one of the 21st century's most critical public health challenges. Currently, one-third of American children and youth are either obese or at risk of becoming obese. That number is projected to grow if our response is not effective in halting the epidemic.
This report offers four distinct contributions to developing an effective and comprehensive response to the childhood obesity epidemic. First, it summarizes the findings of three regional symposia. Second, it provides a framework that stakeholders can use to evaluate progress on a range of outcomes. Third, it measures progress for specific recommendations in the Health in the Balance report. And fourth, it calls for greater leadership and commitment among all stakeholders in preventing childhood obesity.
The committee held three regional symposia to learn about policies and programs that are currently being implemented throughout the nation. At each meeting, the committee heard about the challenges that communities, schools, and industry face when implementing and evaluating childhood obesity-prevention efforts. Additionally, the committee heard from federal representatives and conducted an in-depth literature review.
The committee found that innovative actions and interventions to reduce childhood obesity are emerging across the United States. The number and scope of these programs indicate that the nation is beginning to grasp the severity of the epidemic. However, the committee concluded that despite these encouraging efforts, many of them remain fragmented and small in scale. We still are not doing enough to prevent childhood obesity, and the problem is getting worse. The committee also found that a lack of systematic monitoring and evaluation has hindered the ability to identify promising practices that can be replicated or adapted to different settings. And the number of potentially useful interventions that are not being properly evaluated is large. For example, the first national registry of programs, Shaping America’s Youth, revealed that only half of the 1,090 programs registered had quantifiable outcome measures.
We also observed that many environments do not support healthy behaviors for our children and youth. In some communities, fruits and vegetables are not readily available or affordable, especially for families on limited household budgets. Certain neighborhoods do not offer safe places for children to play.
While there is growing awareness that childhood obesity is a serious public health problem that has substantial costs, the current level of public- and private-sector investment does not match the extent of the problem. Given the many changes being implemented throughout the nation to improve the diets and physical activity levels of children and youth, a comprehensive assessment of progress requires both the tracking of trends and a detailed evaluation of relevant interventions. Stakeholders should commit adequate resources to conduct evaluations and engage in surveillance, monitoring, and research.
The recommendations in this report emphasize the need for a collective responsibility and collaborative actions among all who have a stake in reversing this problem. No single sector of society should bear the responsibility for the problem, and no single sector acting alone can effectively halt and reverse it.
The committee recommends that government, industry, communities, schools, and families demonstrate leadership and mobilize the resources required to identify, implement, evaluate, and disseminate effective policies and interventions to prevent childhood obesity. In particular, each level of government should establish a task force to identify priorities for action, coordinate public-sector efforts, and establish effective interdepartmental collaborations. The federal government also should provide sustained investment in initiatives found to be effective -- for example, the five-year VERB campaign that was not funded in FY 2006. We also recommend that the federal government support surveillance systems that are vital to tracking trends in the obesity epidemic -- such as the National Health and Nutrition Examination Survey and the School Health Policies and Programs Study -- and expand them to include obesity-related outcomes.
We recognize that certain segments of the food, beverage, restaurant, fitness, and entertainment industries have shown constructive responses. Nevertheless, independent and periodic evaluations are needed to determine which industry initiatives are effective. Evaluations of industry efforts should track the proportion of a company’s product portfolio and marketing resources devoted to developing and promoting healthful products; monitor changes in product portion sizes; and show that industry is conveying consistent information to consumers that supports a healthy lifestyle. Industry also should partner more with public institutions to support childhood obesity prevention efforts. This includes creating a mechanism for sharing proprietary data that will enhance our understanding of how marketing influences children’s attitudes and behaviors, and will inform effective interventions. The media are encouraged to develop programs that promote healthy lifestyles and evaluate their effectiveness.
We recommend that communities work with government and others to develop a community health index toolkit examining factors that help create healthy communities. Communities are also encouraged to compile and widely share findings and community action plans.
The report recommends that schools bolster their physical-education and activity requirements and standards, and recommends further actions by preschool, child-care, and after-school programs. Schools should be provided with adequate federal and state funding to implement changes in the school environment that will increase physical activity and the consumption of healthful foods and beverages.
Finally, the report encourages families to ensure that meals, snacks, and beverages provided at home support a healthful diet and are served and consumed in reasonable portion sizes. Families should also make physical activity a family priority and establish rules or guidelines that both encourage activity and limit leisure time in front of the TV or computer.
In many racial and ethnic groups, in low-income populations, and among recent immigrants to the United States, obesity rates in children and youth are alarmingly high or are increasing faster than the average rate. Specific attention must be given to children and youth from these populations to lower risk for becoming obese.
That concludes my statement. My colleagues and I welcome your questions. Please come ask your question at one of the microphones or use the e-mail link on the National Academies Web site, and be sure to first identify yourself by name and affiliation. Thank you.