Mobilizing Communities

By stepping outside the traditional view of obesity as a medical problem, we may more fundamentally focus on the many institutions, organizations, and groups in a community that have significant roles to play in making the local environment more conducive to healthful eating and physical activity. Table 6-1 illustrates categories of many of the stakeholder groups that could be involved in obesity prevention efforts. For community efforts, key stakeholders include youth organizations, social and...

Confronting the Childhood Obesity Epidemic

Obesity in U.S. children and youth is an epidemic characterized by an unexpected and excess number of cases on a steady increase in recent decades. The epidemic is relatively new but widespread, and one that is disproportionately affecting those with the fewest resources to prevent it. Although it does not have the exotic nature or immediate mortality of severe acute respiratory syndrome, anthrax, or Ebola virus, it is harming a much broader cross section of our young people and may...

Total Adults

FIGURE 2-7 Prevalence of overweight and obesity among adults 20 years of age and older, NHANES 1999-2000. SOURCE CDC, 2003. Reprinted with permission from Salinsky and Scott, 2003. Copyright by the National Health Policy Forum. percent to 30.5 percent) among 60 million U.S. adults. Between 1999-2000 and 2001-2002 there were no significant changes in the prevalence of obesity in adults (30.5 percent versus 30.6 percent) (Hedley et al., 2004). These trends, underscored by similar findings at the...

Literature Review

In order to conduct a thorough review of the medical and scientific literature, the committee, Institute of Medicine (IOM) staff, and outside consultants conducted online bibliographic searches of relevant databases (Box C-1) that included Medline, AGRICOLA, CINAHL, Cochrane Database, EconLit, ERIC, PsycINFO, Sociological Abstracts, EMBASE, TRIS, and LexisNexis. To begin the process of identifying the primary literature in this field, the IOM staff at the beginning of the study conducted...

Nutrition And Physical Activity Programs

A number of public- and private-sector programs educate consumers of all ages about proper nutrition and regular physical activity. For example, the USDA's Expanded Food and Nutrition Education Program (EFNEP) uses the resources of county Cooperative Extension System services and other local agencies to reach low-income families and youth, and both the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Food Stamp Program (FSP) have nutrition education...

Consumer Attitudes and Public Awareness

Trends in media coverage suggest a striking increase in public interest in obesity. The International Food Information Council (IFIC) has been following U.S. and international media coverage of the obesity issue since FIGURE 1-5 Daily television viewing by children and youth in hours. SOURCE Rideout et al., 1999. This information was reprinted with permission from the Henry J. Kaiser Family Foundation. 1999 and has tracked a steady upward trend in the volume and breadth of issues covered (IFIC,...

BOX 61 Girls on the

Girls on the Run is a nonprofit organization that works with local volunteers and community-level councils to encourage preteen girls to develop self-respect and healthful lifestyles through running (Girls on the Run, 2004). A 12-week, 24-lesson curriculum has been developed for use in after-school programs and at recreation centers and other locations. Evaluation of the program has found improvements in participants' self-esteem, body-size satisfaction, and eating attitudes and behaviors...

Healthy Marketplace And Media Environments

Children, youth, and their families are surrounded by a commercial environment that strongly influences their purchasing and consumption behaviors. Consumers may initially be unsure about what to eat for good health. 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...

Goals of Obesity Prevention in Children and Youth

The goal of obesity prevention in children and youth is to create through directed social change an environmental-behavioral synergy that promotes For the population of children and youth 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 meeting the Dietary Guidelines for Americans Improvement in the proportion of children meeting...

Promoting Physical Activity

There is still much to be learned about the determinants of physical activity and fitness in children and adolescents and how to influence their level of activity throughout the developmental stages. As discussed throughout the report, physical activity can influence the body-fat level of children (Gutin et al., 2004). Developmental, Biological, and Psychosocial Correlates Children's gender and age are both important factors to consider in examining physical activity levels. Boys are generally...

Developing An Action Plan For Obesity Prevention

The Institute of Medicine Committee on Prevention of Obesity in Children and Youth was charged with developing a prevention-focused action plan to decrease the prevalence of obesity in children and youth in the United States. The primary emphasis of the committee's task was on examining the behavioral and cultural factors, social constructs, and other broad environmental factors involved in childhood obesity and identifying promising approaches for prevention efforts. The plan consists of...

Extent and Consequences of Childhood Obesity

Overall trend data clearly indicate that obesity prevalence in U.S. children and youth has risen to distressing proportions, but many questions remain about the nature, extent, and consequences of this problem. How much do we really know about how this epidemic is unfolding Which population groups are most affected What does the available evidence tell us about how to address this problem Finally, what are the potential consequences of inaction with respect to social, developmental, and health...

Relationship Between the Childhood and Adult Obesity Epidemics

The obesity epidemic that began in the early 1970s and escalated after 1980 for children and youth has progressed similarly in adults over the same time period. As depicted in Figures 2-6 and 2-7, between the 19711974 NHANES and the 1999-2000 NHANES the prevalence of obesity-defined as a BMI at or above 30 kg m2 more than doubled (from 14.5 62 65 62 65 FIGURE 2-6 Overweight and obesity by age in the United States, 1960-2000. NOTE Percents for adults are age-adjusted. Obesity for children is...

Integrated View of the Consequences of Childhood Obesity

In reviews of the correlates of childhood obesity, discussions of the physical impacts and of the social and emotional impacts are often separate. But this distinction may be artificial. First, although the brain plays a central role in the regulation of energy balance and obesity (Schwartz et al., 2000), it is also the central organ for integrating social stimuli, regulating emotion, and executing social interaction. Not surprisingly, cues that affect both eating and activity behaviors are...

Childhood and Adolescent Obesity

Body mass index (BMI) is an indirect measure of obesity based on the readily determined measures of height and weight. This report uses the term obese to refer to children and youth with BMIs equal to or greater than the 95th percentile of the age- and gender-specific BMI charts developed by the Centers for Disease Control and Prevention (CDC) (Kuczmarski et al., 2000). In most children, values at this level are known to indicate excess body fat, which itself is difficult to measure accurately...

Obesity Prevention Goals

Clear specification of obesity prevention goals is essential in shaping an action plan and evaluating its success. Pertinent issues for setting obesity prevention goals for populations include concepts of optimum population BMI and healthy weight levels, potential effects on food intake and patterns of physical activity and inactivity (the primary modifiable determinants of obesity), as well as attitudes and social norms related to food and eating, physical activity and inactivity, body size,...

Physical Activity

At a time when many children and youth need to increase their physical activity levels, schools offer the environment, the facilities, and the teachers not only for meeting students' current physical activity needs, but for helping them form the lifelong habits of incorporating physical activity into their daily lives. As discussed in Chapter 3, current recommendations are for children to accumulate a minimum of 60 minutes of moderate to vigorous physical activity each day (Biddle et al., 1998...

Optimum BMI and Healthy Weight

The concept of optimum BMI can be applied to populations. For countries such as the United States, where undernutrition is not as common as in developing countries,3 a BMI-distribution median of around 21 kg m2 may be optimal (WHO, 2000). Population weight goals for obesity prevention in adults can also be stated in terms of decreasing the proportion that exceed the threshold of 30 kg m2, although this goal includes both preventing new cases of obesity and reducing weight among those already...

Public Health Lessons Learned

The purpose of this paper is not to suggest specific intervention strategies to prevent childhood obesity, but rather to learn from other public health experiences and to glean lessons that might help inform efforts to prevent childhood obesity. There is certainly no shortage of theories, models, and approaches to help guide public health program planning. There are multiple health behavior theories that are commonly used to guide public health efforts (Glanz et al., 2002), and popular planning...

References

AACAP (American Academy of Child and Adolescent Psychiatry). 2001. Children and Watching TV. Facts for Families, No. 54. Online . Available accessed June 7, 2004 . AAP (American Academy of Pediatrics). 2001. Children, adolescents, and television. Pediatrics 107(2) 423-426. AAP. 2003. Prevention of pediatric overweight and obesity. Pediatrics 112(2) 424-430. AAP. 2004. Pediatric Nutrition Handbook. 5th ed. Washington, DC AAP. Abramovitz BA, Birch LL. 2000. Five-year-old girls' ideas about...

Social and Emotional Health

While childhood obesity may not result in recognized clinical symptoms until later in life, the social and emotional correlates often have immediate effects on children's lives. Research on the short- and long-term impacts of obesity on children's emotional and social functioning has been extensively reviewed (French et al., 1995 Dietz, 1998b Must and Strauss, 1999 Puhl and Brownell, 2001 Styne, 2001 Must and Anderson, 2003 Schwartz and Puhl, 2003), and the collective body of research clearly...

Industry

American children and youth represent dynamic and lucrative markets. For example, food and beverage sales to young consumers exceeded 27 billion in 2002 (U.S. Market for Kids' Foods and Beverages, 2003). Simi larly, young people are major consumers of the products and services of the entertainment, leisure, and recreation industries. Providing young consumers and their families with the knowledge and skills to make informed and prudent choices in these marketplaces could be a key obesity...

Introduction

As a nation, we are experiencing an epidemic of obesity that is unprecedented in its magnitude or rapidity. Overweight and obesity not only plague the majority of adults, but children are becoming increasingly overweight, with corresponding decrements in health status and quality of life. While the problem clearly exists, the causes are less clear. There is little clarity about the relative importance of possible causative factors such as changes in dietary patterns, increases in fast food and...

Genetic Variation and Biological Considerations

Obesity has long been recognized to occur in families, and having overweight or obese parents increases a child's risk of being obese. After age 3, parental obesity is a stronger predictor of a child's future obesity as an adult than is the child's current weight (Whitaker et al., 1997). Nonetheless, the familial clustering of obese individuals does not alone predict an individual's weight characteristics, which reflect the combined effects of genetic variations, the common or shared...

Health Care Costs

A RAND study has calculated that the costs imposed on society by people with sedentary lifestyles (i.e., the external costs generated) may be greater than those imposed by smokers (Keeler et al., 1989). More recent computations of national health-care expenditures related to obesity and overweight in adults showed large lifetime external costs related to these conditions. After adjusting for inflation and converting estimates to 2004 dollars, the national direct and indirect health-care costs...

Implications For Children And Society At Large

Many of us consider our weight and height as personal statistics, primarily our own, and occasionally our physician's concern. Our weight is something we approximate on forms and applications requiring this information. Body size has been a cosmetic issue rather than a health issue throughout most of human history, but scientific study has changed this view. One's aesthetic preference for a lean versus a plump body type may be related to personal taste, cultural and social norms, and...

Public Health Precedents

Public health problems of comparably broad scope and complexity have been successfully addressed in the past (Economos et al., 2001), and this experience gives us not only the confidence that childhood obesity too can be moderated, even prevented, but supplies us with some of the needed tools. This solid public health history of achievements is exemplified in Box 1-1 (CDC, 1999 Appendix D). Many of these problems were not apparent at first, and grew to become an accepted part of life before...

Community Stakeholders and Coalitions

Community-Based Interventions Framework and Evidence Base Ecological frameworks, which have been applied across a variety of settings and public health issues to change people or change the environment (Glanz, 1997), suggest that it is important to involve individuals, organizations, communities, and health policy makers in producing desired effects on health (Baker and Brownson, 1998). Given the interactive nature of virtually all elements of a community, most effective interventions act at...

Shifts in the Population BMI Distribution

Researchers can monitor changes in the nature of the obesity epidemic by comparing the BMI distribution curves derived from population-based surveys and noting shifts in any particular distribution over time. A shift toward higher BMIs over the entire distribution would indicate that virtually everyone is becoming heavier, with lean individuals gradually moving into the overweight range, overweight individuals moving into the obese range, and the number of obese individuals becoming more...

Healthy Home Environment

Parents (defined broadly to include primary caregivers) 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. Economic and time constraints, as well as the stresses and challenges of...

An Organizing Framework For Public Health Interventions

To learn from the lessons of other public health experiences and determine whether there is any utility or relevance for preventing childhood obesity, it is useful to have a conceptual framework to organize the experiences, principles, and strategies. In the 2000 Surgeon General's Report, Reducing Tobacco Use, a framework was developed to categorize the different types of tobacco control interventions DHHS, 2000 . This framework reviewed the evidence within the following categories educational,...

BOX 62 Kids Off the Couch

Kids Off the Couch is a community collaborative pilot project in Modesto, California, that works with parents and caregivers to prevent obesity in children up to 5 years of age. The project's goal is to influence behavioral changes in food selection and physical activity among parents and primary caregivers. The program provides parents and caregivers with Information on the risks of childhood obesity Tools to assist their children in achieving normal growth and healthy development Hands-on...