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Encouraging children and youth to be physically active involves providing them with places where they can safely walk, bike, run, skate, play games, or engage in other activities that expend energy. But practices that guide the development of streets and neighborhoods often place the needs of motorized vehicles over the needs of pedestrians and bicyclists. Local governments should find ways to increase opportunities for physical activity in their communities by examining zoning ordinances and priorities for capital investment.

Community actions need to engage child- and youth-centered organizations, social and civic organizations, faith-based groups, and many other community partners. Community coalitions can coordinate their efforts and leverage and network resources. Specific attention must be given to children and youth who are at high risk for becoming obese; this includes children in populations with higher obesity prevalence rates and longstanding health disparities such as African Americans, Hispanic Americans, and American Indians, or families of low socioeconomic status. Children with at least one obese parent are also at high risk.

Health-care professionals, including physicians, nurses, and other clinicians, have a vital role to play in preventing childhood obesity. As advisors both to children and their parents, they have the access and influence to discuss the child's weight status with the parents (and child as age appropriate) and make credible recommendations on dietary intake and physical activity throughout children's lives. They also have the authority to encourage action by advocating for prevention efforts.

Recommendation 6: Community Programs

Local governments, public health agencies, schools, and community organizations should collaboratively develop and promote programs that encourage healthful eating behaviors and regular physical activity, particularly for populations at high risk of childhood obesity. Community coalitions should be formed to facilitate and promote cross-cutting programs and community-wide efforts.

To implement this recommendation:

• Private and public efforts to eliminate health disparities should include obesity prevention as one of their primary areas of focus and should support community-based collaborative programs to address social, economic, and environmental barriers that contribute to the increased obesity prevalence among certain populations.

• Community child- and youth-centered organizations should promote healthful eating behaviors and regular physical activity through new and existing programs that will be sustained over the long term.

• Community evaluation tools should incorporate measures of the availability of opportunities for physical activity and healthful eating.

• Communities should improve access to supermarkets, farmers' markets, and community gardens to expand healthful food options, particularly in low-income and underserved areas.

Recommendation 7: Built Environment

Local governments, private developers, and community groups should expand opportunities for physical activity including recreational facilities, parks, playgrounds, sidewalks, bike paths, routes for walking or bicycling to school, and safe streets and neighborhoods, especially for populations at high risk of childhood obesity.

To implement this recommendation:

Local governments, working with private developers and community groups, should:

• Revise comprehensive plans, zoning and subdivision ordinances, and other planning practices to increase availability and accessibility of opportunities for physical activity in new developments

• Prioritize capital improvement projects to increase opportunities for physical activity in existing areas

• Improve the street, sidewalk, and street-crossing safety of routes to school, develop programs to encourage walking and bicycling to school, and build schools within walking and bicycling distance of the neighborhoods they serve

Community groups should:

• Work with local governments to change their planning and capital improvement practices to give higher priority to opportunities for physical activity

The DHHS and the 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.

Recommendation 8: Health Care

Pediatricians, family physicians, nurses, and other clinicians should engage in the prevention of childhood obesity. Health-care professional organizations, insurers, and accrediting groups should support individual and population-based obesity prevention efforts.

To implement this recommendation:

• Health-care professionals should routinely track BMI, offer relevant evidence-based counseling and guidance, serve as role models, and provide leadership in their communities for obesity prevention efforts.

• Professional organizations should disseminate evidence-based clinical guidance and establish programs on obesity prevention.

• Training programs and certifying entities should require obesity prevention knowledge and skills in their curricula and examinations.

• Insurers and accrediting organizations should provide incentives for maintaining healthy body weight and include screening and obesity preventive services in routine clinical practice and quality assessment measures.

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Gaining Weight 101

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