Summary of Findings and Conclusions

• Childhood obesity is a serious nationwide health problem requiring urgent attention and a population-based prevention approach so that all children may grow up physically and emotionally healthy.

• Preventing obesity involves healthful eating behaviors and regular physical activity—with the goal of achieving and maintaining energy balance at a healthy weight.

• Individual efforts and societal changes are needed. Multiple sectors and stakeholders must be involved.

likely to change as well; in the long term, we can become a nation where proper nutrition and physical activity that support energy balance at a healthy weight will become the standard.

Recognizing the multifactorial nature of the problem, the committee deliberated on how best to prioritize the next steps for the nation in preventing obesity in children and youth. The traditional method of prioritizing recommendations of this nature would be to base these decisions on the strength of the scientific evidence demonstrating that specific interventions have a direct impact on reducing obesity prevalence and to order the evidence-based approaches based on the balance between potential benefits and associated costs including potential risks. However, a robust evidence base is not yet available. Instead, we are in the midst of compiling that much-needed evidence at the same time that there is an urgent need to respond to this epidemic of childhood obesity. Therefore, the committee used the best scientific evidence available—including studies with obesity as the outcome measure and studies on improving dietary behaviors, increasing physical activity levels, and reducing sedentary behaviors, as well as years of experience and study on what has worked in addressing similar public health challenges—to develop the recommendations presented in this report.

As evidence was limited, yet the health concerns are immediate and warrant preventive action, it is an explicit part of the committee's recommendations that all the actions and initiatives include evaluation efforts to help build the evidence base that continues to be needed to more effectively fight this epidemic.

From the ten recommendations presented above, the committee has identified a set of immediate steps based on the short-term feasibility of the actions and the need to begin a well-rounded set of changes that recognize the diverse roles of multiple stakeholders (Table ES-1). In discussions and interactions that have already begun and will follow with this report, each community and stakeholder group will determine their own set of priorities and next steps. Furthermore, action is urged for all areas of the report's recommendations, as the list in Table ES-1 is only meant as a starting point.

The committee was also asked to set forth research priorities. There is still much to be learned about the causes, correlates, prevention, and treatment of obesity in children and youth. Because the focus of this study is on prevention, the committee concentrated its efforts throughout the report on identifying areas of research that are priorities for progress toward preventing childhood obesity. The three research priorities discussed throughout the report are:

• Evaluation of obesity prevention interventions—The committee encourages the evaluation of interventions that focus on preventing an increase in obesity prevalence, improving dietary behaviors, increasing physical activity levels, and reducing sedentary behaviors. Specific policy, environmental, social, clinical, and behavioral intervention approaches should be examined for their feasibility, efficacy, effectiveness, and sustainability. Evaluations may be in the form of randomized controlled trials and quasi-experimental trials. Cost-effectiveness research should be an important component of evaluation efforts.

• Behavioral research—The committee encourages experimental research examining the fundamental factors involved in changing dietary behaviors, physical activity levels, and sedentary behaviors. This research should inform new intervention strategies that are implemented and tested at individual, family, school, community, and population levels. This would include studies that focus on factors promoting motivation to change behavior, strategies to reinforce and sustain improved behavior, identification and removal of barriers to change, and specific ethnic and cultural influences on behavioral change.

• Community-based population-level research—The committee encourages experimental and observational research examining the most important established and novel factors that drive changes in population health, how they are embedded in the socioeconomic and built environments, how they impact obesity prevention, and how they affect society at large with regard to improving nutritional health, increasing physical activity, decreasing sedentary behaviors, and reducing obesity prevalence.

The recommendations that constitute this report's action plan to prevent childhood obesity commence what is anticipated to be an energetic and sustained effort. Some of the recommendations can be implemented immediately and will cost little, while others will take a larger economic investment and require a longer time for implementation and to see the benefits of the investment. Some will prove useful, either quickly or over the longer term, while others will prove unsuccessful. Knowing that it is impossible to produce an optimal solution a priori, we more appropriately adopt surveillance, trial, measurement, error, success, alteration, and dissemination as our course, to be embarked on immediately. Given that the health of today's children and future generations is at stake, we must proceed with all due urgency and vigor.

TABLE ES-l Immediate Steps

Federal government

Establish an interdepartmental task force and coordinate federal actions

Develop nutrition standards for foods and beverages sold in schools

Fund state-based nutrition and physical-activity grants with strong evaluation components

Develop guidelines regarding advertising and marketing to children and youth by convening a national conference

Expand funding for prevention intervention research, experimental behavioral research, and community-based population research; strengthen support for surveillance, monitoring, and evaluation efforts

Industry and media

Develop healthier food and beverage product and packaging innovations Expand consumer nutrition information Provide clear and consistent media messages

State and local governments

Expand and promote opportunities for physical activity in the community through changes to ordinances, capital improvement programs, and other planning practices

Work with communities to support partnerships and networks that expand the availability of and access to healthful foods

Health-care professionals

Routinely track BMI in children and youth and offer appropriate counseling and guidance to children and their families

Community and nonprofit organizations

Provide opportunities for healthful eating and physical activity in existing and new community programs, particularly for high-risk populations

State and local education authorities and schools

Improve the nutritional quality of foods and beverages served and sold in schools and as part of school-related activities

Increase opportunities for frequent, more intensive and engaging physical activity during and after school Implement school-based interventions to reduce children's screen time

Develop, implement, and evaluate innovative pilot programs for both staffing and teaching about wellness, healthful eating, and physical activity

Parents and families

Engage in and promote more healthful dietary intakes and active lifestyles (e.g., increased physical activity, reduced television and other screen time, more healthful dietary behaviors)

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