tions on street and neighborhood design, planning for parks and community recreational facilities, and locations of new schools and retail food facilities are usually up to the local zoning boards, planning commissions, and similar entities. Efforts can be tailored to local residents and institutions, and can be more quickly adapted and revised to meet changing demands and integrate new approaches.

State governments and agencies, including state departments of health, education, and transportation, are also key to ensuring that obesity prevention policies are developed and programs are implemented. Further, state governments are responsible for programs that provide food assistance, address the consequences of obesity (e.g., diabetes and heart disease), and influence health spending and policy (such as Medicaid, Title V [Maternal and Child Health], and direct funding for community development/housing and transportation). In some states, major policy decisions for school systems are made at the community or county level, but in others it is the state department of education that makes most of these decisions.

As numerous and diverse programs and initiatives are being planned or under way in states and communities, organizations that bring together state and local leaders—such as the National Governors Association, the U.S. Conference of Mayors, the National Association of County and City Health Officials, the Association of State and Territorial Health Officials, and the American Public Health Association—can each raise awareness of obesity issues, facilitate the sharing of lessons learned, and help coordinate obesity prevention efforts.

One avenue for expanding state-based obesity prevention efforts is through CDC’s grants program that focuses on local capacity building and implementation of programs to prevent obesity and other chronic diseases (CDC, 2004a). As discussed in Chapter 6, expansion of this grant program could be instrumental in establishing community demonstration projects. Twenty states received funding through these grants in fiscal year (FY) 2003. By expanding the total funding for the state grant programs, needed resources could be allocated to support additional states, particularly those with the highest prevalence of childhood and youth obesity. For example, the committee notes the critical role that the federal government has played in highway safety by providing states with grant funding (the Section 402 State and Community Highway Safety Grant program); these funds have been used for the development and evaluation of new innovative programs to increase the use of seat belts and child safety seats (IOM, 1999).

Another recent initiative to provide funds for city- and community-based health efforts is the DHHS Steps to a Healthier U.S. Initiative (see Chapter 5). In 2003, DHHS provided 12 grants to promote community and tribal initiatives focused on reducing the burden of diabetes, overweight, obesity, and asthma and emphasizing efforts to address physical inactivity,

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