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Preventing Childhood Obesity: Health in the Balance
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Index
A
Abdominal obesity, 69, 70
Academic performance, 105, 215, 252, 253
Action plan for prevention
clinical medicine approach, 107-108, 109
contexts for, 25-44
definitions and terminology, 79-83
developing recommendations, 16, 111-115, 323
energy balance, 3, 90-106
evidence-based strategies, 3, 16, 107-115, 322-323
framework, 83-85
goals, 4-5, 86-90, 115
public health approach, 108-110, 115, 127, 129
Active Living by Design, 206
Added caloric sweeteners, 31, 145-146, 290
Adolescents. See Children and adolescent obesity;
Older Children and Youth
Adopted children, studies, 93
Adults
diabetes, 68
energy balance, 90, 160
obesity, 5, 22, 43-44, 63-65, 68
overweight, 80
physical activity, 29, 35, 179
prevention goals, 88
treatment for obesity, 108
TV viewing time, 160-161
Advertising and marketing
alcoholic beverages, 175
bans and restrictions on, 174-175, 178, 268, 353, 362, 363
codes and monitoring mechanisms, 176-177
and eating behavior, 169-170, 172-173
energy density of advertised foods, 172
and energy imbalance, 172, 173, 174, 355
ethnic groups targeted by, 106
evidence of effects of, 353-354, 355
expenditures, 172
exposure time for children, 171, 174
First Amendment rights, 174-175, 353, 362
health and nutrient claims, 169-170, 176
litigation, 354
packaging, 172, 356
prevention through, 128, 268, 353, 367;
see also Public education
quantity and nature of commercials, 172
recommendations, 9, 177
research needs, 177, 268
in schools, 176, 251, 265-269
self-regulation by industry, 175, 354
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social and public health pressures, 366
standards development, 175-176
targeting children, 106, 145, 172, 174, 355
television commercials, 8, 44, 172-173, 174, 265, 301, 302, 355
vulnerability of children to, 8, 172-173, 267-268, 302, 353-354, 355
Advertising Council, 184
Advocacy
community mobilization, 210-211
by health professionals, 223-225
media, 181, 183, 351
by parents, 300
Age
and BMI, 56-57, 63-65
and child obesity trends, 1, 63
AGRICOLA database, 339, 340
Agricultural policies, 6-7, 144-146, 148, 217
African Americans.
See also Ethnic groups;
Racial and ethnic disparities
body image dissatisfaction, 66, 104
defined, 58 n.4
diabetes, 68
interventions for, 200, 274
obesity trends, 60, 105
targeted marketing of foods to, 106
Alabama, 61
Alaska, 61
Alcohol prevention analogies, 175, 352, 354, 366
America on the Move initiative, 141
American Academy of Family Physicians, 224
American Academy of Pediatrics, 174, 224, 253, 290, 358
American Cancer Society, 201
American Council on Food and Nutrition, 367 n.6
American Federation of School Teachers, 265
American Indians.
See also Ethnic groups;
Racial and ethnic disparities
body image dissatisfaction, 66, 104
defined, 58 n.4
diabetes, 68
obesity trends, 60, 105
school-based dietary interventions, 245, 246, 247-248
American Medical Association, 224
American Planning Association, 210, 218
American Psychological Association, 265, 371
PsychINFO database, 341
Task Force on Advertising and Children, 173-174, 355, 356
American Public Health Association, 132, 358, 359-360
American Stop Smoking Intervention Study (ASSIST), 199
Americans in Motion, 224
Americans’ Use of Time Study, 29, 159
Animal studies, 94
Appetite.
See also Hunger;
Satiety regulatory systems, 95, 157
Arkansas BMI initiative, 271
Asian/Pacific Islanders.
See also Ethnic groups;
Racial and ethnic disparities
body image dissatisfaction, 104
defined, 58 n.4
diabetes, 68
obesity trends, 105
Association of State and Territorial Health Officials, 132, 218
Atherosclerosis, 69
Australia, 44, 180, 256-257
Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC), 140-141
Away-from-home foods.
See also Fast food;
Restaurant industry;
School food and beverages
consumption trends, 27-28, 30, 161, 357-358
costs and convenience, 26
defined, 331
energy density, 92, 162, 163
energy intake, 30, 158, 161
frequency of dining out, 161-162
leisure/social aspects, 28
nutrition labeling, 163-164, 165, 168, 197, 356
portion sizes, 158
B
Back to Sleep campaigns, 179
Balanced diet
benefits associated with, 97
defined, 91, 331
dietary guidelines, 96-97
ethnically appropriate foods, 144, 156
responsibility to provide, 292-293
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Basal metabolism, 331
Behavioral research, 17, 323-324
Behavioral Risk Factor Surveillance System (BRFSS), 29, 35, 36, 61, 160
Behavioral settings. See Community environment;
Home environment;
School environment
Better Business Bureau, 175
Beverages.
See also Food and beverage industry;
Milk and other dairy products;
School food and beverages;
Sodas and fruit drinks
consumption trends, 33
Blood pressure. See High blood pressure;
Hypertension
Blue Cross of California, 201
Body fat, 54, 80, 93, 137, 140, 334.
See also Body mass index
Body image, 66, 91-92, 100, 103-104, 199
Body mass index
age-specific trends, 56-57, 63-65, 80, 336
beverage consumption and, 293-294
calculation, 80
charts, 1 n.1, 55, 79-80, 88, 89-90
clinical screening and tracking, 221-222, 307-308
and co-morbidities, 62, 80
crossing percentiles, 89-90
defined, 79, 331-332
and diabetes, 24, 62, 68
distribution trends, 61-62, 80, 336
ethnicity and, 58-60
gender tends, 56-58
obesity definition, 1 n.1, 22, 54-55, 63
optimum population goals, 86, 88-90
overweight, 80, 336
revised growth reference, 55
school screening, 270-271, 308
socioeconomic status and, 60-61
TV viewing and, 302
Body weight
CDC guidelines for children, 89
and energy intake, 159
goals, 89-90
growth spurts and, 91, 307
as health issue, 306-308
healthy, 335
heritability, 91, 93, 94
inappropriate gain, 90
measurement, 137, 140
monitoring, 306-308
physiological regulation of, 159
survey data, 89, 137, 140
Boy Scouts, 202
Boys and Girls Clubs of America, 44, 202
Brain
regulation of energy balance, 69-70, 94, 95, 157
stress response, 70
Breastfeeding, 222, 288-290
Built environment.
See also Local
communities city planning, 210
community interventions, 203, 204-217
correlation studies, 206-208
defined, 332
designing for physical activity, 11, 12, 125, 132, 196, 204-211, 273-274
evaluation of interventions, 208-209
food access, 215-217
land development codes, 210
race/ethnicity and, 205
rating, 218
recommendations, 11, 209-211, 213-214, 220
recreational facilities, 206, 211
research needs, 208-209
safety considerations, 11, 205, 207-208, 211
schools, 213-215, 273-274
smart growth principles, 209, 210
socioeconomic status and, 205, 207
street-scale interventions, 208
transportation issues, 38, 205
walking and biking opportunities, 207, 208, 209, 210, 211-215
C
California, 71, 103-104, 180, 200, 201, 213, 214, 242, 248, 358, 359
Caloric sweeteners. See Added caloric sweeteners
Calories, defined, 332.
See also Energy expenditure;
Energy intake
Canada, 44, 68, 356
Cancer, 69, 107, 169
Carbohydrates, 34
Cardiovascular disease
food label health claims, 169
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prevention interventions, 107, 109, 196, 200, 223, 262
risk factors, 23, 69
Center for Consumer Freedom, 367 n.6
Centers for Disease Control and Prevention, 346
BMI charts, 1 n.1, 55, 79-80, 88, 89-90
grants program, 132, 133
guidelines for healthy weight, 89
health curriculum recommendations, 261
Healthy Days Measures, 218
physical activity promotion, 141, 255
Project MOVE, 136-137
REACH 2010 initiative, 200
recommended role, 130-131
research funding, 135, 204
revised growth reference, 55
School Health Index, 274-275
surveillance and monitoring, 29, 37, 61, 137
tobacco prevention policies, 358
VERB campaign, 141, 182-183, 184
Check-off programs, 145
Child and Adolescent Trial for Cardiovascular Health (CATCH), 245, 246, 256, 262-263, 270
Child and Adult Care Food Program (CACFP), 142, 143
Childhood and adolescent obesity.
See also Epidemic of childhood/adolescent obesity;
Prevalence of childhood/adolescent obesity
abuse and neglect and, 287
adult obesity trends and, 63-65
age-related trends, 1, 63
and co-morbid health risks, 62, 67-69, 319
definitions, 1 n.1, 22, 56, 63, 79-81, 115, 336
food insecurity and, 215
genetics and, 65, 91, 94, 106
health care costs, 72
intergenerational transmission, 65
international dimensions, 2, 22
medical conditions and, 91
public interest, 40-43
Children and youth.
See also Infants;
Older children and youth;
Toddlers and young children
balanced diet, 91
BMI distributions, 61-62, 80, 336
diabetes, 23, 73
energy balance, 90, 97
energy expenditure, 90
energy requirements, 97, 158, 167-168
free time, 36, 38, 160
physical activity trends, 35-36, 160
purchasing influence, 172, 292, 302
Children’s Advertising Review Unit, 175-176
Cholelithiasis, 67, 72
Cholesterol, dietary, 180
Church-based interventions, 199-200
CINAHL (Cumulative Index to Nursing and Allied Heath Literature), 339, 340
Class of 1989 Study, 197
Clinical medicine.
See also Treatment of obesity
effectiveness of interventions, 365
evidence-based approach, 107-108, 109
preventive services, 221-224, 226
Clinical practice guidelines, 107
Coalition building, 7, 128, 198-199, 200, 202-203, 225-226
Cochrane Database, 339, 340
Common Sense for Consumption Act, 363
Community-based interventions.
See also Built environment;
Local communities
advocacy, 210-211
categories of, 346-349
child/youth programs, 197-198, 201-204
church-based, 199-200
coalition building, 7, 10, 11, 128, 198-199, 200, 202-203, 225-226
culturally appropriate and targeted strategies, 198, 199-201, 203
demonstration projects, 132, 200, 204, 208-209, 213
dietary changes, 196, 197
ecological framework, 196-199, 203
by employers, 195, 202
evaluation of, 11, 17, 203-204, 217-219, 325
evidence of effectiveness, 46, 196-198, 222-223, 348
food-access-related, 11, 144, 216-217, 218, 357-358
funding, 132-133, 209
guide to preventive services, 209, 348-349
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large-scale, 196-197, 217-219, 345, 347
neighborhood associations, 210-211
nutrition education, 198, 201
physical activity, 12, 179-180, 196, 197, 201, 202, 211-215
public health preventive services, 125, 200, 346, 347, 348-349
recommendations, 10-12, 201-204, 219-221, 225
recreational programs, 202
“report cards,” 218
by youth organizations, 201
Community centers, schools as, 272-274
Community environment.
See also Built environment;
Local communities
access to food products, 144, 215-217, 357-358
health impact assessment, 217-219
Community health care
advocacy by professional organizations, 224-225
counseling by health-care professionals, 221-223
insurance coverage, 225-226
preventive services, 12, 221-225, 226, 348-349
quality-improvement programs, 226
recommendations, 12, 225, 226-227
Community Health Status Indicators Project, 218
Community Preventive Services Taskforce, 361
Co-morbidities of obesity.
See also Diabetes
BMI and, 62, 80
defined, 332
disorders, 67
economic costs, 23, 70-71
health risks of children, 62, 67-69
trends, 22, 62
Congress for the New Urbanism, 210
Consumer attitudes.
See also Public interest in obesity
trends, 40-43
Consumer information, 128, 141-142, 163
Continuing Survey of Food Intakes by Individuals, 97, 137, 138, 159, 163, 293
Corn subsidies, 146
Coronary artery disease, 69
Cost-reduction interventions, 46, 347, 349
Costs of childhood obesity.
See also Economic costs of obesity
health-care-related, 70-72
integrated view of, 69-70
physical health, 65, 67-69, 71, 73
social and emotional health, 22-24, 65, 66-67, 69-70, 71, 73
Counseling
by health-care professionals, 221-223
at school, 269-270
Current Population Survey, 45
D
Dairy products. See Milk and other dairy products
Deaths, 67, 68, 73
Demographic trends, 25-40
Demonstration projects, 132, 200, 204, 208-209, 213
Denmark, 287
Depression and depressive symptoms, 66, 67, 69-70, 105
Diabetes, type 1, 67 n.5
Diabetes, type 2
in adults, 68
BMI and, 24, 62, 68
in children, 23, 73
complications of, 68, 69
in ethnic minority groups, 23, 68
gestational, 65, 288
health care costs, 71-72
high-fructose corn syrup and, 146
lifetime risk, 2, 23, 67-68
prevalence, 67-68, 225
risk factors, 68
Diet.
See also Balanced diet
deaths related to, 67, 73
nutrient density, 96
Dietary Guidelines Advisory Committee, 131
Dietary Guidelines for Americans, 13, 96-97, 131, 164, 165, 239, 240, 292, 332
Dietary intake
economic environment and, 100, 101, 215-216, 358
and energy balance, 95-98, 101
health claims advertising and, 169-170
by macronutrient, 34
physiological regulation of, 159
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psychosocial and behavioral considerations, 95-98, 105
research challenges, 97-98
trends, 28, 30-33, 97
Dietary interventions
community-based, 196, 197
education campaigns, 180, 345
effectiveness of, 241, 244-247, 364
school based, 240-241, 244-247, 252-253, 364
self-help, 365
tobacco control interventions compared, 350-351
Dietary Reference Intakes, 168, 333
Disability, defined, 333
Disease
defined, 333
emergency response to, 133
Discrimination, 66, 67, 100, 178
Dyslipidemia, 62, 67
E
Eating behavior
in absence of hunger, 294-296, 305
advertising and, 172-173
brain’s regulation of, 69, 95, 157
breastfeeding and, 222, 288-290
“clean the plate” pressures and, 295
energy density of foods and, 156-157, 159, 291, 293
flavor preferences, 289, 291
food as reward and, 295
health-claims advertising and, 169-170
home environment and, 14-15, 287-296
introducing new foods, 291
package size and, 159
parental influence, 287-289, 305-306
portion size and, 158, 291-292, 294-296, 305
selection and availability of foods, 292-294
self-regulation, 289, 294
TV viewing during meals and, 222, 293
Eating disorders, 43, 287
Eating patterns, trends, 27-28, 30-35
Ecological systems theory model, 83-85, 115
EconLit database, 339, 340
Economic costs of obesity, 23, 70-71, 72, 225
Economic environment
and food intake, 100, 101, 215-216, 358-360
funding of school meals, 250, 252
and physical activity, 100, 102
in schools, 238, 250-252, 358, 359
taxation and pricing interventions, 44, 128, 146-147, 178, 358-360
Edible Schoolyard, 248
Education. See Public education
Electronic media.
See also Television viewing
home environment, 39-40, 303
time spent by children on, 171, 172
EMBASE (Excerpta Medica), 339, 340, 342
Employers and worksite interventions, 195, 202
Energy balance
action plan for prevention, 90-106
adults, 90, 160
body image, 103-104
in children and youth, 90, 97
central nervous system regulation of, 69-70, 94, 95, 157, 159
defined, 83 n.2, 90, 115, 333
dietary intake and, 95-98, 101
ecological systems theory model, 83-85, 115
environmental influences, 100-106
food marketing and advertising practices and, 172, 173, 174, 355
genetic variation and biological considerations, 91, 93-95, 159
physical activity and, 92, 98-99, 102
promotion, 115
psychosocial and behavioral
considerations, 69-70, 95-99
racial and ethnic disparities, 105-106
sociocultural environment and, 84-85, 91-92, 100-106
socioeconomic status, 104-105, 146-147
stigmatization considerations, 100, 103
surveys, 137
transportation patterns and, 37
TV viewing and, 301-302
Energy density of foods, 28
access and affordability issues, 216
of advertised foods, 172
of away-from-home foods, 92, 162, 163
defined, 333
and eating behavior, 156-157, 159, 291, 293
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and energy storage, 156-157
infant response to, 290
labeling foods for, 170, 171
and satiety, 157, 159
of school foods, 240, 243
taxes on energy-dense foods, 44, 146-147
Energy expenditure
adult patterns, 160
defined, 90, 333
measurement of, 99, 332
physical activity and, 92, 99
resting metabolism and, 92 n.6
Energy imbalance, 83-85, 93
Energy intake
away-from-home foods, 30, 158, 161
body weight and, 159
defined, 91, 333
by gender, 35
measurement, 332
physiological regulation of, 289, 294
predictors of, 158-159
trends for children, 97
Energy requirements for children and adolescents, 97, 158, 167-168
Entertainment industry. See Leisure, entertainment, and recreation industries;
Television viewing
Environmental influences.
See also Community environment;
Home environment;
School environment
defined, 334
ecological layers, 15, 100, 101-102, 286, 320
on energy balance, 100-106
genetic interactions, 93-94
monitoring needs, 140
obesogenic, 2, 306, 320, 336
Epidemic of childhood/adolescent obesity
adult obesity epidemic and, 63-65
BMI distribution, 61-62
consumer attitudes and, 40-43
contexts for action, 25-44
costs for children and society, 22-24, 65-72
defined, 21 n.1, 55, 334
demographic trends, 1, 25-40
eating patterns and, 27-28, 30-35
in ethnic groups, 1, 26-27, 58-61
family life and, 25-26
health-care costs, 70-72
high-risk population subgroups, 58-61, 134
lifestyle trends, 25-26, 27-39
media and, 39-40
overall burden, 55-58
physical activity and, 29, 35-39
physical health implications, 22-23, 67-69
prevalence and time trends, 22, 54-65
programs and policies, 43-44
public awareness, 40-43
public health implications, 22-24
public health precedents, 21, 44-47, 343-371
regional differences, 61
social and emotional consequences, 23, 66-67
socioeconomic difference, 60-61, 104-105
ERIC (Educational Resources Information Center) database, 339, 340-341
Ethnic groups.
See also Racial and ethnic disparities;
Sociocultural environment
body image perceptions, 199
definitions, 58 n.4
diabetes, 23, 68
diversity trends, 26-27
food preferences, 27, 106
genetic susceptibility to obesity, 106
high-risk groups, 58-61, 68, 199-201
interventions targeted to, 199-201, 203, 257
media education campaigns, 182-183
obesity prevalence, 1, 10, 26-27, 58-61, 94, 105-106
physical activity, 29-30, 205, 257
and protective effects of breastfeeding in, 289
regional differences, 61
socioeconomic difference, 60-61, 106, 201
targeted marketing of foods to, 106
trust issues, 106, 200
TV viewing time, 301
Evaluation of prevention interventions
BMI distribution as measure of change, 88
community-based participatory studies, 17, 203-204, 217-219, 325
demonstration projects, 132, 200, 204, 208-209, 213
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design of studies, 304
funding for, 204, 215
health impact assessment, 217-219
intermediate goals and, 6, 17, 86-87, 323
natural experiments, 209
pilot programs, 242, 247-248, 251, 252, 274, 277
pretest/posttest design, 208
prospective approach, 217-219
Exercise.
See also Physical activity
defined, 334
Expanded Food and Nutrition Education Program, 141, 142
F
Family Interaction, Social Capital and Trends in Time Use Data, 29, 160
Family life, trends, 25-26, 285-286
Farmers’ markets, 144, 216, 248
Fast food.
See also Restaurant industry
advertising and marketing, 302, 355
consumption trends, 162, 163, 358
defined, 334
energy density, 92, 163
litigation, 363-364
nutrient density, 162
nutrition labeling, 356
sales, 162
Fat, dietary.
See also Body fat
consumption trends, 30-31, 34, 245
food supply trends, 34, 366
saturated, 169
Fat-brain axis, 95
Federal Trade Commission, 9, 153, 174, 175, 177, 355-356
Federal Transportation Enhancements Program, 209
Feeding Infants and Toddlers Study (FITS), 290, 291
Feet First, 206
Finland, 196
Fish and shellfish, 32
Fit ‘n Active Kids program, 141
Fitness.
See also Physical fitness
cardiorespiratory, 179-180
counseling, 269-270
defined, 334
Five-a-Day media campaign, 141, 180, 244
Fluoridation campaigns, 199, 350
Food and beverage industry.
See also Advertising and marketing;
Restaurant industry;
School food and beverages
check-off programs, 145
federal regulation, 361-362
liability protection, 360, 362
litigation, 362-364
motivation for change, 154, 157, 170, 366
packaging, 154, 158-159, 167, 172, 356
portion sizes, 154, 158-159
positive changes, 7, 155, 156, 266-267
product development, 154, 155-157, 170
recommendations, 8, 156, 166
sales to young consumers, 153-154, 172
self-regulation, 175-176, 366
targeted marketing of foods, 106, 145, 172
Food and Drug Administration
nutrition labeling regulation, 9, 167-171, 362
Obesity Working Group, 163
tobacco regulation, 353
Food, Drug and Cosmetic Act, 361
Food environment
access and opportunity, 27, 100, 101, 105, 128, 144, 215-217, 292-294, 356-358
away-from-home foods, 26, 27-28, 331
built environment, 215-217
community-based interventions, 144, 216-217, 218, 357-358
and eating behavior, 292-294
economic factors and, 100, 101, 215-216, 358-360
healthy foods, 105, 144, 215-217
at home, 292-294
policy and political considerations, 100, 101, 144-146, 369
portion sizes, 27, 358, 369
rating, 218
recommendations, 217
restricting availability, 357
sociocultural considerations, 100, 101, 106
Food Guide Pyramid, 28, 164-165, 292, 334
Food insecurity, 88 n.3, 104-105, 143-144, 147, 215
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Food insufficiency, 104-105
Food Marketing Institute, 167
Food security, 215, 334
Food service workers, 134
Food Stamp Program, 141, 142-143, 144, 216
Food supply, 34, 35, 145, 146
Food system, 145, 334
Foods.
See also specific food groups
ethnic, 156
of minimal nutritional value, 241, 335
product groups with health claims, 169
reduced-calorie products, 156
as reward and, 295
4H Clubs, 202
Framework Convention on Tobacco Control (FCTC), 350-351, 356, 360
France, 44
Fruits and vegetables
access to fresh foods, 144, 216, 242, 251
children’s acceptance of, 291
consumption trends, 28, 32
costs, 216, 360
health benefits, 107, 169, 223
promotion, 107, 141, 180, 198, 200, 223
school offerings, 240, 242, 247-248, 251, 291
subsidies, 360
Funding
community-based interventions, 132-133, 209
for evaluation studies, 204, 215
of school meals, 250, 252
G
Gender
and BMI, 56-58
and body image dissatisfaction, 104
and energy intake, 35
and physical activity, 257-258
Genetics
and energy balance, 91, 93-95, 159
environmental interactions, 93-94
and body fatness, 93
and body weight, 91, 93, 94
and prevalence of obesity, 94
single-gene disorders, 94
susceptibility to obesity, 65, 106
Georgia, 211, 250
Germany, 44
Girl Scouts, 44, 198, 202
Girls Health Enrichment Multi-site Study (GEMS), 200, 203
Girls on the Run, 197
Global Strategy for Diet, Physical Activity and Health, 367
Glucose intolerance/insulin resistance, 67, 68, 69, 70
Go for Health, 256
Growth charts, 89 n.4.
See also Body mass index, charts
Growth spurts, 91, 307
Guidelines for School and Community Programs to Promote Lifelong Physical Activity Among Young People, 255
Gun control analogies, 350, 361, 362
H
Health
body weight and, 306-308
costs of obesity, 22-23, 65, 67-69, 71, 73
defined, 335
food security and, 215
impact assessments, 217-219
population, 215, 336
promotion, 100, 106, 128, 335, 359-360
report cards, 270-271
Health-care professionals
advocacy role, 223-225
obesity screening and counseling by, 10, 221-223, 272
school referrals to, 272
training, 224-225
Health-care system, 128
Health education, 106
classroom requirements and practices, 261-262
recommendations, 264-265
teacher training, 264, 265
Health insurance coverage, 60-61, 225-226, 307
Health services.
See also Community health care
costs, 70-72
school-based, 269-272
Healthful diet. See Balanced diet
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HealthStyles Survey, 38, 211
Healthy Days Measures, 218
Healthy Eating Index (HEI), 96-97
Healthy People 2000, 156
Healthy People 2010, 129, 194, 321
Hepatic steatosis, 67
High blood pressure, 62, 69.
See also Hypertension
High-density lipoprotein (HDL) cholesterol, 69
High fructose corn syrup, 145-146
High-risk population subgroups, 6, 58-61, 68, 134, 199-201, 322
Highway safety analogies, 44-45, 126, 128, 132, 350, 361, 366
Hispanics.
See also Ethnic groups;
Racial and ethnic disparities
body image dissatisfaction, 66, 104
energy gaps, 93
defined, 58 n.4
diabetes, 68
obesity trends, 60, 105
HIV prevention, 107
Home environment.
See also Parents;
Television viewing
and eating behavior, 14-15, 287-296
electronic media, 39-40, 303
family characteristics and, 25-26, 285-287
food and beverage selection and availability, 292-294
meal preparation, 26, 28
obesogenic families, 306
and physical activity, 14-15, 296-301
recommendations, 14-15, 290, 308-309
Home visits, 46, 349
Hunger.
See also Appetite;
Satiety eating in absence of, 294-296, 305
in U.S., 88
Hypertension, 62, 67, 225
Hypertriglyceridemia, 69
Hypothalamic-pituitary-adrenal axis, 70
I
Illinois, 213
Inactivity
deaths related to, 67
decreasing, 114, 301-305
defined, 336
health care costs of, 71, 73
prevalence, 29-30
safety reasons, 207
technology and, 160
TV viewing and, 301-305
Indiana, 247
Industry.
See also Advertising and marketing;
Food and beverage industry;
Leisure, entertainment, and recreation industries;
Restaurant industry
health promotion by, 128, 161, 182
recommendations, 8, 165-166, 177
self-regulation, 175, 354
Infants
breastfeeding, 222, 288-290
food insecurity, 105
low birthweight, 288
mortality rates, 21
overweight, 55, 58 n.3, 80-81
Information environment. See Advertising and marketing;
Public education
Injury prevention campaigns, 345, 361
Institute of Medicine, 144, 168, 344, 360
Institute of Traffic Engineers, 210
Insulin levels, 62.
See also Diabetes;
Glucose intolerance/insulin resistance
International dimensions of obesity, 2, 22, 367, 371
International Food Information Council, 40-41
Intervention programs.
See also Community-based interventions
behavioral theory and, 345
comprehensive approaches, 46-47, 128, 131, 196-199, 203, 262-263, 345, 349-352
ethnic groups targeted, 199-201, 203, 257
evaluation of, 133, 134, 136-137, 142, 214-215
evidence of effectiveness, 45-46, 196-198, 222-223, 262-263, 348, 349-352, 370-371
funding, 6, 44, 128, 131, 132-133, 142, 148, 359-360
industry-sponsored, 161
international efforts, 44
large-scale, 196-197, 217-219, 345, 347
parental involvement, 287
registry of, 44
school-based, 239, 244, 246-247
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successful elements of, 46-47, 350-351
taxes on soft drinks and snack foods, 44, 128, 146-147
translation and diffusion of, 134-135
Intrauterine environment, 65, 95, 288
Iowa, 247
J
Joint Committee of National Health Education Standards, 261
Jump Up and Go Program, 225
K
Kaiser Family Foundation, 184, 355, 371
Kidney failure, 69
Kids Off the Couch, 201
Know Your Body study, 244
L
Labeling. See Nutrition labeling
Laws and regulations, 357
evidence of effectiveness, 46, 347, 349
Lead paint control analogies, 350, 362
Leisure, entertainment, and recreation industries, 7-8, 159-161, 166, 172, 175-176
Leisure time
availability, 36, 38, 159-160
physical activity trends, 29, 35, 36, 37
Leptin, 95
Lexis/Nexis, 339, 341
Life expectancy, 23
Lifestyle Education for Activity Program, 257
Lifestyle trends, 25-26, 27-39
Litigation, 128, 154, 354, 362-364
Local communities.
See also Community health care;
Community interventions
built environment, 132, 204-217
defined, 193-194, 332
food environment, 215-217
mobilization, 43-44, 128, 194-221
recommendations, 213, 217, 219-221
stakeholders and coalitions, 128, 133, 194, 195, 196-204
Louisiana, 61, 250
Low-income populations
built environment, 205, 207
community-based interventions, 199, 206, 217, 274
food access issues, 215-216, 217
nutrition programs, 142-144
overweight in, 206
Lung cancer prevention, 107
M
Macronutrients. See Carbohydrates;
Fat, dietary;
Protein, dietary
Marketing. See Advertising and marketing
Maryland, 207
Mass media
advertising and marketing, 8, 171-177, 178
advocacy, 181, 183, 351
anti-drug campaigns, 181-182
anti-tobacco campaigns, 178, 181-182, 347
dietary interventions, 180
effectiveness of campaigns, 46, 179, 347, 349, 364-365
obesity coverage, 40-41, 154, 181, 202
obesity epidemic, 39-40
physical fitness promotion, 179-180
public education campaigns, 8, 9-10, 177-185, 349, 364, 371
public service announcements, 184
Massachusetts, 225, 271
Meals.
See also Balanced diet;
Eating behavior
breakfast, 28
“clean the plate” pressures, 295
eating out, 26
home preparation, 26
snacks, 28
TV viewing during, 222, 293
Meat and poultry
consumption trends, 32
Media.
See also Electronic media;
Mass media;
Television viewing
Medicaid, 61, 71
Early and Periodic Screening, Diagnostic, and Treatment program, 226
Medical Expenditure Panel Survey Household Component, 61
Medicare, 61, 71
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Medline, 339, 341
Menstrual abnormalities, 67
Metabolic syndrome, 69, 70
Metabolism. See Basal metabolism;
Energy balance
resting, 92 n.6, 93
Metropolitan Planning Organizations, 210
Michigan, 61, 247
Micronutrient deficiencies, 88 n.3
Middle-School Physical Activity and Nutrition study, 257
Midwestern Prevention Project, 197
Military recruits, weight-for-height standards, 24
Milk and other dairy products, 31-32, 240, 293
Minnesota, 104, 242-243
Heart Health Program, 179, 180, 196, 197
Mississippi, 61, 250
Monitoring the Future Survey, 40
Montana, 207
N
National Association for Sport and Physical Education, 98, 253
National Association of County and City Health Officials, 132, 218
National Cancer Institute, 180, 199
National Center for Health Statistics, 54
National Committee for Quality Assurance, 226
National Governors Association, 132
National Health and Nutrition Examination Survey (NHANES), 6, 29, 36, 54, 55-56, 60, 61, 63, 68, 89, 137, 138, 139, 140, 148, 157, 160
National Health Education Standards, 261
National Health Examination Survey (NHES), 36, 60
National Health Interview Survey, 29, 159-160, 221
National Heart, Lung, and Blood Institute, 179, 225
National Highway Traffic Safety Administration, 361
National Household Travel Survey (NHTS), 38, 39, 138
National Human Activity Pattern Survey, 160
National Institutes of Health, 358
Task Force on Obesity Prevention, 131, 135
National Library of Medicine, 341
National Longitudinal Study of Adolescent Health, 60, 138
National Longitudinal Survey of Youth (NLSY), 60, 61, 62, 139
National Personal Transportation Surveys, 39
National School Lunch Program, 142, 143, 145, 237 n.1, 239-241, 250
National Walk Our Children to School Day, 213
National Youth Anti-Drug Media Campaign, 182
Native Americans. See American Indians
Neighborhood associations, 210-211
Neonatal critical period, 95
New Mexico, 247
North Carolina, 266
North Carolina Black Churches United for Better Health project, 199-200
North Karelia Project, 179, 196-197
Nutrient density of foods, 96, 115, 162, 171, 172, 243, 335
Nutrition Academic Award Program, 225
Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases, 204
Nutrition assistance programs, 6-7, 142-144, 148
Nutrition education
availability, 100
behavioral curricula, 262-263
community-based interventions, 198, 201, 273
food service personnel, 134
health education curriculum, 261-262
media campaigns, 141
programs, 141-142, 148, 225
recommendations, 6, 142, 148
by restaurant industry, 164-166
at school, 261-263, 273
Nutrition labeling
calorie content, 168
comparative claims, 170-171
consumer understanding and use, 167, 169-170
and eating behavior, 169-170
energy density and nutrient density, 170, 171
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health claims, 9, 167, 169-170, 171, 362
ingredient disclosure, 356
nutrient claims, 9, 167, 168-169, 171
Nutrition Facts Panel, 9, 158, 166-168, 169, 171, 335
percent Daily Value, 166-167, 171
recommendation, 8-9, 171
research needs, 9, 171
restaurant foods, 163-164, 165, 168, 197, 356
serving size, 167, 168, 356
warnings, 353, 356
Nutrition Labeling and Education Act, 166, 170 n.8
Nutrition standards, 44, 125, 129-130, 131, 134
O
Obesity.
See also Childhood and adolescent obesity;
Epidemic of childhood/adolescent obesity;
Prevalence of childhood/adolescent obesity
BMI, 22, 54-55, 63
Ohio, 67, 206, 207, 247
Older children and youth
family decision-making responsibilities, 304-305
fast food consumption, 163
healthful eating behaviors, 290-292
1% or Less campaign, 180
Orthopedic problems, 67
Overweight
age-specific trends, 63, 80
BMI, 80, 336
defined, 55, 80, 336
P
Parents
as advocates, 300
defined, 14
eating behavior, 305-306
involvement in interventions, 287
labor force participation, 25, 26
media campaigns targeting, 179, 183
nutrition education, 142, 287, 299
obese or overweight, 64-65, 93, 104, 199, 289
perception of weight as health issue, 42-43, 65-66, 269, 306-308
physical activity patterns of, 297-298, 302
physician counseling for, 222
promoting healthy food choices, 14-15, 287-296
promoting physical activity, 14-15, 299, 300-301
as role models, 183, 195, 197, 273, 286, 292, 298, 305-306
Partnership for a Walkable America, 141, 213 n.2
Partnership for the Public’s Health, 200
Partnership to Promote Healthy Eating and Active Living, 84, 141
Pathways, 245, 246, 262-263
Pawtucket Heart Health Program, 179, 196
Pediatric Nutrition Surveillance System (PedNSS), 139
Pennsylvania, 207
Physical activity.
See also Inactivity;
Sedentary behavior
and academic performance, 253
active living, 155 n.1, 331
adults, 29, 35, 179
after-school programs, 260, 272-274
age and, 98, 296-297, 302-303
benefits of, 98-99, 253, 300
biological correlates, 69, 296-297
built environment and, 38, 125, 132, 196, 204-211
changes needed, 128, 252-263
classroom curricula, 255, 262-263
community mobilization, 44, 179-180, 196, 197, 201, 202, 211-215
competitive sports, 202, 258-259, 299
counseling, 223
dance classes, 257
defined, 97, 336
developmental correlates, 296-297
economic environment and, 100, 102
education programs, 141-142, 299
effectiveness of interventions, 256-258, 262-263
endurance training, 256-257
and energy balance, 92, 98-99, 102
environmental influences, 102, 105, 257
evaluation of programs and policies, 213, 260, 274-275, 364
extracurricular programs, 258-259
family-based interventions, 299-300
food intakes and, 91, 245
funding for programs, 44
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gender differences, 257-258, 296-297
home environment and, 14-15, 296-301
industry-sponsored efforts, 182
interactive effects of diet and, 92-93
interventions, 136-137, 141-142, 179-180, 182, 211-215, 223, 245
leisure time, 36, 105, 159-160
measurement of, 98-99, 205, 209
media campaigns, 179-180
outdoor play, 205, 222, 299, 300
parental role, 299
PE classes and recess, 35, 37, 125, 253-258, 259, 336
physical environment and, 125, 132, 196, 204-211, 299
promoting, 44, 141-142, 148, 161, 179-180, 200-201, 222, 299
psychosocial and behavioral correlates, 98-99, 297
public programs, 141-142
race/ethnicity and, 29-30, 205, 257
recommendations, 6, 259-261, 273
recommended levels, 29 n.3, 98, 253
reducing sedentary behaviors, 263-264, 301-305
research needs, 261, 300
safety issues, 205, 211, 299, 300
school-based interventions, 43, 245, 256-258, 299
social environment and, 297-299
socioeconomic status and, 105, 201, 205, 206, 298-299
surveillance, 29, 137, 140
transportation patterns and, 37-39, 71
trends, 29, 35-39, 160
TV viewing and, 301-305
types, 29
walking and biking, 37, 38-39, 92, 125, 141, 160, 211-215, 259, 300
Physical environment.
See also Built environment;
Food environment;
School food and beverages
and food intake, 100, 101
and physical activity, 100, 102
Physical fitness, 129, 137, 140, 141, 269-270, 334, 336
Planet Health, 137, 245, 246-247, 263, 264
Policy/political environment
agricultural policies, 144-146
food environment and, 100, 101, 144-146, 369
and implementation of interventions, 348
and physical activity, 100, 102, 214
public opinion and, 178-179
Portion sizes, 358, 369
age and, 165
of away-from-home foods 158
control, 165, 294-296
defined, 158 n.3
and eating behavior, 158, 291-292, 294-296
marketing strategy, 158-159, 366
quantifying dietary intakes, 98
regulation of, 362
trends, 27, 30
Potatoes, 28
Pregnancy
gestational diabetes, 65, 288
intrauterine environment, 65, 95, 288, 289
obesity during, 65, 288, 289
President’s Council on Physical Fitness and Sports, 141
Prevalence of childhood/adolescent obesity
adult obesity and, 22, 63-65
away-from-home foods and, 26, 331
BMI distribution, 61-62, 73
in ethnic groups, 1, 26-27, 58-61, 94, 105-106
food environment and, 356-357
high-risk population subgroups, 58-61, 72-73
overall burden, 1-2, 55-58
population genetics and, 94
regional differences, 61
socioeconomic status and, 60-61, 104-105
Prevention of childhood/adolescent obesity.
See also Action plan for prevention;
Intervention programs
annual report on, 130-131
behaviors targeted, 222
clinical screening and tracking, 221-224, 226
community health services, 221-225, 226, 348-349
congressional support, 131, 177
coordinating task force, 5-6, 130-131, 147
cost considerations, 100
current efforts, 125-126
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definitions, 81-83, 337
economic benefits of, 72
energy balance, 90-106
federal commitment to, 5, 129-131
food industry as target of, 370
global dimension, 371
government support and funding, 5-6, 128
guide to preventive services, 209, 348-349
individual-level approach, 86, 87, 107-108, 109, 110, 221-223
individual responsibility vs. collective action, 369
insurance coverage, 100, 224, 225-226
intermediate goals, 86-87
legislation and regulations, 360-361
lessons learned from other initiatives, 103, 109, 125, 128, 179-183, 344-352, 369-370
longitudinal studies, 140-141, 209
multifactorial approaches, 16, 46-47, 81-82, 83, 109, 125, 126, 128, 178, 179, 245-246, 249, 299, 322, 344, 349-352, 370
national priorities, 5-7, 127, 129-131, 147-148
population-level approach, 82, 86, 87, 88-90, 107-109, 125, 199-201
primary prevention approach, 82, 107, 115, 337
psychosocial considerations, 222
public health precedents for, 24, 44-47, 83, 107, 179-183, 321, 350-351
public-private partnerships, 141
social environment and, 320, 365-367
sociocultural considerations, 100, 103, 106, 109-110, 369
stakeholders, 16, 19, 127, 320, 321, 324
state and local priorities, 6, 131-134, 148
targeted to high-risk populations, 81, 142
treatment distinguished from, 81-82
Prevention research.
See also Evaluation of prevention interventions
best practices and effectiveness evaluations, 97-115, 344-345, 346, 370-371
causality and, 108-109
clinical practice approach, 107-108, 109, 110
community-based, 134, 344-345
components of, 112-113
cost-effectiveness analyses, 136-137
developing recommendations, 111-115
experimental behavioral, 134, 135-136
falsifiability, 108
federal investment in, 135, 177
framework, 136
generalizability, 107-108, 111, 260, 345, 346, 350, 364
incorporation into program planning and implementation, 136
interdisciplinary and interdepartmental collaborations, 130, 134, 135
literature on, 114, 339-342
phases, 108
population-based, 110, 134
predictability, 107
public health approach, 108-110
randomized controlled trials, 110, 111, 114
recommendations, 148
replicability, 107-108
review of evidence, 107-115
scientific uncertainty and, 109
social values and, 109-110
standard of evidence, 111, 114
Project MOVE (Measurement of the Value of Exercise), 136-137
Protein, dietary
consumption trends, 34
food supply trends, 34
Provider reminder systems, 46, 347, 348, 349
PsychINFO database, 339, 341
Psychosocial and behavioral considerations
depression and depressive symptoms, 66, 67, 69-70, 105
and dietary intake, 95-98, 105
in energy balance, 69-70, 95-99
health costs of obesity, 23, 65, 66-67, 69-70, 71, 73
and physical activity, 98-99
stigmatization of obesity, 2, 23, 103
Puberty, 297
Public education
areas of focus, 183-184
audience exposure, 180-181
barriers to success, 180-181
complementary components, 178
dietary interventions, 180, 345
evaluation and monitoring component, 178
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funding for, 184
media campaigns, 9-10, 43, 128, 177-185, 353
nutrition and physical activity programs, 141-142
of parents, 179, 183
recommendations, 9-10, 183-185
sensitivity in design of, 178
Public health.
See also Prevention of childhood/adolescent obesity
access and opportunity issues, 356-358
achievements of 20th century, 21, 44-46, 346-348
action plan for preventions, 108-110, 115, 127, 129
agricultural policies and, 144-146, 148
community preventive services, 7, 125, 200, 346, 347, 348-349
criteria for comparison of prior approaches, 368
economic factors, 347, 358-360
evidence-based approach, 108-110, 126
framework for interventions, 352-367
implications of obesity epidemic, 22-24
individual and clinical efforts, 348, 365
information environment, 353-356
leadership, coordination, and priority setting, 7, 129-134
legal environment, 349, 360-361
lessons learned, 125, 128, 179-183, 344-352, 369-370
litigation, 362-364
media campaigns, 179-183, 346, 347, 349, 364-365
multi-problem approaches, 126, 349-352
nutrition assistance programs, 142-144, 148
nutrition education programs, 141-142
oversight and enforcement role, 133-134
physical activity programs, 141-142
precedents for prevention, 21, 24, 44-47, 83, 125-126, 128, 179-183, 343-371
prevention and treatment programs, 107-109, 364-365
product labeling, 356
recommendations, 131, 134, 135, 137, 140, 141, 142, 144, 147-148
regulatory environment, 361-362
research and evaluation, 107-109, 134-137, 148
school-based interventions, 347, 348, 349, 364
social environment and, 126-127, 365-367
state and local agencies, 133-134, 148
surveillance and monitoring, 137-141, 148
taxes on food and beverages, 146-147
Public Health Foundation, 218
Public interest in obesity
and policy changes, 178-179, 365-367
raising, 306-308
trends, 40-43, 154
triggers for, 126-127
R
Racial and ethnic disparities.
See also Ethnic groups;
Sociocultural environment
in BMI, 58-60
in body size dissatisfaction, 103-104
in built environment, 205
community health interventions, 203
in energy balance, 105-106
in food access, 215-216
in physical activity opportunities, 205
in prevalence of obesity, 105-106
REACH 2010 initiative, 200
Recommendations
evidence-based approach to developing, 16, 111-115, 323
Recreation industry. See Leisure, entertainment, and recreation industries
Recreational facilities and programs, 202, 206, 211
Regional differences in prevalence of obesity, 61
Research priorities, 16-17, 88, 177, 322-325.
See also Prevention research
Restaurant industry.
See also Away-from-home foods;
Fast food
advertising, 172, 175-176
healthier food options, 162, 163-164
nutrition education, 164-166
nutrition labeling, 163-164, 165, 168, 197, 356
recommendations, 8, 165-166
sales, 162
self-regulation, 175-176
Reyes Syndrome campaigns, 179
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Risk, defined, 337
Risk analysis, defined, 337
Robert Wood Johnson Foundation, 206, 218
Role models
health professionals as, 223
parents as, 183, 195, 197, 273, 292, 298, 305-306
Roper Youth Report, 173
S
Safe Routes to School programs, 213, 214
Safety
in built environment, 205, 207-208, 211
defined, 337
Satiety, 157, 159, 289, 294, 295
School Breakfast Program, 142, 143, 237 n.1, 239-241, 258-259
School environment
after-school and extracurricular programs, 200, 258-259, 260, 272-274
behavioral nutrition curricula, 262-263
changes needed in, 248-250, 252-263, 264-265
Channel One News, 265, 266
classroom curricula, 253, 261-265
as community center, 272-274
competitive sports, 258-259
evaluation of programs and policies, 260, 274-275, 277-278
fitness screening and counseling, 269-272
health education, 14, 261-262
health services, 14, 269-272, 308, 349
interventions, 46, 114-115, 128, 137, 141, 197, 211-215, 244-247, 256-258, 349
location in community, 213-215
nutrition education programs, 141, 249-250, 273
PE classes, 125, 336, 253-258, 259, 260, 358
physical activity, 13, 14, 43, 211-215, 253-261, 262-263, 276-277, 358
prevention opportunities, 12-13, 237-238
rating, 218
recess, 255, 258
recommendations, 12-14, 114-115, 259-261, 264-265, 273, 276-278
reducing sedentary behaviors, 263-264
research needs, 261
tobacco prevention policies, 358
School food and beverages
access to, 44, 252, 358
advertising, 14, 176, 251, 265-269
bonus commodities, 145, 248, 250
cafeteria offerings, 238-239, 240
changes needed in, 248-250, 252-263
competitive foods, 13, 241-244, 250, 251-252, 332
dietary intervention studies, 240-241, 244-247, 252-253, 364
energy density of, 240, 243
energy intakes, 237
environmental interventions, 245-246
federal meal programs, 142, 143, 145, 237, 239-241, 250, 337, 358, 364
fresh fruits and vegetables, 217, 242, 243, 247-248, 251, 291
funding of meals, 250, 252, 277
garden programs, 217, 248
menu planning, 239-240
nutrition guidelines, 239
nutritional quality and standards, 13, 240, 241, 243, 245, 249, 251, 277
pilot programs, 242, 247-248, 251, 252, 274, 277
pricing strategies, 251-252
recommendations, 13-14, 114-115, 248-250, 252-253, 276-277
research needs, 252-253
restricting sales of, 241-242, 249, 250, 358, 359
revenue issues, 250-252, 358, 359
standards setting, 44, 125, 129-130, 131, 134
training of food service personnel, 249-250
vending machines, 44, 114-115, 239, 241, 242, 243, 250, 251-252, 266, 358, 359, 364
School Health Index, 274-275
School Health Policies and Programs Study (SHPPS), 137, 139, 242, 253, 254, 266, 269
School Meals Initiative for Healthy Children, 240
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School Nutrition Dietary Assessment Study, 240, 250
Section 402 State and Community Highway Safety Grant program, 132
Sedentary behavior
defined, 337
electronic media and, 40
energy expenditure patterns, 160
health care costs, 70
reducing, 263-264
Self-efficacy, 262
Self-esteem issues, 43
race/ethnicity and, 66
Self-help interventions, 126, 365
Serving size.
See also Portion size
defined, 158 n.3
infant feeding and, 290
package size and, 167, 168, 356
recommended, 165
Shaping America’s Youth, 44, 161
Sleep apnea, 67, 72
Small Steps campaign, 181
Smart Growth America, 210
Smart Growth Network, 210
Smart growth principles, 209, 210
Snacks and snacking
activities needed to burn calories in, 92
energy-dense foods, 28, 92
Social change models, 351-352
Social cognitive theory, 262, 264
Social marketing campaign, 182-183, 184
Social movement theory, 350-351, 360
Social norms and values, 8, 15-16, 84-85, 91-92, 100, 103, 106, 126, 286, 320, 321, 369
Sociocultural environment
body image, 66, 91-92, 100, 103-104
and energy balance, 84-85, 91-92, 100-106
and food intake, 100, 101, 106
and obesity, 64, 100
and physical activity, 100, 102
and prevention, 100, 103, 369, 371
prior reform movements, 45
stigmatization, 23, 43, 66, 100, 103
targeting interventions to, 198, 199-201, 203, 275
Socioeconomic status.
See also Low-income populations
and BMI, 60-61
and community interventions, 10, 203, 205
and energy balance, 104-105, 146-147
and healthy food access, 105, 106, 201
and intergenerational obesity, 65
and obesity prevalence, 10, 60-61, 104-105
and physical activity opportunities, 105, 201, 205, 207
racial/ethnic disparities, 60-61, 106, 201
Sociological Abstracts, 339, 341
Sodas and fruit drinks
bans on school sales, 242
and BMI, 293-294
consumption trends, 293, 358
diet beverages, 156
energy density and nutrient density, 170 n.7, 293
limiting consumption, 222, 242
marketing contracts with schools, 251, 266
taxes on, 44, 128, 146-147, 359
South Australian Daily Physical Activity Program, 256-257
South Carolina, 61
Special Supplemental Nutrition Program for Women, Infants and Children (WIC), 55, 65, 141, 142, 143-144, 216
Sports, Play and Active Recreation for Kids (SPARK), 247, 256
Stanford Adolescent Heart Health Program, 245, 247, 263
Stanford Dance for Health, 257
Stanford Five-City Project, 179-180, 196
Stanford SMART (Student Media Awareness to Reduce Television), 247, 263-264
Stanford Three Community Study, 179, 196
Steps to a Healthier U.S. Initiative, 132-133, 181, 204
Stereotyping, negative, 66
Stigmatization, 2, 23, 43, 66, 100, 103, 178, 222, 270
Stress response, 70
Stroke, 69
Sudden Infant Death Syndrome, 179
Summer Food Service Program, 142
Surveillance and monitoring.
See also individual surveys
adolescent health and behavior, 60, 61, 62, 138, 139, 209
body weight, 89, 137, 140
collaborations, 137-138
dietary intake, 97, 137, 138
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energy balance, 137
funding, 140
longitudinal studies, 140-141
needs, 140
nutrition and health, 29, 36, 54, 55-56, 60, 61, 63, 68, 89, 137, 138, 139
physical activity, 29, 137, 140
public health, 137-141
recommendations, 6, 140-141
school health policies and programs, 137, 139
time use, 60, 61, 62, 139, 159-160
transportation patterns, 38, 39, 138
Sweden, 44
Sweeteners. See Added caloric sweeteners
T
Task Force on Community Preventive Services, 299
Taxation and pricing interventions, 44, 128, 146-147, 178, 358-360
Team Nutrition, 141
Teasing, 100, 178
Television viewing
advertising, 8, 44, 172, 174, 265, 301, 302, 355
bedroom sets, 39, 302, 304
household sets, 39
interventions to reduce, 200, 222, 247, 263-264, 303-304
mealtime viewing, 222, 293, 302
and obesity prevalence, 177-178, 301-302, 303
position statements of medical professionals, 224, 304
recommended limits, 15, 304, 308
time management monitor, 264
time spent, 39-40, 41, 114, 160-161, 301-302
Texas, 61
Tobacco control analogies, 45, 103, 107, 126, 128, 133, 146, 154, 178, 197, 199, 223, 350-351, 352-356, 357, 360, 361, 362, 363, 364, 366, 368, 369-371
Toddlers and young children
food insecurity, 105
healthful eating behaviors, 290-292
predictors of energy intake, 158-159
Tort reform, 363-364
Transportation
and access to healthy foods, 216
patterns, 37-39, 205, 211-212
Transportation Alternatives, 214
Transportation Research Board, 205, 341
Treatment of obesity
prevention distinguished from, 81-82
research approach, 108
TRIS (Transportation Research Information Services) database, 339, 341
21st Century Community Learning Centers program, 273
Twin studies, 93, 94
2 Fruit ‘n’ 5 Veg Every Day, 180
U
United Kingdom, 44, 213, 214, 248
University of California Cooperative Extension, 201
U.S. Census Bureau, 105
U.S. Conference of Mayors, 132
U.S. Department of Agriculture, 268, 332
Agricultural Marketing Service, 145
Cooperative Extension Service, 141
dietary guidelines, 96-97, 131, 164-165, 332
dietary intake surveys, 137-138
Farm Service Agency, 145
Healthy Eating Index, 96-97
and industry, 153
nutrition programs, 129, 141-142, 144, 145, 238, 239, 240, 250, 252
obesity prevention role, 13, 129, 130, 131
research on nutrition, 135
U.S. Department of Defense, 130, 131
Fresh Produce Program, 145, 248
U.S. Department of Education, 130, 131, 268, 273, 341
U.S. Department of Health and Human Services, 253, 332
collaboration with CDC, 200
dietary guidelines, 96-97, 131, 164, 332
funding of community-based health efforts, 132-133, 208
guideline development for advertising and marketing, 9, 175-176, 177
health and nutrition survey, 29, 36, 54, 55-56, 60, 61, 63, 68, 89, 137-138, 139, 140, 148
OCR for page 414
Preventing Childhood Obesity: Health in the Balance
and industry, 153, 175-176
obesity prevention role, 129, 130, 131, 147, 204, 220-221
registry of research and intervention programs, 44
Small Steps campaign, 181, 184
U.S. Department of Housing and Urban Development, 130, 131
U.S. Department of Justice, 354
U.S. Department of the Interior, 130, 131
U.S. Department of Transportation, 130, 131, 208, 220-221
U.S. Preventive Services Task Force (USPSTF), 221
V
Vegetables. See Fruits and vegetables
VERB campaign, 141, 182-183, 184
Virginia, 207
W
Walking and biking opportunities
built environment and, 207, 208, 209, 210, 211-215
Walking School Bus program, 213
Washington, 206
Weight. See Body weight
Well-being, defined, 65, 337
West Virginia, 61, 250
White House Office of National Drug Control Policy, 182
Whites.
See also Racial and ethnic disparities
body image dissatisfaction, 66, 104
defined, 58 n.4
obesity prevalence, 143
World Health Organization, 290, 350, 367
Y
YMCA, 202
Youth Media Campaign Longitudinal Survey, 37
Youth Risk Behavior Surveillance System (YRBSS), 35, 137, 139, 209, 256, 258, 301
Z
Zuni Indian Tribal Organization, 247
