providers, fostering coalitions and networks, changing institutional practices, and influencing policy (Cohen and Swift, 1999).

The prevention frameworks discussed lend themselves relatively easily to infectious diseases in which there are clear endpoints and progressions. But the frameworks can be more complex to apply to health outcomes (e.g., childhood obesity) in which the progression is a continuum and the condition is both a risk factor for other chronic diseases and a health outcome in itself. The committee concluded that the well-established concept of primary prevention was most amenable to its assigned task of developing a broad-based action plan that addresses the social, cultural, and environmental factors associated with childhood obesity.

A primary prevention approach emphasizes efforts that can help the majority of children who are at a healthy weight to maintain that status and not become obese. Within this approach, the committee developed the majority of its recommendations as “population-based” actions—directed to the entire population instead of high-risk individuals. However, the committee acknowledges that obesity prevention will need to combine population-based efforts with targeted approaches for high-risk individuals and subgroups. Consequently, the report also contains specific actions aimed at high-risk populations affected by obesity, such as children and adolescents in particular ethnic groups with higher than average obesity-prevalence rates and communities in which there are recognizable social and economic disparities. Subpopulations of children warranting special consideration also include children with disabilities or special health-care needs. The complex medical, psychological, physical, and psychosocial difficulties that these children encounter may well put them at elevated risk for low physical activity levels and unhealthful dietary behaviors.

The committee acknowledges that although population-based prevention approaches may be theoretically or conceptually the most useful approaches for addressing a society-wide problem, the practical challenge is in determining how best to implement these interventions to achieve broad outreach and maximal coverage. These issues will be discussed further in the sections on local communities and evaluation of interventions (see Chapters 4 and 6).

The committee was not charged with, nor did it develop, recommendations directed specifically at obesity treatment or reducing excess weight in children and youth. However, it is likely that many of the suggested actions will also benefit children and youth who are already obese, even if the interventions are insufficient to produce enough short-term weight loss for achieving normal weight status. For example, obese children can benefit from healthful choices in the school cafeteria.

Prevention of obesity, particularly among those at high risk, may seem very similar to treatment in that screening is involved and individualized

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