tives that may hinder progress toward childhood obesity prevention. Examples include school siting policies that locate schools far outside of walking distance from the neighborhoods that those schools serve; U.S. agricultural policies including marketing practices, nutrition standards, agricultural subsidies, and procurement policies for agricultural commodity programs that affect the types and quantities of foods and beverages available in schools, communities, and through federal food assistance programs; land use policies that do not encourage mixed use of residential and business space and that subsequently discourage walking to neighborhood stores or businesses; and school policies that shorten the length of time in the school day devoted to healthy school meals and physical activity.

This chapter provides an overview of the role of government at all levels in the response to the childhood obesity epidemic. It provides examples of the policies, programs, and activities undertaken by federal, state, and local governmental agencies to reverse the current obesity epidemic and prevent a future rise in childhood obesity rates. The chapter examines the approaches needed to effectively evaluate policies and interventions and explores the factors that constitute success for the governmental sector. The chapter also recommends next steps in assessing progress with regard to leadership; implementing and evaluating policies and interventions and developing evaluation capacity; enhancing surveillance, monitoring, and research efforts; and using and disseminating the evidence from evaluation results.

SETTING THE CONTEXT

The severity of the obesity epidemic in the United States was first observed and publicized with data from the Behavioral Risk Factor Surveillance System (BRFSS). BRFSS is a system that uses telephone interviews for health surveillance and is jointly managed by the 50 state health departments and the Centers for Disease Control and Prevention’s (CDC’s) National Center for Chronic Disease Prevention and Health Promotion. In 1991, BRFSS data showed that four states had adult obesity prevalence rates of 15 to 19 percent and that no states had rates of 20 percent or greater. By 2004, BRFSS showed that 7 states had adult obesity prevalence rates of 15 to19 percent, 33 states had adult obesity rates of 20 to 24 percent, and 9 states had adult obesity rates of 25 percent or greater (CDC, 2005a).

The National Health and Nutrition Examination Survey (NHANES), a CDC surveillance system that is based on personal interviews and a physical examination and that was initiated in 1971, also revealed a rapidly evolving obesity epidemic in children, adolescents, and adults (Flegal et al., 2002; Ogden et al., 2002, 2006; Troiano et al., 1995). CDC presented the emerging data to the U.S. Congress at a House Appropriations Hearing in



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