in which evidence of progress has been noted is the monitoring of state legislation. Currently, several organizations track this information and provide online reports including CDC’s Nutrition and Physical Activity Legislative Database (CDC, 2006e), the National Conference of State Legislatures summary of childhood obesity policy options (NCSL, 2006), the Trust for America’s Health annual report of federal and state policies and legislation (TFAH, 2004, 2005), and NetScan’s Health Policy Tracking Services for state legislation related to school nutrition and physical activity (NetScan, 2005). Enhanced coordination of these state legislative tracking efforts is needed.

A second area of general surveillance deficiency is in the surveillance of certain age or population groups, for which gaps certain gaps exist. This is particularly problematic for heterogeneous ethnic groups, for example, Asian Americans/Pacific Islanders. Pacific Islanders’ obesity rates more closely mirror those of Latinos than those of Asian Americans, and in many Asian subgroups, obesity-related comorbidities are associated with BMIs lower than those for other populations (even BMIs considered nonoverweight or obese). As another example, state-specific information about elementary school-aged children and children ages 1 to 5 years who do not participate in the WIC program are not available.

Finally, few local surveillance systems have been established. Although community-level agencies and other sources are sampled and these data comprise the data used to make national and state estimates, the information from any given local area is generally insufficient in size or frequency to be used for surveillance for the local area itself. With the exception of data systems that collect data on every event (e.g., death and hospitalization data), the sample size limitations of any given surveillance system preclude the collection of sufficient data to monitor all localities. As a result, communities and local agencies should consider developing systems of their own, such as the Los Angeles County Health Survey or the SHAPE in Hennepin County, Minnesota (SHAPE, 2006). Local surveillance can often be jointly funded to leverage state and federal funds and to build on shared interests. Such an effort could consist of a collaboration between the local department of public works and the local health department to collect data on bicycling and walking.


What Constitutes Progress for Government?

The success of government efforts to prevent childhood obesity—and for all other sectors—will be determined by the reversal of the rise in the obesity and at-risk obesity prevalence for children and youth and a reduc-

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