tion in their obesity-related morbidities. Although the desire is to reverse this trend as quickly as possible, the achievement of long-term success to prevent childhood obesity may take several years or decades (as it did for tobacco-control efforts) and will require the sustained and coordinated implementation of a comprehensive and integrated spectrum of strategies and actions to produce the necessary changes in a variety of outcomes including structural, institutional, systemic, environmental, behavioral, and health outcomes. For the government sector, the achievement of short- and intermediate-term success will require evidence of leadership, strategic planning, political commitment, adequate funding, and capacity development, and a wide range of new, revised, or expanded policies, programs, surveillance and monitoring systems, partnerships and collaborations, and communications activities.

For the federal government, leadership and political commitment are essential and are made tangible by the provision of increased resources to support surveillance and monitoring, innovative interventions, and program evaluation. Support for goal setting, research, and surveillance by the federal government is particularly important. Federal research efforts should emphasize intervention research, that is, scientific assessments of the values of policies, environments, programs, and other activities that are implemented to improve dietary and physical activity behaviors. Surveillance systems need to be expanded not only to include behavioral and health outcomes, but also to monitor levels of funding, research, public health capacity, programmatic activities, policy development and implementation, and structural, institutional, and systemic outcomes.

Current Approaches to Assess Government Progress in Childhood Obesity Prevention

Evaluation is a priority for many federally and state-funded programs, which are generally required to conduct an evaluation and report on its results. Evaluation of government policies is more difficult.

Federal agencies and departments are held accountable and are evaluated in several ways, although the level of specificity often does not allow a specific set of initiatives, such as childhood obesity prevention programs, to be the focus of the evaluation. Each agency or department submits an annual report summarizing how budgets are spent and the status of programs; these reports usually need to cover a broad array of information and provide an overview of the entire agency, with few specifics on individual issues provided (CDC, 2005c; DHHS, 2005a; FTC, 2005; USDA, 2005a). Additionally, the U.S. Government Accountability Office (GAO) frequently conducts evaluations of federal programs at the request of Congress, some of which are relevant to childhood obesity prevention (GAO, 2004c, 2005a).



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