For example, GAO has examined the availability of competitive foods in relation to the USDA-administered school meals programs, USDA’s nutrition education activities, and other related topics, such as commercial activities in schools and the use of schools as community centers (GAO, 2000a,b, 2003, 2004b, 2005b).

A 2005 congressionally requested GAO study focused on the collection of information on childhood obesity prevention program strategies and elements identified by experts as being “likely to contribute to success.” For that assessment, GAO surveyed 233 experts in academia, the private sector, and government at all levels and interviewed program officials. The GAO assessment, which has had limited application, found that no comprehensive national inventory of childhood obesity programs exists at present and that there is no general consensus about the outcome measures that should be used to determine the success of programs for childhood obesity prevention (GAO, 2005a) (Chapter 2).

Another mechanism for assessing federal agency accountability is the Office of Management and Budget’s (OMB’s) Program Assessment Rating Tool (PART), which is used to evaluate federal agency programs for each fiscal year. Many of these federal agencies either currently support or have the potential to initiate or support childhood obesity prevention efforts. PART involves a review of evidence pertaining to the program purpose and design, strategic planning, program management, and results. The results are weighted for each component of the assessment; and the final results are issued in the form of a report card, in which a grade is assigned using five rating categories: fully effective, moderately effective, adequate, results not demonstrated, and ineffective (OMB, 2006). OMB evaluated 234 programs in FY 2005 and FY 2006 and found that over half (50.5 percent) had not demonstrated results, mostly because of a “lack of performance measures and/or performance data.” OMB also noted that a majority of programs have measures that emphasize inputs rather than outcomes. Moreover, obesity prevention was absent from the evaluations of many programs in several federal agencies that have obesity prevention programs and that could be integrating evaluation activities into the existing programs, including USDA, and the U.S. Departments of Education, Interior, and Transportation (OMB, 2006).

A general lack of consensus and clarity exists about the types of outcome measures that should be used to determine the effectiveness of childhood obesity prevention policies or programs. Additionally, no evaluative component exists that can be used to examine the leadership activities, political commitment, funding, and capacity development efforts adopted by federal government agencies to address childhood obesity in the United States. There is a need for objective public health expertise to provide this evaluative component.

At the state level, several organizations use report card approaches that



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