childhood obesity. These conclusions serve as the foundation for the report’s recommendations and the specific implementation actions discussed in the previous chapters.

The United States is still in an early phase of developing a coherent and comprehensive response to obesity as a national public health challenge. A mature understanding of the long-term investments and scope of an adequate response is needed. Many countries and regions around the world are similarly recognizing the extent of their own obesity and chronic disease challenges and are beginning to take constructive steps to formulate comprehensive strategies or action plans that promote health and that aim to prevent overweight and obesity in their populations. These strategies and plans often include evaluation components that can be used to assess their own progress (Table 9-1).

The World Health Organization estimates that obesity and related chronic diseases account for approximately 60 percent of the overall rate of mortality worldwide and 47 percent of the global burden of disease (WHO, 2002). Many middle-income countries around the world, including Brazil, China, Indonesia, Mexico, Russia, and Vietnam, are experiencing obesity epidemics that vary by socioeconomic groups (Doak et al., 2000, 2005; IOM, 2007; Wang et al., 2002). Countries with transitional economies often face the dual challenges of both malnutrition and overnutrition (Ezzati et al., 2005; Gillespie and Haddad, 2003; Hawkes, 2006; WHO, 2006a). Additionally, obesity and cardiovascular disease risks are expected to increase in low- and middle-income countries, which, along with the persistent burden of infectious diseases and malnutrition, may further exacerbate global health inequities (Ezzati et al., 2005).

A greater understanding is needed of the dietary and physical activity patterns that lead to the co-existence of obesity, under-nutrition, and micronutrient deficiencies in developing countries, as well as the environmental, economic, and social trends that influence them. Evidence-based guidance for the design, implementation, and evaluation of effective programs and policies that address this double burden is also needed (Doak et al., 2000, 2005; Hawkes, 2006). Effective and innovative practices to prevent childhood obesity and the lessons learned are beginning to be shared internationally; however, more can be accomplished with a coordinated global dissemination effort.

CHANGING SOCIAL NORMS

Healthful diets and regular physical activity are far from the accepted social norm, although there is a growing awareness by the public that obesity has health, economic, and social consequences. A Harvard School of Public Health poll of 2,033 adults nationwide found that an estimated



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