Moreover, a survey of 1,000 Americans found that 9 out of 10 consumers were unable to provide an accurate estimate of their recommended calorie intakes, three-quarters of obese consumers underestimated their weight, only one-third of consumers believe that the health information that they receive is consistent, and taste and cost remain more important drivers of choice than healthfulness (IFIC Foundation, 2006). Another survey of 2,200 adult consumers found that only 17 percent had ever visited the U.S. Department of Agriculture’s (USDA’s) MyPyramid website; only a quarter (24 percent) stated that they understood food labels; nearly three-quarters (72 percent) indicated that if food does not taste good, they will not eat it, despite its nutritional value; and one-half of the consumers surveyed did not know how much fat, carbohydrate, or salt to consume in a 2,000-calorie diet (Yankelovich, 2006).

Trend data show that the rate of participation in physical activity declines as American children get older. More than one-third of high school students (grades 9 to 12) do not regularly engage in physical activity, more than 11 percent of high school students get no moderate to vigorous physical activity, and 30 percent of states do not mandate physical education for elementary and middle school students (NASPE and AHA, 2006). Between 1981 and 1997, children’s free playtime decreased by 25 percent, attributed to the increased amount of time spent in structured activities. A desirable social norm to work toward, especially for preschoolers, is to promote unstructured outdoor play in their lives (Burdette and Whitaker, 2005). For older children and adolescents, a social norm to aspire to is the integration of physical activity or active living into their lives every day.

Social movements related to promoting public and environmental health (e.g., tobacco control, underage drinking, seatbelt use, recycling, and reducing litter) have historically resulted from actions in which the population is made aware of a problem, educated, and mobilized over years and decades to challenge power structures and societal norms to address social problems (Economos et al., 2001; Kersh and Morone, 2002). Meaningful social change often involves the tensions and interactions among three different cultures: a private-sector market culture, a public-sector bureaucratic culture, and a nonprofit relational culture (Gecan, 2002).

It will take time to change social norms that have become deeply embedded in American society. Parents often use electronic media, such as television to manage busy schedules; maintain peace in the household; and facilitate family routines with their children, such as relaxing, eating, and falling asleep (Rideout and Hamel, 2006). Media now have a more central role in socializing today’s children and youth than ever before (IOM, 2006).

The promotion of obesity prevention as a successful social change movement and evaluation of the extent of the changes in social norms are imminent challenges. A coherent approach is needed to assess the progress of this



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