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Progress in Preventing Childhood Obesity: How Do We Measure Up?
can lead to policy refinements, program improvements, community advocacy, and the strategic redirection of investments in human and financial resources.
Insights obtained during the committee’s three regional symposia suggest that there is a substantial gap between the opportunity for state and local agencies and organizations to implement obesity prevention activities and programs and their capacity to evaluate them (Figure 2-1). It was not surprising to find that at the community level, where the great majority of obesity prevention strategies are expected to be carried out, the capacity for conducting comprehensive program evaluations is limited. Research conducted in academic settings is the principal source of in-depth scientific evidence for specific intervention strategies. Existing public sector surveillance systems and special surveys serve as critical components for the ongoing monitoring and tracking of a wide range of childhood obesity-related indicators. Although more comprehensive evaluations are needed and surveillance systems need to be expanded or enhanced, especially for the monitoring of policy, system, and environmental changes, the gap between the opportunity for evaluations and the capacity to conduct evaluations at the local level appears to be a significant impediment to the identification and widespread adoption of effective childhood obesity prevention programs.
Three strategies might be helpful in addressing the opportunity-capacity evaluation gap. First, and most important, local program managers should be encouraged to conduct for every activity and program an evaluation that is of a reasonable scale and that is commensurate with the existing local resources. The evaluation should be sufficient to determine whether the program was implemented as intended and to what extent the expected changes actually occurred. For most programs for which strategies and desired outcomes are adequately described, careful assessment of how well those strategies are carried out (also called fidelity) and modest assessments of outcomes after the program is implemented compared with the situation at the baseline are sufficient. In these contexts, obtaining baseline measures at the outset of programs is critical. As noted above, every program deserves an evaluation but not every intervention program needs to or has the capacity to undertake a full-scale and comprehensive evaluation. Second, government and academic centers can increase the amount of guidance and technical assistance concerning intervention evaluations that they provide to local agencies (Chapter 4). Third, government and academic agencies and centers conducting comprehensive evaluations can more quickly identify activities and programs that deserve more