E
Compilation of Recommendations and Implementation Actions

Recommendation 1: Government, industry, communities, schools, and families should demonstrate leadership and commitment by mobilizing the resources required to identify, implement, evaluate, and disseminate effective policies and interventions that support childhood obesity prevention goals.


Implementation Actions for Government

Federal, state, and local governments should each establish a high-level task force to identify priorities for action, coordinate public-sector efforts, and establish effective interdepartmental collaborations.


To accomplish this,

  • The president of the United States should request that the secretary of the U.S. Department of Health and Human Services convene a high-level task force involving the secretaries or senior officials from all relevant federal government departments and agencies (e.g., the U.S. Departments of Agriculture, Education, Defense, Interior, and Transportation; the Federal Communications Commission; and the Federal Trade Commission) to coordinate departmental budgets, policies, and research efforts and establish effective interdepartmental collaboration and priorities for action.

  • State governments should convene high-level task forces involving the state departments of health, education, agriculture;



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Progress in Preventing Childhood Obesity: How Do We Measure Up? E Compilation of Recommendations and Implementation Actions Recommendation 1: Government, industry, communities, schools, and families should demonstrate leadership and commitment by mobilizing the resources required to identify, implement, evaluate, and disseminate effective policies and interventions that support childhood obesity prevention goals. Implementation Actions for Government Federal, state, and local governments should each establish a high-level task force to identify priorities for action, coordinate public-sector efforts, and establish effective interdepartmental collaborations. To accomplish this, The president of the United States should request that the secretary of the U.S. Department of Health and Human Services convene a high-level task force involving the secretaries or senior officials from all relevant federal government departments and agencies (e.g., the U.S. Departments of Agriculture, Education, Defense, Interior, and Transportation; the Federal Communications Commission; and the Federal Trade Commission) to coordinate departmental budgets, policies, and research efforts and establish effective interdepartmental collaboration and priorities for action. State governments should convene high-level task forces involving the state departments of health, education, agriculture;

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Progress in Preventing Childhood Obesity: How Do We Measure Up? the land-grant cooperative extension services, and other relevant agencies. Childhood obesity prevention should be a priority that is reflected in each state government’s public statements, policies and programs, budgets, research efforts, and interagency collaborations. Local government agencies should convene community- or regional-level task forces to provide coordinated leadership in preventing childhood obesity by increasing resources, collaborating with community stakeholders, and developing or strengthening policies and programs that promote opportunities for physical activity and healthful eating in communities and neighborhoods. Implementation Actions for Industry Industry should use the full range of available resources and tools to create, support, and sustain consumer demand for products and opportunities that support healthy lifestyles including healthful diets and regular physical activity. To accomplish this, Industry should continue to support and market product innovations and reformulations that promote energy balance at a healthy weight for children and youth and that are compatible with obesity prevention goals. Industry should support the review of the existing self-regulatory guidelines for advertising directed to children. It should also expand the guidelines to advertising vehicles beyond those used in traditional advertising to include evolving vehicles and venues for marketing communication and apply and enforce the guidelines for the traditional and expanded vehicles. Companies should consider developing their own advertising and marketing guidelines for children that are consistent with the industry-wide guidelines. Implementation Actions for Communities Community stakeholders should establish and strengthen the local policies, coalitions, and collaborations needed to create and sustain healthy communities. To accomplish this, Communities should make childhood obesity prevention a priority through the coordinated leadership of local government, community organizations, local businesses, health care organizations, and other relevant stakeholders. These efforts would

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Progress in Preventing Childhood Obesity: How Do We Measure Up? involve increased resources, an emphasis on collaboration among community stakeholders, and the development and implementation of policies and programs that promote opportunities for physical activity and healthful eating, particularly for high-risk communities. Implementation Actions for Schools School boards, administrators, and staff should elevate the priority that is placed on creating and sustaining a healthy school environment and advance school policies and programs that support this priority. To accomplish this, Relevant federal and state agencies and departments, local school districts, individual schools and preschools, and childcare and after-school programs should prioritize opportunities for physical activity and expand the availability and access in schools to fruits, vegetables, and other low-calorie and high-nutrient foods and beverages that contribute to healthful diets. Increased resources are needed to develop, implement, and evaluate policies and programs. State and local school-based nutrition and physical activity standards need to be implemented, and the relevant educational entities should be held accountable for promoting and adhering to these standards. Implementation Actions for Home Families, parents, and caregivers should commit to promoting healthful eating and regular physical activity to create a healthy home environment. To accomplish this, Parents and caregivers should make physical activity and healthful eating priorities at home. They should provide food and beverage choices for their children that contribute to a healthful diet, encourage and support physical activity, limit children’s television viewing and other leisure screen time, and serve as positive role models. Parents can also serve as advocates to promote changes that encourage and support healthy behaviors in their local schools and communities. Recommendation 2: Policy makers, program planners, program implementers, and other interested stakeholders—within and across relevant sectors—should evaluate all childhood obesity prevention efforts, strengthen

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Progress in Preventing Childhood Obesity: How Do We Measure Up? the evaluation capacity, and develop quality interventions that take into account diverse perspectives, that use culturally relevant approaches, and that meet the needs of diverse populations and contexts. Implementation Actions for Government Federal and state government departments and agencies should consistently evaluate the effects of all actions taken to prevent childhood obesity and strengthen the evaluation capacity, paying particular attention to culturally relevant evaluation approaches. To accomplish this, The actions of federal agencies, including policies that have been implemented, should be consistently evaluated to determine whether these actions and policies provide evidence of leadership and to identify the promising actions that are likely to be the most effective in preventing childhood obesity. The U.S. Congress should increase federal support for capacity-building activities, such as the Centers for Disease Control and Prevention’s State-Based Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases and Steps to a HealthierUS Program. Federal and state agencies should assess and strengthen the capacities of state and territorial health departments to provide leadership and technical assistance, enhance surveillance efforts, and implement and evaluate programs to prevent childhood obesity. DHHS, other federal agencies, and private-sector partners should work toward evaluating existing media efforts (including SmallStep and SmallStep Kids!) with the goal of developing, coordinating, and evaluating a more comprehensive, long-term, national multimedia and public relations campaign focused on obesity prevention in children and youth. Implementation Actions for Industry Industry should partner with government, academic institutions, and other interested stakeholders to undertake evaluations to assess its progress in preventing childhood obesity and promoting healthy lifestyles. To accomplish this, Industry should evaluate its progress in developing and promoting affordable foods, beverages, and meals that support a healthful diet; physical activity products and opportunities;

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Progress in Preventing Childhood Obesity: How Do We Measure Up? storylines and programming that promote healthy lifestyles; and advertising and marketing practices directed to children and youth. Industry should provide resources and expertise to local businesses and community-based organizations to implement and evaluate initiatives that provide opportunities for consumers to engage in healthful eating and regular physical activity, especially for children and youth in racially and ethnically diverse groups and high-risk populations. Implementation Actions for Communities Community stakeholders should strengthen evaluation efforts at the local level by partnering with government agencies, foundations, and academic institutions to develop, implement, and support evaluation opportunities and community-academic partnerships. To accomplish this, Federal and state agencies, foundations, academic institutions, community-based nonprofit organizations, faith-based groups, youth-related organizations, local governments, and other relevant community stakeholders should Increase funding and technical assistance to conduct evaluations of childhood obesity prevention policies and interventions, Develop and widely disseminate effective evaluation training opportunities, and Develop and support community-academic partnerships. Implementation Actions for Schools Schools and school districts should strengthen evaluation efforts by partnering with state and federal agencies, foundations, and academic institutions to develop, implement, and support evaluations of all relevant school-based programs. To accomplish this, Federal agencies (e.g., the Centers for Disease Control and Preventions, the U.S. Department of Agriculture, and the U.S. Department of Education), state departments of education and health, foundations, academic institutions, school districts, and local schools should Increase the resources devoted to technical assistance for evaluating school-based childhood obesity prevention policies, programs, and interventions and

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Develop partnerships to fund, develop, and implement childhood obesity prevention evaluations. Implementation Actions for Home Parents and caregivers, as the policy makers in the household, should assess their family’s progress in achieving positive lifestyle changes. To accomplish this, Families should regularly assess their progress in adopting and maintaining healthy behaviors at home and achieving positive lifestyle changes. Recommendation 3: Government, industry, communities, and schools should expand or develop relevant surveillance and monitoring systems and, as applicable, should engage in research to examine the impact of childhood obesity prevention policies, interventions, and actions on relevant outcomes, paying particular attention to the unique needs of diverse groups and high-risk populations. Additionally, parents and caregivers should monitor changes in their family’s food, beverage, and physical activity choices and their progress toward healthier lifestyles. Implementation Actions for Government Government at all levels should develop new surveillance systems or enhance existing surveillance systems to monitor relevant outcomes and trends and should increase funding for obesity prevention research. In order to accomplish this, Federal and state government surveillance systems should monitor the full range of outcomes in the evaluation framework. Surveillance systems—such as the National Health and Nutrition Examination Survey, the School Health Policies and Programs Study, the Youth Media Campaign Longitudinal Survey, the Youth Risk Behavior Surveillance System, and the National Household Transportation Survey—should be expanded to include relevant obesity-related outcomes. Surveillance systems that monitor the precursors of dietary and physical activity behaviors, including policies that have been implemented and structural, institutional, and environmental outcomes should be expanded or developed. All states should have a mechanism in place to monitor childhood obesity prevalence, dietary factors, physical activity lev-

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Progress in Preventing Childhood Obesity: How Do We Measure Up? els, and sedentary behaviors through population-based sampling over time. The U.S. Congress should appropriate sufficient funds to support research on obesity prevention (e.g., efficacy, effectiveness, quasiexperimental, cost-effectiveness, sustainability, and scaling up research) to improve program implementation and outcomes for children and youth. Implementation Actions for Industry The U.S. Congress, in consultation with industry and other relevant stakeholders, should appropriate adequate funds to support independent and periodic evaluations of industry’s efforts to promote healthier lifestyles. To accomplish this, The Food and Drug Administration should be given the authority to evaluate full serve and quick serve restaurants’ expansion of healthier food, beverage, and meal options; the effectiveness of the restaurant sector in providing nutrition labeling and nutrition information at the point of choice; and the effect of this information on consumers’ purchasing behaviors. The Centers for Disease Control and Prevention should evaluate the effectiveness of corporate-sponsored physical activity programs, energy-balance education programs, and the use of branded physical activity equipment (e.g., physical videogames) on children’s leisure-time preferences and physical activity behaviors. The U.S. Congress should designate a responsible agency to conduct the periodic monitoring and evaluation of the self-regulatory guidelines of the Children’s Advertising Review Unit (CARU), which should include an assessment of CARU’s effectiveness, impact, and enforcement capacity. The food retail sector, the restaurant sector, and relevant trade associations should collaborate with the U.S. Department of Agriculture and the U.S. Department of Health and Human Services to provide marketing data on pricing strategies, consumer food purchases, and consumption trends from proprietary retail scanner systems, household scanner panels, household consumption surveys, and marketing research. The collaborative work should examine the quality of the data, consider reducing the cost to make the data more accessible, and establish priorities for applying the information to promote healthful diets.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Industry should demonstrate corporate responsibility by sharing marketing research findings that may help public health professionals and community-based organizations develop and implement more effective childhood obesity prevention messages, policies, and programs. Implementation Actions for Communities Community stakeholders and relevant partners should expand the capacity for local-level surveillance and applied research and should develop tools for community self-assessment to support childhood obesity prevention efforts. To accomplish this, Federal and state agencies, foundations, academic institutions, community-based nonprofit organizations, faith-based groups, youth-related organizations, local governments, and other relevant community stakeholders should Expand the surveillance of outcomes of community-level activities and changes to the built environment as they relate to childhood obesity prevention; Facilitate the collection, analysis, and interpretation of local data and information; Develop, refine, and disseminate community assessment tools, such as a community health index; Develop methods for the rapid evaluation of natural experiments; Explore the use of spatial mapping technologies to assist communities with their assessment needs and to help communities make changes that increase access to opportunities for healthy lifestyles; and Encourage the evaluation of interventions to examine both the risk and protective factors related to obesity. Implementation Actions for Schools Schools and school districts should conduct self-assessments to enhance and sustain a healthy school environment, and mechanisms for examining links between changes in the school environment and behavioral and health outcomes should be explored. To accomplish this, Relevant federal agencies (e.g., the Centers for Disease Control and Prevention, the National Institutes of Health, the U.S. Department of Agriculture, and the U.S. Department of Education),

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Progress in Preventing Childhood Obesity: How Do We Measure Up? state education departments, school districts, and local schools should Expand and fully use current surveillance systems related to children’s dietary and physical activities, obesity-related health indicators, and relevant school policies and programs; Implement a national survey focused on the physical activity behaviors of all children and youth; Support research on means to improve the monitoring of diet and physical activity; Establish mechanisms to link health, educational, economic, and sociological data sources across a variety of areas related to childhood obesity prevention; and Expand and adapt self-assessment tools for schools, preschools, child-care, and after-school programs and evaluate their validity for predicting changes in children’s levels of physical activity, dietary intakes, and weight. Implementation Actions for Home Parents and caregivers should monitor their families’ lifestyle changes; and government, foundations, and industry should support applied research that examines family interventions in real-world settings. To accomplish this, Parents and caregivers should monitor their families’ lifestyle changes on an ongoing basis, including their capabilities as role models, the family’s dietary intake and levels of physical activity, and their children’s weight status. Parents should work with their child’s physician to track body mass indices and healthy growth. The federal government should create and make available simple tools for parents and families to track their children’s dietary intake and physical activity behaviors. Relevant federal agencies (e.g., the Centers for Disease Control and Prevention, the National Institutes of Health, the U.S. Department of Agriculture, and the U.S. Department of Education), foundations, and other organizations should fund and support applied research that examines family interventions focused on specific ways that families can improve diets, reduce sedentary behaviors, and increase the levels of physical activity in the home setting. Relevant federal and state agencies, foundations, and academic institutions should develop and enhance surveillance systems

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Progress in Preventing Childhood Obesity: How Do We Measure Up? and other data sources and assessment tools to expand knowledge about the relationship between changes in the home environment and a variety of outcomes for children and youth. Recommendation 4: Government, industry, communities, schools, and families should foster information-sharing activities and disseminate evaluation and research findings through diverse communication channels and media to actively promote the use and scaling up of effective childhood obesity prevention policies and interventions. Implementation Actions for Government Government at all levels should commit to the long-term support and dissemination of childhood obesity prevention policies and interventions that have been proven to be effective. To accomplish this, Federal, state, and local governments should publicly disseminate and promote the results of evaluations of childhood obesity prevention policies and interventions. The federal government should provide a sustained commitment and long-term investment to adequately support and disseminate childhood obesity prevention interventions that are proven to be effective—such as the VERB™ campaign. Further, the federal government should provide sustained support for surveillance systems that are vital to the monitoring of trends and progress in response to the childhood obesity epidemic. Incentives and rewards should be developed for state and local government agencies to coordinate efforts that improve obesity-related outcomes for children and youth. Implementation Actions for Industry Industry should collaborate with the public sector and other relevant stakeholders to develop a mechanism for sharing proprietary data and a sustainable funding strategy that can inform and support childhood obesity prevention interventions. To accomplish this, The private sector (e.g., industry and foundations) and the public sector (e.g., government and nonprofit organizations) should partner to develop a mechanism for sharing proprietary data (e.g., product sales information, marketing research data, and the results of evaluations of industry-supported programs)

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Progress in Preventing Childhood Obesity: How Do We Measure Up? that can inform research efforts and assist in developing a healthy lifestyles social marketing campaign. A long-term funding strategy should be established to sustain the campaign. Such a strategy should include a dedicated government appropriation and a dedicated set-aside from relevant industries. Government and other interested stakeholders should develop incentives and rewards for industry stakeholders that collaborate on this endeavor. Implementation Actions for Communities Community stakeholders should partner with foundations, government agencies, faith-based organizations, and youth-related organizations to publish and widely disseminate the evaluation results of community-based childhood obesity prevention efforts. To accomplish this, Community stakeholders should publish evaluation results using diverse communication channels and media; and develop incentives to encourage the use of promising practices. Implementation Actions for Schools Schools should partner with government, professional associations, academic institutions, parent-teacher organizations, foundations, communities, and the media to publish and widely disseminate the evaluation results of school-based childhood obesity prevention efforts and related materials and methods. To accomplish this, Schools, preschools, child-care and after-school programs, and relevant stakeholders should broadly disseminate the evaluation results using diverse communication channels and media and develop incentives to encourage the use of promising practices. Implementation Actions for Home Government (federal, state, and local), communities, families, and the media should disseminate and widely promote the evaluation results of effective family- and home-based childhood obesity prevention efforts. To accomplish this, Government agencies (federal, state, and local), communities, and the media should promote the results of evaluations and

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Progress in Preventing Childhood Obesity: How Do We Measure Up? specific practical guidance related to promising family-based obesity prevention interventions such as approaches for reducing children’s television viewing, promoting leisure-time physical activity, and promoting healthier food and beverage choices at home. Parents, children, and youth should share information about promising obesity-prevention strategies and activities with other families through parenting groups and school meetings and in family, social, faith-based, and other venues.