Much remains to be learned about the role of race/ethnicity, socioeconomic status (SES), and regional disparities in childhood obesity to build an evidence base that will support the most effective strategies and promising practices. Progress in preventing childhood obesity should include an examination of efforts to define and address the contexts and mechanisms that lead to and perpetuate childhood obesity in environments with excessive risks. Several recommendations in the Health in the Balance report (IOM, 2005) emphasized the need for prominent government leadership and community collaboration to develop and promote programs and policies that will collectively encourage healthful eating patterns and physical activity behaviors, particularly for young populations at the highest risk for obesity and related chronic diseases.

Helping at-risk children and youth balance their energy intakes and their energy expenditures requires an understanding of the complex and interacting influences of the social, economic, and built environments and the adverse environmental conditions that low-income and racially/ethnically diverse populations encounter as they regularly attempt to obtain affordable foods, beverages, and meals that contribute to a healthful diet and find opportunities to engage in recreational play and physical activity (Day, 2006; Glanz et al., 2005; Goodman, 2003; Gordon-Larsen et al., 2006; IOM, 2005; Jetter and Cassady, 2005; Powell et al., 2004). A multifaceted approach to address obesity and related health considerations is relevant to children and youth overall but leads to different perspectives on the appropriate solutions for specific populations, depending on their historical and sociopolitical contexts and the timing and rate of relevant economic and lifestyle transitions (Kumanyika, 1994; Kumanyika and Golden, 1991).

Because the focus of this report is on evaluation, this chapter provides only a brief overview of the context for these issues. The reader is referred to the extensive body of research regarding the interactions among societal, cultural, genetic, and biobehavioral risk and protective factors and their implications for promoting population health (Dabelea et al., 2000; Gillman et al., 2003; Halfon and Hochstein, 2002; Halfon and Inkelas, 2003; IOM, 2001, 2003; Krieger, 1994; Krieger and Davey Smith, 2004; McEwen, 2001; NRC and IOM, 2000, 2004; Reilly et al., 2005; Rosenbloom, 2002). The chapter focuses on the key issues relevant to improving the implementation and evaluation of obesity prevention efforts involving high-risk and culturally diverse populations.

UNDERSTANDING SPECIFIC CONTEXTS

Many aspects of society have changed concomitantly with the rise in childhood obesity. A broader understanding of the potential interplay



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