Local Government Actions to Prevent Childhood Obesity

Committee on Childhood Obesity Prevention Actions for Local Governments

Food and Nutrition Board

Board on Children, Youth, and Families

Board on Population Health and Public Health Practice

Transportation Research Board

Lynn Parker, Annina Catherine Burns, and Eduardo Sanchez, Editors

INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

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Local Government Actions to Prevent Childhood Obesity Committee on Childhood Obesity Prevention Actions for Local Governments Food and Nutrition Board Board on Children, Youth, and Families Board on Population Health and Public Health Practice Transportation Research Board Lynn Parker, Annina Catherine Burns, and Eduardo Sanchez, Editors

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THE NATIONAL ACADEMIES PRESS   500 Fifth Street, N.W.   Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Grant No. 61747 between the National Academy of Sciences and The Robert Wood Johnson Foundation and Contract No. 200-2005-13434, Task Order 13, between the National Academy of Sciences and the Centers for Disease Control and Prevention. Any opinions, findings, conclusions, or recommendations expressed in this pub- lication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Institute of Medicine (U.S.). Committee on Childhood Obesity Prevention Actions for Local Governments.   Local government actions to prevent childhood obesity / Committee on Childhood Obesity Prevention Actions for Local Governments, Food and Nutrition Board . . . [et al.] ; Lynn Parker, Annina Catherine Burns, and Eduardo Sanchez, editors.    p. ; cm.   Includes bibliographical references.   ISBN 978-0-309-13927-4 (pbk.) — ISBN 978-0-309-13928-1 (pdf)  1.  Obesity in children—United States.  I. Parker, Lynn. II. Burns, Annina Catherine. III. Sanchez, Eduardo (Eduardo J.) IV. Title.   [DNLM: 1.  Obesity—prevention & control—United States. 2.  Child—United States. 3.  Government Programs—United States. 4.  Health Promotion—organization & a ­ dministration—United States. 5.  Local Government—United States.  WD 210 I602L 2009]   RJ399.C6I573 2009   618.92′398—dc22 2009044336 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all ­cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine) and National Research Council. 2009. Local Government Actions to Prevent Childhood Obesity. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distin- guished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is au- tonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to se- cure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the fed- eral government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering commu- nities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON CHILDHOOD OBESITY PREVENTION ACTIONS FOR LOCAL GOVERNMENTS Eduardo J. Sanchez (Chair), Vice President and Chief Medical Officer, Blue Cross and Blue Shield of Texas, Richardson Peggy Beltrone, Commissioner, Cascade County Commission, Great Falls, MT Laura K. Brennan, President and CEO, Transtria, LLC, St. Louis, MO Joseph A. Curtatone, Mayor, City of Somerville, Somerville, MA Eric A. Finkelstein, RTI International, Research Triangle Park, NC Tracy Fox, President, Food, Nutrition, and Policy Consultants, Washington, DC Susan L. Handy, Professor in the Department of Environmental Science and Policy, University of California at Davis James Krieger, Chief of the Chronic Disease and Injury Prevention Section, Public Health–Seattle and King County, Seattle, WA Donald Diego Rose, Associate Professor, Community Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA Mary T. Story, Professor, Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis Adewale Troutman, Director, Louisville Metro Department of Public Health and Wellness, Louisville, KY Antronette K. (Toni) Yancey, Professor of Health Services, University of California at Los Angeles School of Public Health Paul Zykofsky, Director, Land Use/Transportation Programs, Local Government Commission, Sacramento, CA Study Staff Lynn Parker, Study Director Annina Catherine Burns, Program Officer Catharyn T. Liverman, Scholar Nicole Ferring, Research Associate Matthew B. Spear, Senior Program Assistant Anton L. Bandy, Financial Associate Geraldine Kennedo, Administrative Assistant Linda D. Meyers, Director, Food and Nutrition Board 

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Reviewers T his report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The p ­ urpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as pos- sible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Don Bishop, Minnesota Department of Health, St. Paul, MN Kelly Brownell, Rudd Center for Food Policy and Obesity, ����������������� Yale University, New Haven, CT Michael Caldwell, Health Officer, Dutchess County, NY Eve Higginbotham, Morehouse School of Medicine, Atlanta, GA Allison Karpyn, Director of Research and Evaluation, The Food Trust, Philadelphia, PA George Leventhal, Councilmember, Montgomery County Council, MD Malisa Mccreedy, Families, Parks and Recreation Department, City of Orlando, FL Miriam Nelson, Tufts University, Boston, MA Sarah Samuels, President, Samuels and Associates, Oakland, CA Will Wynn, Mayor, Austin, TX (Ret.) vii

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Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by HUGH TILSON, University of North Carolina, and JOHANNA DWYER, Tufts University Schools of Medicine and Nutrition. Appointed by the National Research Council and Institute of Medicine, they were responsible for making cer- tain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. viii Reviewers

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Preface T his report is the first in a series of publications dedicated to providing brief, succinct information on childhood obesity prevention specifically for policy makers. Funded by The Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention, the report focuses on one of the major recom- mendations in two previous Institute of Medicine (IOM) reports on obesity (Preventing Childhood Obesity: Health in the Balance and Progress in Preventing Childhood Obesity: How Do We Measure Up?) regarding the vital role of local governments in helping to prevent childhood obesity. When people look back 50 years from now, childhood obesity may well stand out as the most important public health issue of our time. The prevalence of childhood obesity has tripled in just three decades, contributing to the ever more frequent appearance in children and youth of what were once chronic diseases and conditions usually associated with adulthood—“adult-onset” diabetes, high blood pressure, and high cholesterol. There is no more sobering thought than the grow- ing consensus that the life expectancy of many of today’s children will be less than their parents’ because of the impact of early and continuing obesity on their health. The good news is that much can and is being done in all sectors of our society to reverse this dangerous trend and its sad and costly consequences. This report focuses on the food and physical activity environments in which children live, study, and play, and recommends local government actions that have the potential to improve these environments by making healthy eating and optimum physical activity possible and easy for all children. The report also highlights the value of understanding the local context in which decisions are made on child- ix

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hood obesity prevention efforts; the importance of paying particular attention to community conditions that result in unequal access to opportunities for healthy foods and physical activity, and therefore contribute to health disparities; and the need for evaluation of local childhood obesity prevention actions to learn more about what works. It is our hope that the report will find its way to local govern- ment officials and community members who can put what we have learned to good use in their efforts to improve the present and future health of their children and their communities. I want to express my sincere appreciation and thanks to the committee members for their deep commitment to our task and the countless volunteer hours they contributed to this study and the development of the report. I also want to thank our excellent and thought-provoking workshop speakers, Marice Ashe, Matthew Longjohn, and Gerardo Mouet, for the insight and perspectives they brought to bear regarding local government initiatives on childhood obesity prevention. In addition, many thanks to Rona Briere for her valuable copyedit- ing. Finally, I want to express my gratitude to the dedicated IOM staff who worked with the committee on this project: Lynn Parker, Study Director; Annina Burns, Program Officer; Nicole Ferring, Research Associate; Matthew Spear, Senior Program Assistant; Cathy Liverman, Scholar; and Linda Meyers, Food and Nutrition Board Director. I also wish to thank their IOM and National Research Council collaborators: Rosemary Chalk, Director of the Board on Children, Youth, and Families; Nancy Humphrey, Senior Program Officer in the Studies and Special Program Division of the Transportation Research Board; and Rose Marie Martinez, Director of the Board on Population Health and Public Health Practice. Eduardo Sanchez, Chair Committee on Childhood Obesity Prevention Actions for Local Governments  Preface

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Contents SUMMARY 1 1 INTRODUCTION 13 2 ACTING LOCALLY 25 3 Creating Equal Opportunities for Healthy Weight 45 4 ACTIONS FOR HEALTHY EATING 49 5 ACTIONS FOR INCREASING PHYSICAL ACTIVITY 71 APPENDIXES A Glossary 89 B Toolkits and Related Resources 95 C Methodology 99 D Assessing the Evidence for Childhood Obesity Prevention Action Steps 103 E Statement of Task 111 F Open Session 113 G Biographical Sketches 115 xi

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