COMMUNITY PERSPECTIVES ON OBESITY PREVENTION IN CHILDREN

Workshop Summaries

Paula Tarnapol Whitacre, Annina Catherine Burns, Cathy Liverman, and Lynn Parker, Rapporteurs

Food and Nutrition Board

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page R1
COMMUNITY PERSPECTIVES ON OB ESIT Y P R EVENTION I N CH I LDR EN Workshop Summaries Paula Tarnapol Whitacre, Annina Catherine Burns, Cathy Liverman, and Lynn Parker, Rapporteurs Food and Nutrition Board

OCR for page R1
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 Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate balance. This study was supported by Contract No. OPVT-8390 between the National Acad- emy of Sciences and The California Endowment. Any opinions, findings, conclu- sions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-14081-2 International Standard Book Number-10: 0-309-14081-1 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). 2009. Community Perspectives on Obesity Prevention in Children: Workshop Summaries. Washington, DC: The National Academies Press.

OCR for page R1
“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

OCR for page R1
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished 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 Acad- emy 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 autonomous 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 engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal 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 Sci- ences 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 communities. 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

OCR for page R1
PLANNINg COMMITTEE FOR COMMuNITy PERSPECTIvES ON ObESITy PREvENTION* PATRICIA CRAWFORD (Chair), School of Public Health and Department of Nutritional Sciences and Toxicology, University of California, Berkeley SARAH SAMuELS, Samuels and Associates, Oakland, California MARy T. STORy, Department of Pediatrics, School of Medicine at the University of Minnesota Study Staff ANNINA CATHERINE buRNS, Study Director LyNN PARKER, Scholar NICOLE FERRINg, Research Associate MATTHEW b. SPEAR, Senior Program Assistant PAuLA TARNAPOL WHITACRE, Consultant Science Writer CATHy LIvERMAN, Scholar ANTON L. bANDy, Financial Associate gERALDINE KENNEDO, Administrative Assistant LINDA D. MEyERS, Director, Food and Nutrition Board * Institute of Medicine (IOM) planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

OCR for page R1

OCR for page R1
Reviewers JuNE 2008 WORKSHOP SuMMARy This 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 purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible 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 process. We wish to thank the following individuals for their review of this report: TRACy A. FOx, Food, Nutrition & Policy Consultants, LLC, Washington, DC ESMERALDA gONzALEz, Stanislaus County Health Services Agency, Modesto, California gAIL g. HARRISON, University of California, Los Angeles Center for Health Policy Research SARAH SAMuELS, Samuels & Associates, Oakland, California Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by CATHERINE ROSS, Department of Nutritional Sciences, The Pennsylvania vii

OCR for page R1
viii REVIEWERS State University. Appointed by the Institute of Medicine, she was respon- sible for making certain 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 authors and the institution.

OCR for page R1
Reviewers MAy 2009 WORKSHOP SuMMARy This 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 purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible 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 process. We wish to thank the following individuals for their review of this report: LEANN L. bIRCH, Center for Childhood Obesity Research, Pennsylvania State University, State College, Pennsylvania TRACy A. FOx, Food, Nutrition & Policy Consultants, LLC, Washington, DC LESLIE MIKKELSEN, Prevention Institute, Oakland, California EDuARDO J. SANCHEz, Blue Cross and Blue Shield of Texas, Richardson, Texas Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by HugH TILSON, School of Public Health, University of North Carolina. Appointed ix

OCR for page R1
x REVIEWERS by the Institute of Medicine, he was responsible for making certain 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 authors and the institution.

OCR for page R1
Preface Obesity among the nation’s children has increased dramatically over the past several decades. Recent statistics show that nearly one-third of U.S. children and adolescents are overweight or obese, which puts their physical and emotional health at risk, severely compromises their future well-being, and adds significant costs to the country’s already massive health care expenditures. As the public health threat of childhood obesity has become clear, the issue has become the focus of local, state, and national initiatives. Many of these efforts are centered on the community environment in recog- nition of the role of environmental factors in individual behaviors related to food and physical activity. These efforts have shown that the seemingly simple formula for pre- venting obesity of consuming fewer calories than expended must take into account the social, environmental, and policy-related factors that affect eating and physical activity. Otherwise, success is almost impossible to sustain over the long term. In many communities, for example, fresh pro- duce is not available or affordable, streets and parks are not amenable to exercise, and policies and economic choices make fast food cheaper and more convenient than healthier alternatives. Addressing such factors can have an impact on obesity rates across communities by creating conditions that facilitate healthier options for children and their families. In the past few years, recognizing the consequences of inaction, a growing number of nonprofit organizations, government agencies, policy makers, and others have stepped up their efforts to combat the obesity epidemic. Carried out in diverse settings and with diverse populations, these efforts have resulted in xi

OCR for page R1
xii PREFACE many promising approaches that encompass the community context rather than focusing solely on individual weight-loss programs. These community efforts vary in scope and scale; overall, however, they remain fragmented, and little is known about their effectiveness. At the local level, communities are struggling to determine which obesity prevention programs to initiate and how to evaluate their impact. Recom- mendations presented in recent Institute of Medicine (IOM) reports on prevention of childhood obesity1,2 include actions that can be taken by mul- tiple stakeholders and all sectors to improve children’s nutrition, increase their physical activity, and decrease their sedentary time. According to the 2005 IOM report Preventing Childhood Obesity: Health in the Balance: Given that obesity is a serious health risk, preventive actions should be taken even if there is as-yet-incomplete scientific evidence on the interven- tions to address specific causes and correlates of obesity. However, there is an obligation to accumulate appropriate evidence not only to justify a course of action but to assess whether it has made a difference. As child- hood obesity is a serious public health problem calling for immediate reductions in obesity prevalence and in its health and social consequences, the committee strongly believes that actions should be based on the best available evidence—as opposed to waiting for the best possible evidence. (p. 3) In this context, the IOM’s Food and Nutrition Board held two workshops—in June 2008 and May 2009—funded by The California Endowment. The purpose of the workshops was to inform the IOM’s cur- rent work on obesity prevention in children through input from individuals who are actively engaged in community- and policy-based obesity preven- tion programs. Community perspectives were elicited on the challenges involved in undertaking policy and programmatic interventions aimed at preventing childhood obesity, and on approaches to program implementa- tion and evaluation that have shown promise. Highlights of the workshop presentations and discussions are presented in this volume. 1 IOM (Institute of Medicine). 2005. Preventing Childhood Obesity: Health in the Balance. Washington, DC: The National Academies Press. 2 IOM. 2007. Progress in Preventing Childhood Obesity: How Do We Measure Up? Wash- ington, DC: The National Academies Press.

OCR for page R1
Contents SuMMARy OF WORKSHOP 1: JuNE 2008 1 INTRODuCTION 3 2 PERSPECTIvES OF EvALuATORS 5 Address the Need for Common Measures, 5 Sustain Long-Term Commitments by Foundations and Policy Makers, 7 Identify or Develop Relevant Research Models, 7 Ease the Burden That Is Often Imposed by Evaluation, 7 Develop Solutions to the Data Burden Associated with Multifactorial Obesity Prevention Measurements, 8 Improve Opportunities for Publishing and Disseminating Evaluation Results, 8 3 PERSPECTIvES OF SITE LEADERS 11 Improve Coordination and Communication Among the Various Stakeholders, 11 Lengthen Evaluation Periods, 12 Enhance Evaluation Methods to Capture Progress as Well as Long-Term Outcomes, 12 Develop Local Data and an Accessible Database, 13 REFERENCES 15 xiii

OCR for page R1
xiv CONTENTS SuMMARy OF WORKSHOP 2: MAy 2009 SuMMARy 19 4 INTRODuCTION 25 Workshop Themes, 25 Community Voices and Evidence, 27 Report Organization, 28 5 COMMuNITy-bASED PROgRAMS: HOW DOES INFORMATION HELP THEM ACHIEvE THEIR gOALS? 29 Providing Opportunities for Recreation in Densely Populated Santa Ana, California, 31 Developing a Citywide Blueprint for Health in Baltimore, 34 Collaborating on a Regional Level in Central California, 38 Focusing on an Underserved Ward in Washington, DC, 40 Discussion, 44 6 RESEARCH AND ADvOCACy gROuPS: HOW DOES EvIDENCE INFORM POLICy? 47 Understanding Challenges to Advocacy for Obesity Prevention, 48 Establishing the Burden of Evidence, 51 Connecting Research and Action, 54 Organizing the Community in Support of Obesity Prevention, 58 Discussion, 60 7 DECISION MAKERS: HOW DO COMMuNITy PERSPECTIvES INFLuENCE POLICy? 63 Support for Recreation and Open Space in Fairfax City, Virginia, 64 Rigor of Evidence in New York Food Policy, 66 “Culture of Fitness” in Arlington, Virginia, 68 Efforts to Speak Out on Obesity Prevention in Montgomery County, Maryland, 69 Evidence in Minnesota Health Policy Decisions, 70 Reframing of the Conversation in Washington, DC, 72 Discussion, 73 8 CLOSINg REMARKS 75 Diversity of Efforts, 75 A Movement Versus Discrete Policies and Programs, 75 Communication Is Key, 76 Core Data, 76 Community Knowledge, 77

OCR for page R1
xv CONTENTS REFERENCES 79 APPENDIxES A Workshop Agendas 81 B Biographical Sketches 85 C Workshop Attendees 93

OCR for page R1