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Introduction

The United States is experiencing an epidemic of childhood obesity. Recent national statistics show that almost one-third of U.S. children and adolescents are overweight or obese (Ogden et al., 2008). Approximately one of six U.S. children is classified as obese (≥ 95th percentile for weight), and 1 of 10 is classified as very obese (≥ 97th percentile for weight). Childhood obesity pervades all sectors of society regardless of race, education level, or income. The current trajectory of the problem will affect the health of the U.S. population for decades to come, incurring substantial costs to the nation.

If the growing epidemic of childhood obesity is not addressed, some have suggested the current generation of U.S. children will be the first to have a shorter average lifespan than their parents (Olshansky and Ludwig, 2005). In addition, the nation may miss the opportunity to contain the future costs of preventable chronic diseases linked to obesity, including diabetes, heart disease, and some forms of cancer. Given the scope of the problem, comprehensive change within the social, cultural, and environmental contexts in which children live is needed to achieve a sustainable transformation.

In 2002, Congress charged the Institute of Medicine (IOM) with developing a prevention-focused action plan for decreasing the number of obese children in the United States. In response, the IOM conducted an in-depth review of the literature on obesity prevention and a series of fact-finding workshops and issued two reports. The first report, Preventing Childhood Obesity: Health in the Balance (IOM, 2005), identified promising approaches for obesity prevention efforts and a set of recommendations for a variety of stakeholders and sectors. The second report, Progress in



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1 Introduction The United States is experiencing an epidemic of childhood obesity. Recent national statistics show that almost one-third of U.S. children and adolescents are overweight or obese (Ogden et al., 2008). Approximately one of six U.S. children is classified as obese (≥ 95th percentile for weight), and 1 of 10 is classified as very obese (≥ 97th percentile for weight). Child- hood obesity pervades all sectors of society regardless of race, education level, or income. The current trajectory of the problem will affect the health of the U.S. population for decades to come, incurring substantial costs to the nation. If the growing epidemic of childhood obesity is not addressed, some have suggested the current generation of U.S. children will be the first to have a shorter average lifespan than their parents (Olshansky and Ludwig, 2005). In addition, the nation may miss the opportunity to contain the future costs of preventable chronic diseases linked to obesity, including diabetes, heart disease, and some forms of cancer. Given the scope of the problem, com- prehensive change within the social, cultural, and environmental contexts in which children live is needed to achieve a sustainable transformation. In 2002, Congress charged the Institute of Medicine (IOM) with devel- oping a prevention-focused action plan for decreasing the number of obese children in the United States. In response, the IOM conducted an in-depth review of the literature on obesity prevention and a series of fact-finding workshops and issued two reports. The first report, Preventing Child- hood Obesity: Health in the Balance (IOM, 2005), identified promising approaches for obesity prevention efforts and a set of recommendations for a variety of stakeholders and sectors. The second report, Progress in 

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 CHILDHOOD OBESITY PREVENTION IN TEXAS Preventing Childhood Obesity: How Do We Measure Up? (IOM, 2007), provides a progress report on efforts undertaken since the 2005 report, with a particular focus on minority and underserved populations, and recommends evaluation of prevention efforts. To sustain a nationwide call to action for childhood obesity prevention, the IOM maintains a Standing Committee on Childhood Obesity. The present report summarizes the information gathered at a workshop held February 5−6, 2009, in Austin, Texas. Texas was chosen as a case study because of its childhood obesity statistics, demographics, size, and efforts to prevent and reduce obesity. At this workshop, committee members met with Texas lawmakers, public officials, and community leaders to exchange ideas and to view first-hand strategies that are being implemented effectively at the state and local levels to prevent and reverse childhood obesity. The focus on obesity efforts in Texas is particularly appropriate given that state’s sobering statistics. Texas is home to three of the five cities with the highest obesity rates in the nation. In 2007, two-thirds of Texas adults and one-third of Texas high school students were either overweight or obese. Moreover, information released in January 2009 by the state demographer indicates that, absent preventive measures, the number of obese Texans will triple by 2040 to reach 15 million (Eschbach and Fonseca, 2009). Accord- ing to Texas Governor Rick Perry, “Texas obesity rates are well above the national average, and the negative effects are spreading.” Indeed, if the obesity epidemic in Texas is not controlled, particularly among children, one can easily envision a scenario in which the state’s children and young adults compete with aging baby boomers for limited health resources. In the face of this prospect, one Texas lawmaker has gone so far as to identify obesity as the state’s most serious threat. Texas leaders at the workshop expressed the strong belief that the state’s economic vitality and security depend on the health of its population. Accordingly, the state is no longer simply describing the personal, commu- nity, and financial costs of its obesity crisis; it is taking proactive steps to address the problem through strategic initiatives. An overarching strategy is to address obesity by targeting the state’s youth, in whom it may be pos- sible to instill healthy behaviors and lifestyles to last a lifetime. A guiding principle of these efforts is that they should be evidence based, community specific, sustainable, cost-effective, and supported by effective partnerships. Moreover, the goal is for the responsibility to be broadly shared by indi- viduals, families, communities, and the public and private sectors. This report describes a variety of efforts highlighted at the work - shop aimed at preventing and reversing childhood obesity in Texas. The report also identifies themes that emerged during the workshop discussions, including common attributes of successful programs and barriers that can impede action.

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 INTRODUCTION REFERENCES Eschbach, K., and V. Fonseca. 2009. Summary: Findings about the Obesity Epidemic in Texas. http://txsdc.utsa.edu/download/pdf/obesity/THI_Obesity_Summary.pdf (accessed July 21, 2009). IOM (Institute of Medicine). 2005. Preventing Childhood Obesity: Health in the Balance. Washington, DC: The National Academies Press. IOM. 2007. Progress in Preventing Childhood Obesity: How Do We Measure Up? Washing- ton, DC: The National Academies Press. Ogden, C. L., M. D. Carroll, and K. M. Flegal. 2008. High body mass index for age among U.S. children and adolescents, 2003−2006. Journal of the American Medical Association 299(20):2401−2405. Olshansky, S. J., and D. S. Ludwig. 2005. Effect of obesity on life expectancy in the U.S. Food Technology 59(7):112.

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