• identify the challenges associated with integrating scientific evidence with broader influences on policy and programmatic considerations;

  • provide a practical and action-oriented framework of recommendations for how to select, implement, and evaluate obesity prevention efforts;

  • identify ways in which existing or new tools and methods can be used to build a useful and timely evidence base appropriate to the challenges presented by the epidemic, and describe ongoing attempts to meet these challenges;

  • develop a plan for communicating and disseminating the proposed framework and its recommendations; and

  • specify a plan for evaluating and refining the proposed framework in current decision-making processes.


Recognition is increasing that overweight and obesity are not only problems of individuals, but also societywide problems of populations. Acting on this recognition will require multifaceted, population-based changes in the socioenvironmental variables that influence energy intake and expenditure. There exist both a pressing need to act on the problem of obesity and a large gap between the type and amount of evidence needed to act and the type and amount of evidence available to meet that need. A new framework is necessary to assist researchers and a broad community of decision makers in generating, identifying, and evaluating the best evidence available and in summarizing it for use in decision making. This new framework also is important for researchers attempting to fill important evidence gaps through studies based on questions with program and policy relevance. However, the methods used and the evidence generated by traditional research designs do not yield all the types of evidence useful to inform actions aimed at addressing obesity prevention and other complex public health challenges. An expanded approach is needed that emphasizes the decision-making process and contextual considerations.

The Framework

To meet this need, the committee developed the L.E.A.D. (Locate Evidence, Evaluate Evidence, Assemble Evidence, and Inform Decisions) framework, designed to facilitate a systematic approach to the identification, implementation, and evaluation of promising, reasonable actions to address obesity prevention and other complex public health challenges (see Figure 10-1). The framework is designed to help identify the nature of the evidence that is needed and clarify what changes in current approaches to generating and evaluating evidence will facilitate meeting those needs. This section describes the main components of the framework and issues related to these components.

Obesity prevention has not been addressed successfully by traditional study designs, which are generally linear and static. A systems approach is needed to develop more complex, interdisciplinary strategies. Accordingly, the L.E.A.D. framework

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