8
Concluding Remarks

The final session of the workshop provided an opportunity to comment on some of the similarities and differences between the United States and United Kingdom in the perspectives on and actions taken to address the obesity problem, including innovative approaches in each country that could be applied in the other.

FINAL THOUGHTS: A UK PERSPECTIVE

Jackson observed that although the two countries have different systems, their commonalities and areas of agreement on how to tackle the obesity problem were clear from the workshop presentations and discussions:

  • Working across sectors—There was strong consensus among the presenters about the need to work across sectors and take the time to develop partnerships, however difficult they may be to create and maintain.

  • Top-down versus bottom-up approaches—Jackson noted the creative tension that can emerge between top-down and bottom-up approaches. A great deal of power comes from people working in their communities. At the same time, national messages and programs must create a context that enables people to see that fighting obesity is in their common interest. This is especially important in the current economic environment, in which the obesity problem needs to be framed as an economic problem as well.



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8 Concluding Remarks T he final session of the workshop provided an opportunity to com- ment on some of the similarities and differences between the United States and United Kingdom in the perspectives on and actions taken to address the obesity problem, including innovative approaches in each country that could be applied in the other. FINAL THOUgHTS: A UK PERSPECTIVE Jackson observed that although the two countries have different sys- tems, their commonalities and areas of agreement on how to tackle the obe- sity problem were clear from the workshop presentations and discussions: • Working across sectors—There was strong consensus among the presenters about the need to work across sectors and take the time to develop partnerships, however difficult they may be to create and maintain. • Top-down versus bottom-up approaches—Jackson noted the cre- ative tension that can emerge between top-down and bottom-up approaches. A great deal of power comes from people working in their communities. At the same time, national messages and pro- grams must create a context that enables people to see that fighting obesity is in their common interest. This is especially important in the current economic environment, in which the obesity problem needs to be framed as an economic problem as well. 

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 PERSPECTIVES FROM UK AND US POLICY MAKERS • Reframing “obesity”—Socioeconomic implications must be addressed proactively. In particular, the discussion of obesity pre- vention must not be confined to those with more education. At present, for example, the group least likely to be obese in the United Kingdom is affluent women. Therefore, in taking action to combat the problem, it is essential to involve women of all classes, as not to create a divide between classes. Those who work to com- bat obesity must find language that resonates across all classes of society. Despite these challenges, Jackson said she wanted to close on a positive note. The level of activity taking place to fight obesity in both countries offers great cause for hope, and both have many promising areas to explore further. FINAL THOUgHTS: A US PERSPECTIVE Dietz summarized some of the issues the workshop had highlighted for him: • Role of philanthropies—One difference between the two countries is the larger role of philanthropies in obesity prevention in the United States. In addition to national organizations, local foundations, some of which have resulted from nonprofit hospitals transitioning to for-profit institutions, fund many community initiatives. • Influence of national-level reports—The Foresight report had a clear, direct impact on UK policy. Although an equivalent report has not emerged in the United States, the IOM has produced a number of influential publications, from its initial report on child- hood obesity to its recently released publication on local govern- ment actions that can address obesity (IOM, 2005, 2009a). • National standards—The United States is several years behind the United Kingdom in terms of setting national food and physi- cal activity standards, although the US government is beginning to focus on voluntary efforts in such areas as food labeling and advertising. • Environmental changes—Presenters from both countries agreed on the need for environmental changes. An area of particular com- monality is initiatives related to transport. • global evidence—Whereas presenters said global evidence can be used effectively in the United Kingdom, Americans appear to demand US-based evidence. One reason may be the need to frame the issue according to the diversity of the US population. Issues play

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 CONCLUDING REMARKS out differently across ethnic groups and geographic locations—rural Texas, for example, versus New York City. In the United States, a great deal of energy and innovation in generating evidence is seen at the local level, as demonstrated by the case examples presented for Los Angeles County, New York, and Hernando (Chapter 7). • Impact data—A challenge is to demonstrate the effectiveness of initiatives at the local level. One of the greatest deficits in the field is intervention and outcome studies that can be used to accumulate a database of what works. Also needed are studies of how to take local programs to scale. • Messages that resonate—In line with the eight behaviors in Change4Life (Chapter 6), CDC is focusing on actions Americans can take to increase physical activity; promote breastfeeding; increase fruit and vegetable consumption; reduce TV time; and reduce the consumption of energy-dense, low-nutrient foods and sugar-sweetened beverages. As in the United Kingdom, the term “obesity” resonates poorly with most Americans. People do not recognize themselves or their children as obese in accordance with the clinical definition; furthermore, the term is pejorative in con- notation. In a national campaign, as is occurring in the United Kingdom, a different frame of reference is necessary, such as health communities or health reform, that resonate with those the cam- paign is trying to reach.

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