Paula Tarnapol Whitacre and Annina Catherine Burns, Rapporteurs

Standing Committee on Childhood Obesity Prevention

Food and Nutrition Board



Washington, D.C.

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PERSPECTIVES FROM U N ITED KI NGDOM AN D U NITED STATES POLICY MAKERS ON OBESITY PREVENTION WORKSHOP SUMMARY Paula Tarnapol Whitacre and Annina Catherine Burns, Rapporteurs Standing Committee on Childhood Obesity Prevention Food and Nutrition Board

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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 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 Grant No. 61747 between the National Academy of Sciences and The Robert Wood Johnson Foundation. Any opinions, findings, conclusions, 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: 978-0-309-15078-1 International Standard Book Number-10: 0-309-15078-7 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: Copyright 2010 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). 2010. Perspectives from United Kingdom and United States Policy Makers on Obesity Prevention: Workshop Sum- mary. 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 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.

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PLANNINg COMMITTEE FOR A WORKSHOP ON PERSPECTIVES FROM THE UNITED KINgDOM AND UNITED STATES POLICY MAKERS ON OBESITY PREVENTION* WILLIAM H. DIETZ (Chair), Director, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention ADAM DREWNOWSKI, Professor of Epidemiology, School of Public Health and Community Medicine, University of Washington RUSSELL R. PATE, Professor of Exercise Science, Department of Exercise Science, University of South Carolina JOHN EDWARD PORTER, Partner, Hogan and Hartson, LLP, Washington, DC JOSEPH W. THOMPSON, Surgeon General, State of Arkansas Study Staff ANNINA CATHERINE BURNS, Study Director LYNN PARKER, Scholar NICOLE FERRINg HOLOVACH, Research Associate SAUNDRA A. LEE, Senior Program Assistant ANTON L. BANDY, Financial Associate gERALDINE KENNEDO, Administrative Assistant LINDA D. MEYERS, Director, Food and Nutrition Board *Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

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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 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 confiden- tial to protect the integrity of the process. We wish to thank the following individuals for their review of this report: William H. Dietz, Director, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA gail Woodward Lopez, Associate Director, Dr. Robert C. and Veronica Atkins Center for Weight �� Health, University of Center California, Berkeley Eduardo J. Sanchez, Vice President and Chief Medical Officer, Blue Cross and Blue Shield of Texas, Richardson, TX 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 this report before its release. The review of this report was overseen by Melvin Worth. Appointed vii

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viii 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 con- sidered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Contents Summary 1 1 Introduction 7 Setting the Stage, 7 Report Organization, 8 2 Scope of the Problem 9 Obesity as a Growing Epidemic in the United Kingdom, 10 Prevalence, Trends, and Contributing Factors in the United States, 13 3 Government Structures to Address Obesity 17 Three Roles for the British Government, 18 Federal and Local Efforts in the United States, 20 4 School Meal Policies 23 Healthier Meals Through the UK School Food Trust, 23 Food and Nutrition Service Programs in US Schools, 26 Discussion, 27 5 Physical Activity and the Built Environment 31 Washington, DC: “Healthy by Design,” 32 Increasing Physical Activity Through the Built Environment in England, 34 Discussion, 36 ix

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x CONTENTS 6 National Policies and Programs 39 US Department of Agriculture: Meeting Nutrition Needs, 39 US Department of Education: Promoting Physical Education in US Schools, 41 UK Food Standards Agency: Encouraging Healthier Eating, 44 Implementing Change4Life, 46 Discussion, 48 7 Local Policies and Programs 51 Los Angeles County: The Health Department as a Focal Point, 52 New York City: Menu Labeling to Promote Health, 55 Hernando, Mississippi: Creative Leadership on a Limited Budget, 58 Discussion, 59 8 Concluding Remarks 61 Final Thoughts: A UK Perspective, 61 Final Thoughts: A US Perspective, 62 References 65 Appendixes A Workshop Agenda 67 B List of Participants 71 C Planning Committee Biosketches 75 D Speaker Biosketches 79