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9 Closing Remarks Key Presenter Messages • Reauthorization of several critical bills in the next few years will provide unparalleled opportunities to change policies that affect food consumption and obesity in the United States. • The attention being given to obesity by the First Lady and many policy makers has increased the impetus for change. • The potential for change demands continued focused research to determine which actions will be most effective. This is an extraordinary time to be working on the prevention of child- hood obesity, said William Dietz, member of the Standing Committee on Childhood Obesity Prevention, in his closing remarks at the workshop. The 2010 Child Nutrition Reauthorization Bill will arguably have the greatest impact on child nutrition of any legislation in the past 20 years because it will establish standards for the child and adult care food program and for what is served in schools. The Farm Bill will continue to have a profound impact on the agricultural system and food supply in the United States, in part through its subsidies for food prices, which in turn affect consumption levels. The Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, is authorized under the Farm Bill as well. Dietz 71
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72 LEGAL STRATEGIES IN CHILDHOOD OBESITY PREVENTION noted that legislation that affects obesity is often intertwined with other important issues. The Farm Bill, as well as many other pieces of legislation, also affects such issues as land use and even infectious disease issues that arise from the use of antibiotics in cattle feeding operations. Finally, the reauthorization of the transportation bill includes measures that affect com- munity design, public transit, and air quality, all of which have an impact on health and chronic disease. “From the national legislative perspective, there are some very important opportunities in front of us,” said Dietz. Other activities at the federal level also will have an effect on childhood obesity. The Food and Drug Administration (FDA) is working on menu and front-of-package labeling. The Federal Trade Commission (FTC) is devel- oping voluntary standards for foods marketed to children. The Affordable Care Act mandates that companies afford breast-feeding support to nursing mothers, which has an effect on childhood nutrition. And the Communities Putting Prevention to Work initiative has allocated a substantial amount of money for community and state efforts to develop nutrition and physical activity strategies to address obesity. Child care and healthy pregnancy are a substantial focus of the Child- hood Obesity Task Force that is part of the First Lady’s Let’s Move initia- tive, particularly with respect to weight gain, tobacco use, and diabetes during pregnancy, all of which are risk factors for early childhood obesity. Also, the National Prevention Council, now getting under way, will work on obesity prevention initiatives, with an emphasis on nutrition and physi- cal activity. The council includes 12 Cabinet members, providing an oppor- tunity to incorporate health considerations into all federal policies. Dietz identified these developments as the greatest opportunity to achieve advances in the fight against childhood obesity since the 1969 White House Conference on Food, Nutrition, and Health, from which a variety of important programs emerged (The White House, 1969). This opportunity is greatly enhanced by the First Lady’s role as a champion for obesity prevention, and indeed for nutrition generally. “She is visible, articulate, and passionate about these issues,” said Dietz. Gaps are also plentiful, however. The multitude of initiatives being undertaken raises a number of questions. How can multiple efforts be not only coordinated but integrated? Which activities should have priority? Do networks exist to promote the rapid dissemination of innovations? If a les- son is learned in one area, how quickly can it be shared, amplified, dissemi- nated, or replicated? How can new ideas and perceptions be transmitted to those in the field? Implementation requires pragmatism, opportunism, and mobilization, said Dietz. Scientific advances must be applied within the limits of political opportunities and pragmatism, which have a stronger effect on policy making. Because obesity prevention is a new field, funds are needed for evalua-
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73 CLOSING REMARKS tion, not just for action, said Dietz. Only through evaluation can we learn what works. Continuous measurement identifies areas for change, reveals problems, shows the impact of interventions, and drives change. Finally, the question arises of how a workforce will be developed to carry out antiobesity efforts. Only then will the sustainability of these efforts be ensured. Obesity prevention is but one component of meeting the broader needs of children, Dietz said. It is essential to institutionalize environments that protect the needs of children, nurture healthy development, and advance obesity prevention through improved nutrition and physical activity. Per- haps childhood obesity “could become the initiative that goes beyond the lip service that we give to children as our most precious resource,” sug- gested Dietz.
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