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 community 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 developing 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 Childhood Obesity Task Force that is part of the First Lady’s Let’s Move initiative, 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 physical activity. The council includes 12 Cabinet members, providing an opportunity 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 lesson is learned in one area, how quickly can it be shared, amplified, disseminated, 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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