A

Acronyms and Glossary

ACRONYMS

AAFP American Academy of Family Physicians
AAP American Academy of Pediatrics
ACA Patient Protection and Affordable Care Act of 2010
ACOG American College of Obstetricians and Gynecologists
AHA American Heart Association
AIM Americans In Motion
AMA American Medical Association
ARRA American Recovery and Reinvestment Act
 
BGCA Boys & Girls Clubs of America
BMI body mass index
BRFSS Behavioral Risk Factor Surveillance System
 
 
CACFP Child and Adult Care Food Program
CATCH Coordinated Approach To Child Health (formerly Child and Adolescent Trial for Cardiovascular Health)
CDC Centers for Disease Control and Prevention
CFBAI Children’s Food and Beverage Advertising Initiative
CSFII Continuing Survey of Food Intakes by Individuals
CSPI Center for Science in the Public Interest
 
DGAC Dietary Guidelines Advisory Committee
DOE U.S. Department of Education
DOT U.S. Department of Transportation
 
EFNEP Expanded Food and Nutrition Education Program


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A Acronyms and Glossary ACRONYMS AAFP American Academy of Family Physicians AAP American Academy of Pediatrics ACA Patient Protection and Affordable Care Act of 2010 ACOG American College of Obstetricians and Gynecologists AHA American Heart Association AIM Americans In Motion AMA American Medical Association ARRA American Recovery and Reinvestment Act BGCA Boys & Girls Clubs of America BMI body mass index BRFSS Behavioral Risk Factor Surveillance System CACFP Child and Adult Care Food Program CATCH Coordinated Approach To Child Health (formerly Child and Adolescent Trial for Cardiovascular Health) CDC Centers for Disease Control and Prevention CFBAI Children’s Food and Beverage Advertising Initiative CSFII Continuing Survey of Food Intakes by Individuals CSPI Center for Science in the Public Interest DGAC Dietary Guidelines Advisory Committee DOE U.S. Department of Education DOT U.S. Department of Transportation EFNEP Expanded Food and Nutrition Education Program 393

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EHR electronic health record EPSDT Early and Periodic Screening, Diagnosis, and Treatment ERS Economic Research Service FDA U.S. Food and Drug Administration FTC Federal Trade Commission FY fiscal year GAO Government Accountability Office (previously General Accounting Office) HEDIS Healthcare Effectiveness Data and Information Set HHS U.S. Department of Health and Human Services HIE health information exchange HIPAA Health Insurance Portability and Accountability Act HITECH Health Information Technology for Economic and Clinical Health IBCLC International Board Certified Lactation Consultant IOM Institute of Medicine IWG Interagency Working Group L.E.A.D. Locate Evidence, Evaluate Evidence, Assemble Evidence, Inform Decisions (framework) MEPS Medical Expenditure Panel Survey MET metabolic equivalent of task mPINC Maternity Practices in Infant Nutrition and Care NASN National Association of School Nurses NASPE National Association for Sport and Physical Education NCCOR National Collaborative on Childhood Obesity Research NCHS National Center for Health Statistics NCI National Cancer Institute NHANES National Health and Nutrition Examination Survey NHIS National Health Interview Survey NHWS National Health and Wellness Survey Accelerating Progress in Obesity Prevention 394

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NIH National Institutes of Health NRPA National Recreation and Park Association NSLP National School Lunch Program OECD Organisation for Economic Co-operation and Development PAG Physical Activity Guidelines for Americans PE physical education PSA public service announcement QALY quality-adjusted life-year RDA Recommended Dietary Allowance RWJF The Robert Wood Johnson Foundation SCHIP State Children’s Health Insurance Program SHPPS School Health Policies and Programs Study SNAP Supplemental Nutrition Assistance Program SNAP-Ed SNAP Education SoFAS solid fats and added sugars SRTS Safe Routes to School SUS Shape Up Somerville UNICEF United Nations Children’s Fund USDA U.S. Department of Agriculture USPSTF U.S. Preventive Services Task Force WHO World Health Organization WIC Special Supplemental Nutrition Program for Women, Infants, and Children YMCA Young Men’s Christian Association YRBS Youth Risk Behavior Survey YRBSS Youth Risk Behavior Surveillance System 395 Appendix A

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GLOSSARY Absenteeism A persistent failure to appear for work, school, or other regular activities. Active living A way of life that integrates physical activity into daily rou- tines. The two types of activities that make up active living are recreational or leisure, such as jogging, skateboarding, and playing basketball; and utilitarian or occupational, such as walking or biking to school, shopping, or running errands. Adiposity The state of an excess of body fat. Advergame A branded product that is built directly into an Internet-based game or video game, or game appearing in print materials. Advertising A paid public presentation and promotion of ideas, goods, or services by a sponsor that is intended to bring a product to the attention of consumers through a variety of media channels, such as broadcast and cable television, radio, print, billboards, the Internet, or personal contact. Away-from-home Foods categorized according to where they are obtained, such foods as restaurants and other places with wait service; fast-food establishments and self-service or carry-out eateries; schools, including day care, after-school programs, and summer camp; and other outlets, including vending machines, community feeding programs, and other people’s homes. Basal metabolism The minimum amount of energy that an individual needs to maintain vital functions in a resting state. BMI z-score Number of standard deviations away from the population mean body mass index (BMI); in other words, the degree to which an individual’s measurement deviates from what is expected for that individual. Accelerating Progress in Obesity Prevention 396

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Body mass index An indirect measure of body fat, calculated as the ratio of a person’s body weight in kilograms to the square of a person’s height in meters. BMI (kg/m2) = weight (kilograms) ÷ height (meters)2 BMI (lb/in2) = weight (pounds) ÷ height (inches)2 × 703 In children and youth, BMI is interpreted using growth charts for age and gender and is referred to as BMI-for-age and sex, which is used to assess underweight, overweight, and obesity. According to the Centers for Disease Control and Prevention (CDC), a child with a BMI that is equal to or greater than the 95th percentile is considered to be obese. A child with a BMI that is equal to or between the 85th and 95th percentile is considered to be overweight. Built environment The man-made elements of the physical environment; build- ings, infrastructure, and other physical elements created or modified by people and the functional use, arrangement in space, and aesthetic qualities of these elements. Calorie A calorie is defined as the amount of heat required to change the temperature of one gram of water from 14.5 degrees Celsius to 15.5 degrees Celsius. In this report, “calorie” is used synonymously with “kilocalorie,” the unit of measure for energy obtained from food and beverages. Calorie-dense Foods and beverages that contribute few vitamins and minerals food to the diet but contain substantial amounts of fat and/or sugar and are high in calories. Consumption of these foods, such as sugar-sweetened beverages, candy, and chips may contribute to excess caloric intake and unwanted weight gain in children. Capacity building A multidimensional and dynamic process that improves the ability of individuals, groups, communities, organizations, and governments to meet their objectives or enhance performance 397 Appendix A

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to address population health. In public health, capacity build- ing involves the ability to carry out essential functions, such as developing and sustaining partnerships, leveraging resources, conducting surveillance and monitoring, providing training and technical assistance, and conducting evaluations. Community A social entity that can be spatial based on where people live in local neighborhoods, residential districts, or municipalities, or relational, as with people who have common ethnic or cul- tural characteristics or share similar interests. Competitive Foods and beverages offered at schools other than meals and foods snacks served through the federally reimbursed school lunch, breakfast, and after-school snack programs. Competitive foods includes food and beverages items sold through à la carte lines, snack bars, student stores, vending machines, and school fundraisers. Dietary A federal summary of the latest dietary guidance for the Guidelines public based on current scientific evidence and medical for Americans knowledge, issued by the Department of Health and Human Services and U.S. Department of Agriculture and revised every 5 years. Disability A physical, intellectual, emotional, or functional impairment that limits a major activity, and may be a complete or partial impairment. Disease An impairment, interruption, disorder, or cessation of the nor- mal state of the living animal or plant body or of any of its components that interrupts or modifies the performance of the vital functions, being a response to environmental factors (e.g., malnutrition, industrial hazards, climate), to specific infective agents (e.g., worms, bacteria, or viruses), to inherent defects of the organism (e.g., various genetic anomalies), or to combina- tions of these factors; conceptually, a disease (which is usually tangible or measurable but may be symptom-free) is distinct Accelerating Progress in Obesity Prevention 398

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from illness (i.e., the associated pain, suffering, or distress, which is highly individual and personal). Disparities A term used to describe differences in quality of health and health care across racial, ethnic, and socioeconomic groups. Energy balance A state in which energy intake is equivalent to energy expen- diture, resulting in no net weight gain or weight loss. In this report, energy balance is used to indicate equality between energy intake and energy expenditure that supports normal growth without promoting excess weight gain. Energy-dense Foods that are high in calories. foods Energy density The amount of energy stored in a given food per unit vol- ume or mass. Fat stores 9 kilocalories/gram (gm), alcohol stores 7 kilocalories/gm, carbohydrate and protein each store 4 kilocalories/gm, fiber stores 1.5 to 2.5 kilocalories/gm, and water has no calories. Foods that are almost entirely com- posed of fat with minimal water (e.g., butter) are more energy dense than foods that consist largely of water, fiber, and carbohydrates (e.g., fruits and vegetables). Energy Calories used to support the body’s basal metabolic functions expenditure plus those used for thermogenesis, growth, and physical activity. Energy intake Calories ingested as food and beverages. Environment The external influences on the life of an individual or community. Epidemic A condition that is occurring more frequently and extensively among individuals in a community or population than is expected. 399 Appendix A

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Exercise Planned, structured, and repetitive body movements done to improve or maintain one or more components of physical fit- ness, such as muscle tone and strength. Fast food Foods designed for ready availability, use, or consumption and sold at eating establishments for quick availability or take-out. Fat The chemical storage form of fatty acids as glycerol esters, also known as triglycerides. Fat is stored primarily in adipose tissue located throughout the body, but mainly under the skin (subcutaneously) and around the internal organs (viscerally). Fat mass is the sum total of the fat in the body, while, cor- respondingly, the remaining, nonfat components of the body constitute the fat-free mass. Lean tissues such as muscle, bone, skin, blood, and the internal organs are the principal locations of the body’s fat-free mass. In common practice, however, the terms “fat” and “adipose tissue” are often used interchange- ably. Furthermore, “fat” is commonly used as a subjective or descriptive term that may have a pejorative meaning. Fitness A set of attributes, primarily respiratory and cardiovascular, relating to the ability to perform tasks requiring physical activity. Food Guide An educational tool designed for the public that graphically Pyramid illustrates recommendations from the Dietary Guidelines for Americans and nutrient standards such as the Dietary Reference Intakes and translates them into food-group-based advice that promotes a healthful diet. Food insecurity A household-level economic and social condition of limited or uncertain access to adequate food. Food security Consistent, dependable access to enough food for active, healthy living. Accelerating Progress in Obesity Prevention 400

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Food system The interrelated functions that encompass food production, processing, and distribution; food access and utilization by individuals, households, communities, and populations; and food recycling, composting, and disposal. Guidelines In the present context, standardized information describing the best practices for addressing health problems commonly encountered in public health practice. The information is based on scientific evidence for the effectiveness and efficiency of the practices described. Where such evidence is lacking, guidelines are sometimes based on the consensus opinions of public health experts. Health A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Health The process of enabling people to increase control over and promotion improve their health. To reach a state of complete physical, mental, and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living, and is a positive concept emphasizing social and personal resources, as well as physical capacities. Healthy weight In children and youth, a level of body fat at which comorbidities are not observed. In adults, a BMI at or between 18.5 and 24.9 kg/m2. Incidence The frequency of new cases of a condition or disease within a defined time period. Incidence is commonly measured in terms of new cases per 1,000 (or 100,000) population at risk per year. Indicator of In the context of this report, an objective measure that can be progress used to assess the effect of, or association with, a given recom- mendation in accelerating progress toward obesity prevention. 401 Appendix A

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Intervention A policy, program, or action intended to bring about identifi- able outcomes. Marketing An organizational function and a set of processes for creat- ing, communicating, and delivering value to customers and for managing customer relationships in ways that benefit an organization and its stakeholders. Marketing encompasses a wide range of activities, including conducting market research; analyzing the competition; positioning a new product; pricing the product and services; and promoting products and services through advertising, consumer promotion, trade promotions, public relations, and sales. Moderate- On an absolute scale, moderate-intensity physical activity is intensity completed at 3.0 to 5.9 times the intensity of rest. On a scale physical activity that is relative to an individual’s personal capacity, moderate- intensity physical activity is usually a 5 or 6 on a scale of 0 to 10. Nutrient density The amount of nutrients that a food contains per unit vol- ume or mass. Nutrient density is independent of energy den- sity although, in practice, the nutrient density of a food is often described in relationship to the food’s energy density. Fruits and vegetables are nutrient dense but not energy dense. Compared with foods of high fat content, soda or soft drinks are not particularly energy dense because they are made up primarily of water and carbohydrate, but because they are otherwise low in nutrients, their energy density is high for their nutrient content. Nutrition Facts Standardized detailed nutritional information on the contents panel and serving sizes of nearly all packaged foods sold in the marketplace. The panel was designed to provide nutrition information to consumers and was mandated by the Nutrition Labeling and Education Act of 1994. Accelerating Progress in Obesity Prevention 402

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Obesity An excess amount of subcutaneous body fat in proportion to lean body mass. In adults, a BMI of 30 or greater is considered obese. In this report, obesity in children and adolescents refers to age- and sex-specific BMIs that are equal to or greater than the 95th percentile of the CDC BMI growth charts. In most children, these values are known to indicate elevated body fat and to reflect the comorbidities associated with excessive body fatness. Obesogenic Environmental factors that may promote obesity and encour- age the expression of a genetic predisposition to gain weight. Overweight In adults, a BMI between 25.0 and 29.9 is considered over- weight. In this report, overweight in children and adolescents refers to age- and sex-specific BMIs at or above the 95th per- centile of the CDC BMI growth charts. Physical activity Body movement produced by the contraction of skeletal mus- cles that results in energy expenditure above the basal level. Physical activity consists of athletic, recreational, housework, transport, or occupational activities that require physical skills and utilize strength, power, endurance, speed, flexibility, range of motion, or agility. Physical Refers to a planned, sequential program of curricula and education instruction that helps students develop the knowledge, atti- tudes, motor skills, self-management skills, and confidence needed to adopt and maintain physically active lifestyles. Physical fitness A set of attributes that people have or achieve that relates to the ability to perform physical activity. The ability to carry out daily tasks with vigor and alertness, without undue fatigue, and with ample energy to enjoy leisure-time pursuits and meet unforeseen emergencies. Physical Not meeting the type, duration, and frequency of recommended inactivity leisure time and occupational physical activities. 403 Appendix A

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Policy A written statement reflecting a plan or course of action of a government, business, community, or institution that is intended to influence and guide decision making. For a gov- ernment, a policy may consist of a law, regulation, ordinance, executive order, or resolution. Population health The state of health of an entire community or population as opposed to that of an individual. It is concerned with the inter- related factors that affect the health of populations over the life course and the distribution of the patterns of health outcomes. Presenteeism The degree to which individuals attend regular activities such as work and school but are not fully functioning because of a medical or psychological condition. Prevalence The number of instances of a condition or disease in a popula- tion at a designated period of time, usually expressed as a per- centage of the total population. Prevention With regard to obesity, primary prevention represents avoiding the occurrence of obesity in a population; secondary preven- tion represents early detection of disease through screening with the purpose of limiting its occurrence; and tertiary pre- vention involves preventing the sequelae of obesity in child- hood and adulthood. Price elasticity The degree to which consumers change their purchasing and con- sumption behaviors in response to higher food/beverage prices. Program An integrated set of planned strategies and activities that sup- port clearly stated goals and objectives designed to lead to desirable changes and improvements in the well-being of peo- ple, institutions, or environments or all of these. Risk The possibility or probability of loss, injury, disadvantage, or destruction. Accelerating Progress in Obesity Prevention 404

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Safety The condition of being protected from or unlikely to cause danger, risk, or injury that may be either perceived or objec- tively defined. School meals Comprises the food service activities that take place within the school setting. The federal child nutrition programs include the National School Lunch Program, School Breakfast Program, Child and Adult Care Food Program, Summer Food Service Program, and Special Milk Program. Sector A distinct subset of a market, society, industry, or the economy in which the members share similar characteristics. Examples of the sectors discussed in this report include government or the public sector, communities, nonprofit and philanthropic organizations, health care, business/the private sector, schools, and households. Sedentary A way of living or lifestyle that requires minimal physical activity and that encourages inactivity through limited choices, disincentives, and/or structural or financial barriers. Social marketing The application of commercial marketing principles to the analysis, planning, implementation, and evaluation of pro- grams designed to influence voluntary behavioral changes in target audiences to improve their personal welfare and benefit society. Solid fats Fats with a high content of saturated and/or trans fatty acids, which are usually solid at room temperature. Common examples of solid fats include butter, beef fat, lard, shortening, coconut oil, palm oil, and milk fat, which is solid at room temperature but is suspended in fluid milk by homogenization. Systematic review A review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research and to collect and analyze data from the studies that are included in the review. Statistical methods 405 Appendix A

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(meta-analysis) may or may not be used to analyze and sum- marize the results of the included studies. Systems approach A paradigm or perspective involving a focus on the whole picture and not just a single element, awareness of the wider context, an appreciation for interactions among different com- ponents, and transdisciplinary thinking. Systems thinking An iterative learning process in which one takes a broad, holistic, long-term perspective on the world and examines the linkages and interactions among its elements. Tween A child in the middle of childhood and adolescence (between the ages of 9 and 13). Unhealthy Although there is no consensus on the definition of “unhealthy” foods/beverages, the term as used in this report refers to foods and beverages that are calorie-dense and low in naturally occurring nutrients. Such foods and beverages contribute little fiber and few essential nutrients and phyto- chemicals, but contain added fats, sweeteners, sodium, and other ingredients. Unhealthy foods and beverages displace the consumption of foods recommended in the Dietary Guidelines for Americans and may lead to the development of obesity. Vigorous- On an absolute scale, vigorous-intensity physical activity is intensity completed at 6.0 or more times the intensity of rest. On a scale physical activity relative to an individual’s personal capacity, vigorous-intensity physical activity is usually a 7 or 8 on a scale of 0 to 10. Accelerating Progress in Obesity Prevention 406