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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
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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
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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
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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.
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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
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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
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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.
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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.
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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.
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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.
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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.
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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.
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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
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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.
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