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1
Introduction and Workshop1 Goals
The prevalence of overweight and obesity2 is high among children
and adults in the United States and particularly so for some demographic
groups, with serious health, economic, and social consequences. Carrying
excess weight raises an individual’s risk of health problems that include
cardiovascular disease, gallbladder disease, type 2 diabetes, hypertension,
dyslipidemia, and osteoarthritis, while psychosocial consequences of over-
weight and obesity may impair functioning and quality of life (IOM, 2005).
Health problems related to obesity are also expensive: by one estimate, the
annual medical burden of obesity could reach $147 billion (Finkelstein et
al., 2009). Additional costs to society come in the form of reduced pro-
ductivity at and absenteeism from work and higher costs for disability and
unemployment benefits, for example (Cawley et al., 2007; Finkelstein et al.,
2005). The social costs of obesity can include stigmatization, discrimina-
tion, and teasing and bullying (IOM, 2005). In addition, national security
is affected by rising rates of obesity. U.S. military leaders have recently
1 This report summarizes the views expressed by workshop participants, and while the
committee is responsible for the overall quality and accuracy of the report as a record of
what transpired at the workshop, the views contained herein are not necessarily those of the
committee.
2 Researchers classify adults with a body mass index (BMI) of 25 to 29.9 as overweight,
those with a BMI of 30 or higher as obese, and those with a BMI of 40 or higher as extremely
obese. Children and adolescents with a BMI for age and sex at or above the 95th percentile or
at or above the 85th but below the 95th percentile (based on the Centers for Disease Control
and Prevention’s [CDC’s] growth charts) are classified as obese or overweight, respectively.
1
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2 MEASURING PROGRESS IN OBESITY PREVENTION
described the role of obesity in reducing the pool of potential recruits to
the armed services (Christeson et al., 2010).
Rates of adult and childhood obesity in the United States vary signifi-
cantly by region and by race/ethnicity and age, but overall rates are high.
Data from the 2007-2008 National Health and Nutrition Examination
Surveys (NHANES)3 show that among adults aged 20 or older, nearly
34 percent have weight levels in the obese range, and another 34 percent
are classified as overweight; thus the combined prevalence of obesity and
overweight is nearly 68 percent (Flegal et al., 2010). Among children and
adolescents aged 2 through 19, nearly 17 percent are classified as obese
and 15 percent as overweight; thus close to 32 percent are either obese or
overweight (Ogden et al., 2010).
While there is no evidence that underlying biological susceptibility to
weight gain has changed, there is ample evidence of increases in such fac-
tors as the amount of food available; the palatability of food (i.e., increases
in fat, sugar, and salt); and eating environments that are highly conducive
to the consumption, often unintentional, of excess calories (Gearhardt et
al., 2011; Kral and Rolls, 2004; Ledikwe et al., 2005; Story et al., 2008;
Wansink, 2004). As a result, researchers and policy makers are focusing
increased attention on environmental and policy factors that may affect
obesity. Individual factors, including genetics, psychological issues, and
social and cultural factors, play a role in people’s diets, but so do the physi-
cal environments in which they live, the kinds of food that are accessible
and affordable where they live and work, the marketing and other media
messages they receive, and public policies such as requirements for side-
walks or provision of nutrition information in restaurants.
In this context, the Institute of Medicine (IOM) formed the Commit-
tee on Accelerating Progress in Obesity Prevention, which was charged
to review IOM’s past obesity-related recommendations, identify a set of
critical recommendations for future action, and recommend indicators of
progress in implementing these actions. Given the urgency of a problem
that has been described as an epidemic, researchers and policy makers are
eager to identify improved measures of the behavioral influences that may
contribute to obesity and of the effectiveness of policies designed to reduce
obesity rates. Accordingly, as part of its information-gathering process, the
committee conducted a workshop in March 2011 to explore measurement
methodology in obesity prevention. Held with the support of the Michael
& Susan Dell Foundation and the Robert Wood Johnson Foundation, the
workshop was an opportunity for the committee to discuss opportunities
and challenges related to measurement and to hear from experts in many
3 NHANES is a continuous program of studies designed to assess the health and nutritional
status of a nationally representative sample of children and adults in the United States.
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3
INTRODUCTION AND WORKSHOP GOALS
relevant fields, including public health, epidemiology, nutrition, media stud-
ies and communication, psychology, and public policy. The workshop was
designed to support the committee in carrying out its charge, and not to
serve as a forum for the committee to discuss findings or conclusions related
to the charge.
This report summarizes the presentations and discussions at the work-
shop. Chapters 2 and 3 provide an overview of issues related to measure-
ment in two key areas: Chapter 2 addresses physical activity and the built
environment, while Chapter 3 focuses on food and nutrition policies and
environments. Chapter 4 reviews the measures, data sources, and methods
that relate to both of these environments and may help researchers and pol-
icy makers assess progress in obesity prevention. Chapter 5 examines mar-
keting strategies, public health campaigns, and data on marketing exposure.
Chapter 6 focuses on state and local policy efforts, exploring both existing
measures of their effectiveness and possibilities for the future. Chapter 7
addresses the ethnic, geographic, and other disparities in obesity prevalence
that must be considered in measuring progress in obesity prevention. The
final chapter presents a summary of key themes from the workshop.
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4 MEASURING PROGRESS IN OBESITY PREVENTION
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