The Institute of Medicine’s (IOM’s) report Accelerating Progress in Obesity Prevention (APOP) (IOM, 2012a) presents a new way to frame obesity prevention by targeting policies, systems, and environments, rather than focusing on individual change, as many previous recommendations have done. The evaluation of recommendations and strategies in the APOP report requires a similar frame of reference, because prior evaluation efforts in the United States have focused predominantly on outcomes from individual-level interventions and largely ignored or only superficially included monitoring of obesity prevention policies and environmental changes or surveillance of the effects of them. Thus, commitment to the APOP plan of action requires a concomitant commitment to an expanded view of evaluation that includes outputs, outcomes, and impacts at the environmental, systems, programmatic, and policy levels (see Chapter 3, Figure 3-1). As explained in Chapter 1, national evaluation needs to include (1) monitoring of obesity prevention policies, environmental changes, and other interventions; (2) surveillance of the changes in obesity and obesity-related behaviors, determinants, and consequences; and (3) summative evaluation of the effects of interventions on the incidence and prevalence of obesity and obesity-related behaviors, determinants, and consequences. In this chapter, the Committee sometimes uses the term evaluation to refer to all three of these functions. The inconsistent and varied use of these three terms in the various sectors, agencies, disciplines, and professions involved in obesity prevention necessitates that the Committee’s usage in this report will sometimes not match the way the term is used elsewhere. In addition, the use of consistent definitions in this report complements the use of evaluation as a term in biological and psychological research that lends itself more to individual-level studies and highly controlled experiments on the efficacy of interventions.
Many initiatives have targeted obesity prevention, but monitoring, surveillance, and summative evaluation plans within and across sectors and levels at the national and community levels have not yet been harmonized. Without the coordinated development of evaluation, uneven and stalled progress will go unnoticed and opportunities to correct efforts or build on successes will be missed. Although the United States previously developed a nutrition monitoring plan (Briefel, 2006; Briefel and McDowell, 2012) and a surveillance plan for Healthy People 2020 exists (Green and Fielding, 2011), the nation does not yet have an evaluation plan for obesity prevention as recommended in the APOP report (IOM, 2012a). This chapter describes recommendations for a U.S. National Obesity Evaluation Plan that can be used as a resource and model for state and regional evaluations. This chapter includes summaries of current international and national evaluation plans; an outline of a National Obesity Evaluation Plan to evaluate strategies identified in the APOP report; recommendations to adapt this plan at the state and regional levels; and considerations for how community and local level data, which will be discussed in Chapters 7 and 8, can be incorporated to enhance and support the National Obesity Evaluation Plan. In addition, because the Committee was tasked to identify measurement ideas for The Weight of the Nation (TWOTN) campaign,1 this chapter discusses opportunities and challenges for evaluating this campaign within the National Obesity Evaluation Plan.
1 The Weight of the Nation is a coordinated, multi-media, multi-organizational campaign designed to help create awareness, inform, and motivate action to slow, arrest, and reverse the trend of obesity across the United States.