and environments for food and physical activity have been spearheaded primarily by the Robert Wood Johnson Foundation through the Bridging the Gap, Active Living Research, and Healthy Eating Research programs (Ottoson et al., 2009; RWJF, 2013a,b; University of Illinois at Chicago, 2013a). Many of these measures have been evaluated for psychometric properties such as validity and reliability and are now being used consistently in research studies. Along with the physical and policy environment, the behavioral environment should also be assessed, including social norms for diet, physical activity, and obesity.

Components and Guidance for Implementing the National Obesity Evaluation Plan

The National Obesity Evaluation Plan for assessing progress in obesity prevention builds on the current strengths and infrastructure of the existing monitoring and surveillance systems in the United States, including Healthy People 2020 (HHS, 2010b), but it proposes the incorporation of new infrastructure (i.e., surveys and sources of data) to measure policy, systems, and environmental indicators (see Box 6-2), as well as integration with international efforts. The plan includes many of the proposed methods and indicators outlined in the WHO Global Strategy on Diet, Physical Activity and Health: A Framework to Monitor and Evaluate Implementation (WHO, 2008) and thus will be consistent with similar evaluation efforts internationally. Insofar as APOP strategies (IOM, 2012a) focus largely on policy, systems, and environmental approaches, while existing assessment, monitoring, surveillance, and summative evaluation efforts primarily focus on individual-level outcomes, the plan needs to align the newer intervention approaches with appropriate indicators.

Components of the plan are tied to proposed activities, including identification of overall leadership, infrastructure, resources, and timeline for the plan; identification of current federal efforts and data gaps; proposals for additional and new measures, infrastructure, and data collection systems to address these gaps; mechanisms for feedback to data users; and adaptations of the plan to state and regional applications (see summary Table 6-1). Plan activities need to prioritize and leverage existing resources to maximize efficiency of data collection, as well as to avoid duplication of efforts. Several of the proposed activities could be implemented relatively easily and with little cost as, for example, new questionnaire items added to the BRFSS or the YRBSS. Other recommendations, such as decreasing the time period for SHPPS from 6 years to 3 years are relatively expensive, and therefore must be balanced with other priorities. Other considerations when prioritizing recommendations include

•   Which sectors to target with priority? Are the appropriate stakeholders and potential users involved in setting these priorities and providing feedback (see Chapter 2)?

•   What is the appropriate time frame for each measurement? Does this fit within the time frame needed to evaluate obesity prevention efforts?

•   How precise do the measures for the indicator need to be? Can a survey tool be used, or is a more objective or precise measure required?

•   Which populations need to be measured? Do survey planners need to oversample certain racial and ethnic groups, such as pregnant women or Native American populations?

To be relevant, as well as to address the current status of APOP strategies (IOM, 2012a), evaluation activities for the National Obesity Evaluation Plan should follow the steps outlined in Chapter 8 (see



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