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Introduction
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BACKGROUND

For the first time in decades, promising news has emerged regarding efforts to curb the obesity crisis in the United States. According to individual speakers throughout the workshop, obesity rates have fallen among low-income children in 18 states, the prevalence of obesity has plateaued among girls, regardless of ethnicity, and targeted efforts in states such as Massachusetts have demonstrably reduced the prevalence of obesity among children. Workshop speakers individually noted that although the reasons for this turnaround are as complex and multifaceted as the reasons for the dramatic rise in obesity rates in recent decades, interventions to improve nutrition and increase physical activity are almost certainly major contributors.

Yet major problems remain. Diseases associated with obesity continue to incur substantial costs and cause widespread human suffering (IOM, 2012a). Moreover, substantial disparities in obesity rates exist among population groups, and in some cases these disparities are widening. As noted by individual speakers, some groups and regions are continuing to experience increases in obesity rates, and the prevalence of severe obesity is continuing to rise. Recent good news is no guarantee that progress will continue.

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1The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus.



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1 Introduction1 BACKGROUND For the first time in decades, promising news has emerged regarding efforts to curb the obesity crisis in the United States. According to indi- vidual speakers throughout the workshop, obesity rates have fallen among low-income children in 18 states, the prevalence of obesity has plateaued among girls, regardless of ethnicity, and targeted efforts in states such as Massachusetts have demonstrably reduced the prevalence of obesity among children. Workshop speakers individually noted that although the reasons for this turnaround are as complex and multifaceted as the reasons for the dramatic rise in obesity rates in recent decades, interventions to improve nutrition and increase physical activity are almost certainly major contributors. Yet major problems remain. Diseases associated with obesity continue to incur substantial costs and cause widespread human suffering (IOM, 2012a). Moreover, substantial disparities in obesity rates exist among popu- lation groups, and in some cases these disparities are widening. As noted by individual speakers, some groups and regions are continuing to experience increases in obesity rates, and the prevalence of severe obesity is continu- ing to rise. Recent good news is no guarantee that progress will continue. 1  The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteur as a factual summary of what oc- curred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the Institute of Medicine, and they should not be construed as reflecting any group consensus. 1

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2 CURRENT STATE OF OBESITY SOLUTIONS The Institute of Medicine’s (IOM’s) pioneering work on obesity preven- tion has informed thought leaders at the forefront of the campaign to con- trol obesity in the United States. It has published major consensus reports on obesity prevention and treatment (IOM, 2006, 2007a,b, 2009a,b, 2010a,b, 2011a, 2012a, 2013a,b) and held a number of workshops on more focused obesity-related topics (IOM, 2007c, 2011b, 2012b,c, 2013c,d). Standing committees established by the IOM have monitored particular aspects of the obesity crisis and have organized events and issued publications in those areas. In 2013 the IOM formed the Roundtable on Obesity Solutions to engage leadership from multiple sectors in addressing the obesity crisis. The roundtable’s membership includes representatives of public health, health care, government, the food industry, education, philanthropy, the nonprofit sector, and academia. Through meetings, public workshops, background papers, and innovative collaboratives, the roundtable aims to foster an ongoing dialogue on critical and emerging implementation, policy, and research issues to accelerate progress in obesity prevention and care. Box 1-1 summarizes the introduction to the roundtable offered by Harvey Fineberg, president of the IOM, at the workshop that is the subject of this volume. On January 7, 2014, the roundtable held its first public event, a half- day workshop titled “The Current State of Obesity Solutions in the United BOX 1-1 The Institute of Medicine and the Obesity Crisis At the inaugural public event of the newly formed Roundtable on Obesity Solu- tions, Harvey Fineberg, president of the Institute of Medicine, lauded the recent declines in obesity rates among some population groups in the United States. “But how do we make the decline of obesity not the exception but the norm?” he asked. “What do we need to do?” The Roundtable on Obesity Solutions was formed to bring together leaders who can work together to identify effective solutions and act to implement those solutions, Fineberg said. He particularly promoted the idea of “action innovation collaboratives” in which groups could work together on aspects of the problem such as physical activity among young people, child care and early education, the food system, prevention in the community, and indicators of success. “The Institute of Medicine brings together the best expertise and the most thoughtful people to try to set forth solutions to the health challenges of our na- tion,” said Fineberg. “There is no problem that more readily exemplifies both the challenge and the potential for solution than obesity in the United States.”

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INTRODUCTION 3 States.” More than 100 people gathered for the workshop in Washington, DC, while approximately 450 registered participants watched the webcast of the event. Twenty-three presenters described interventions designed to prevent and treat obesity in seven settings: • early care and education, • schools, • worksites, • health care institutions, • communities and states, • the federal government, and • businesses and industry. For each of these settings, an initial presenter and two respondents pro- vided an overview of current efforts to improve nutrition, increase physi- cal activity, and reduce disparities among population groups. In addition, individual speakers suggested opportunities and topics the roundtable may consider as it examines future obesity solutions. The workshop was planned by Lisa Gable, president of the Healthy Weight Commitment Foundation; Shiriki Kumanyika, associate dean for health promotion and disease prevention at the University of Pennsylva- nia; Russell Pate, professor of exercise science at the University of South Carolina; Bill Purcell, attorney at law, Jones Hawkins & Farmer, PLC; Loel Solomon, vice president for community health at Kaiser Permanente; and Mary Story, professor of global health and community and family medicine at Duke University. This workshop summary describes the major observations, conclusions, and suggestions made by the presenters during their talks and subsequent discussions with workshop participants. The statements in this summary represent the viewpoints of the individual speakers and should not be construed as the conclusions or recommendations of the workshop. Col- lectively they provide a valuable snapshot of the current state of obesity solutions and the most promising paths forward. THEMES OF THE WORKSHOP Over the course of the workshop, several themes emerged from the presentations and discussions among individual workshop participants. These themes are presented here not as the conclusions of the workshop but as an introduction to the major topics of discussion: • The current opportunity • A multifaceted multisectoral approach

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4 CURRENT STATE OF OBESITY SOLUTIONS • Reducing disparities • Scale-up and dissemination • Continued innovation and research ORGANIZATION OF THIS SUMMARY Following this introductory chapter, Chapter 2 provides an overview of the epidemiology of obesity in the United States. Chapters 3 through 9 then examine the seven settings discussed at the workshop: early care and education (Chapter 3), schools (Chapter 4), worksites (Chapter 5), health care institutions (Chapter 6), communities and states (Chapter 7), the fed- eral government (Chapter 8), and businesses and industry (Chapter 9). A final chapter summarizes the closing remarks of the chair of the Roundtable on Obesity Solutions.