THE CURRENT STATE OF

OBESITY SOLUTIONS

IN THE UNITED STATES

Workshop Summary

Steve Olson, Rapporteur

Roundtable on Obesity Solutions

Food and Nutrition Board

INSTITUTE OF MEDICINE
            OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu



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Steve Olson, Rapporteur Roundtable on Obesity Solutions Food and Nutrition Board

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THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose mem- bers are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This activity was supported by contracts between the National Academy of Sciences and The JPB Foundation (Contract No. 10001561); Kaiser Permanente (Contract No. 10001518); The Kresge Foundation (Contract No. 10001539); Robert Wood Johnson Foundation (Contract No. 10001565); Academy of Nutrition and Dietet- ics; Alliance for a Healthier Generation; American Academy for Pediatrics; Ameri- can College of Sports Medicine; American Council on Exercise; American Heart Association; American Society for Nutrition; Bipartisan Policy Center; Blue Cross Blue Shield of North Carolina; ChildObesity180/Tufts University; Edelman; General Mills, Inc.; Greater Rochester Health Foundation; HealthPartners, Inc.; Healthy Weight Commitment Foundation; Highmark, Inc.; Kellogg Company; Mars, Inc.; Nemours Foundation; Nestlé Nutrition, North America; Nestlé USA; The Obesity Society; Partnership for a Healthier America; President’s Council on Fitness, Sports, and Nutrition; Reebok, International; Salud America!; Sesame Workshop; and YMCA of the USA. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity. International Standard Book Number-13:  978-0-309-30275-3 International Standard Book Number-10:  0-309-30275-7 Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2014. The current state of obesity solutions in the United States: Workshop summary. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE FOR A WORKSHOP ON THE CURRENT STATE OF OBESITY SOLUTIONS IN THE UNITED STATES1 BILL PURCELL III (Chair), Jones Hawkins & Farmer, PLC, Nashville, Tennessee RUSSELL R. PATE (Vice Chair), University of South Carolina, Columbia MARY T. STORY (Vice Chair), Duke University, Durham, North Carolina LISA GABLE, Healthy Weight Commitment Foundation, Washington, DC SHIRIKI KUMANYIKA, University of Pennsylvania, Philadelphia LOEL SOLOMON, Kaiser Permanente, Oakland, California IOM Staff LYNN PARKER, Scholar LESLIE J. SIM, Senior Program Officer HEATHER DEL VALLE COOK, Program Officer SARAH ZIEGENHORN, Research Associate SARAH SIEGEL, Senior Program Assistant Consultant WILLIAM H. DIETZ, Centers for Disease Control and Prevention (retired) 1  Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. v

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ROUNDTABLE ON OBESITY SOLUTIONS1 BILL PURCELL III (Chair), Jones Hawkins & Farmer, PLC, Nashville, Tennessee RUSSELL R. PATE (Vice Chair), University of South Carolina, Columbia MARY T. STORY (Vice Chair), Duke University, Durham, North Carolina SHARON ADAMS-TAYLOR, American Association of School Administrators, Alexandria, Virginia NELSON G. ALMEIDA, Kellogg Company, Battle Creek, Michigan LEON ANDREWS, National League of Cities, Washington, DC SHAVON ARLINE-BRADLEY, National Association for the Advancement of Colored People, Baltimore, Maryland HEIDI MICHELS BLANCK, Centers for Disease Control and Prevention, Atlanta, Georgia DON W. BRADLEY, Blue Cross and Blue Shield of North Carolina, Durham CEDRIC X. BRYANT, American Council on Exercise, San Diego, California DEBBIE I. CHANG, Nemours Foundation, Newark, Delaware YVONNE COOK, Highmark, Inc., Pittsburgh, Pennsylvania EDWARD COONEY, Congressional Hunger Center, Washington, DC KITTY HSU DANA, United Way Worldwide, Alexandria, Virginia BONNIE C. DEVINNEY, Greater Rochester Health Foundation, Rochester, New York CHRISTINA ECONOMOS, Tufts University, Boston, Massachusetts DAVID D. FUKUZAWA, The Kresge Foundation, Troy, Michigan LISA GABLE, Healthy Weight Commitment Foundation, Washington, DC PAUL GRIMWOOD, Nestlé USA, Glendale, California SANDRA G. HASSINK, American Academy for Pediatrics, Wilmington, Delaware SCOTT I. KAHAN, STOP Obesity Alliance, Washington, DC SHIRIKI KUMANYIKA, University of Pennsylvania, Philadelphia CATHERINE KWIK-URIBE, Mars, Inc., Germantown, Maryland THEODORE KYLE, The Obesity Society, Pittsburgh, Pennsylvania LISEL LOY, Bipartisan Policy Center, Washington, DC MARY-JO MAKARCHUK, Canadian Institutes of Health Research/ Instituts de recherche en santé du Canada, Toronto, Ontario LINDA D. MEYERS, American Society for Nutrition, Bethesda, Maryland H. MELVIN MING, Sesame Workshop, New York, New York NEIL NICOLL, YMCA of the USA, Chicago, Illinois 1  Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution. vi

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SHELLIE PFOHL, President’s Council on Fitness, Sports, and Nutrition, Rockville, Maryland BARBARA PICOWER, The JPB Foundation, New York, New York DWAYNE PROCTOR, Robert Wood Johnson Foundation, Princeton, New Jersey NICOLAS P. PRONK, HealthPartners, Inc., Minneapolis, Minnesota AMELIE G. RAMIREZ, Salud America!, San Antonio, Texas OLIVIA ROANHORSE, Notah Begay III Foundation, Santa Ana Pueblo, New Mexico SYLVIA ROWE, S.R. Strategy, LLC, Washington, DC JOSE (PEPE) M. SAAVEDRA, Nestlé Nutrition, North America, Florham Park, New Jersey MARGIE SAIDEL, Chartwells School Dining Services, Toms River, New Jersey JAMES F. SALLIS, University of California, San Diego EDUARDO J. SANCHEZ, American Heart Association, Dallas, Texas BRIAN SMEDLEY, Joint Center for Political and Economic Studies, Washington, DC LAWRENCE SOLER, Partnership for a Healthier America, Washington, DC LOEL S. SOLOMON, Kaiser Permanente, Oakland, California ALISON L. STEIBER, Academy of Nutrition and Dietetics, Chicago, Illinois MAHA TAHIRI, General Mills, Inc., Minneapolis, Minnesota KATHLEEN TULLIE, Reebok, International, Canton, Massachusetts TISH VAN DYKE, Edelman, Washington, DC HOWELL WECHSLER, Alliance for a Healthier Generation, New York, New York JAMES R. WHITEHEAD, American College of Sports Medicine, Indianapolis, Indiana IOM Staff LYNN PARKER, Scholar LESLIE J. SIM, Senior Program Officer HEATHER DEL VALLE COOK, Program Officer SARAH ZIEGENHORN, Research Associate SARAH SIEGEL, Senior Program Assistant FAYE HILLMAN, Financial Associate GERALDINE KENNEDO, Administrative Assistant ANN L. YAKTINE, Interim Director, Food and Nutrition Board Consultant WILLIAM H. DIETZ, Centers for Disease Control and Prevention (retired) vii

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Reviewers This workshop summary has been reviewed in draft form by individu- als chosen for their diverse perspectives and technical expertise, in accor- dance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the summary meets institutional standards for objectivity, evidence, and respon- siveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary: Jessica Donze-Black, The Pew Charitable Trusts Tracy Fox, Food, Nutrition, and Policy, Consultants Sandra Hassink, A.I. Dupont Hospital for Children Geri Henchy, Food Research and Action Center Ellen Wartella, Northwestern University Although the reviewers listed above provided many constructive com- ments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this summary was overseen by Hugh Tilson, University of North Carolina. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this summary was carried out in accordance with institu- tional procedures and that all review comments were carefully considered. Responsibility for the final content of this summary rests entirely with the rapporteur and the institution. ix

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Contents 1 INTRODUCTION 1 Background, 1 Themes of the Workshop, 3 Organization of This Summary, 4 2 CURRENT EPIDEMIOLOGY OF OBESITY IN THE UNITED STATES 5 Adult and Child Obesity Rates, 6 An Analogy with Tobacco, 8 Severe Obesity, 9 The Costs of Obesity, 10 Policy Interventions, 13 3 EARLY CARE AND EDUCATION 15 Status and Current Needs, 16 Monitoring and Technical Assistance, 18 Improving and Expanding the Child and Adult Food Care Program, 20 4 SCHOOLS 23 Putting the Evidence to Work, 24 Promoting Physical Activity, 27 Promoting Nutrition, 28 xi

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xii CONTENTS 5 WORKSITES 31 Hy-Vee: An Example of Success, 32 General Mills: A Multifaceted Approach, 33 Transportable Worksite Initiatives, 34 6 HEALTH CARE 37 The Role of the Insurance Industry, 38 Health Care Providers, 39 Health Systems, 40 7 COMMUNITIES AND STATES 43 Action at the Local Level, 44 Strategies in Massachusetts, 47 The Power of Policies, 48 8 THE FEDERAL GOVERNMENT 51 Nutrition Programs at USDA, 52 Physical Activity Programs and Policies at HHS, 53 Potential Principles and Actions, 55 9 BUSINESSES AND INDUSTRY 57 Initiatives of the Food and Beverage Industry, 58 Effective Public–Private Partnerships, 59 10 CLOSING REMARKS 61 REFERENCES 63 APPENDIXES A WORKSHOP AGENDA 65 B SPEAKER BIOGRAPHICAL SKETCHES 69