Progress in Preventing Childhood Obesity
How Do We Measure Up?
Jeffrey P. Koplan, Catharyn T. Liverman, Vivica I. Kraak, Shannon L. Wisham, Editors
THE NATIONAL ACADEMIES PRESS
THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
The study was supported by Grant Nos. 052339 and 56982 between the National Academy of Sciences and the Robert Wood Johnson Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
Library of Congress Cataloging-in-Publication Data
Progress in preventing childhood obesity : how do we measure up? / Committee on Progress in Preventing Childhood Obesity ; Jeffrey P. Koplan … [et al.], editors.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-309-10208-7 (hbk.)
ISBN-10: 0-309-10208-1 (hbk.)
1. Obesity in children—United States—Prevention. 2. Child health services—United States—Evaluation. 3. Nutrition policy—United States—Evaluation. I. Koplan, Jeffrey. II. Institute of Medicine (U.S.). Committee on Progress in Preventing Childhood Obesity.
[DNLM: 1. Child. 2. Obesity—prevention & control. WD 210 P964 2007]
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COMMITTEE ON PROGRESS IN PREVENTING CHILDHOOD OBESITY
JEFFREY P. KOPLAN (Chair),
Woodruff Health Sciences Center, Emory University, Atlanta, GA
ROSS C. BROWNSON,
Department of Community Health, St. Louis University School of Public Health, MO
Health and Medical Division, Eastern Band of Cherokee Indians, Cherokee, NC
SUSAN B. FOERSTER,
Cancer Prevention and Nutrition Section, California Department of Health Services, Sacramento, CA
JENNIFER C. GREENE,
Department of Educational Psychology, University of Illinois Urbana-Champaign
DOUGLAS B. KAMEROW,
Health, Social, and Economics Research, RTI International, Washington, DC
MARSHALL W. KREUTER,
Institute of Public Health, College of Health and Human Sciences, Georgia State University, Atlanta, GA
RUSSELL R. PATE,
Department of Exercise Science, University of South Carolina, Columbia
JOHN C. PETERS,
Food and Beverage Technology, Procter & GambleCompany, Cincinnati, OH
KENNETH E. POWELL,
Chronic Disease, Injury, and Environmental Epidemiology Section, Division of Public Health, Georgia Department of Human Resources (emeritus), Atlanta, GA
THOMAS N. ROBINSON,
Division of General Pediatrics and Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA
EDUARDO J. SANCHEZ,
Texas Department of State Health Services, Austin, TX
ANTRONETTE (TONI) YANCEY,
Department of Health Services and Center to Eliminate Health Disparities, UCLA School of Public Health, Los Angeles, CA
SHIRIKI K. KUMANYIKA,
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
DONNA NICHOLS, Senior Prevention Policy Analyst,
Texas Department of State Health Services, Austin
VIVICA I. KRAAK, Co-Study Director
CATHARYN T. LIVERMAN, Co-Study Director
LINDA D. MEYERS, Director,
Food and Nutrition Board
SHANNON L. WISHAM, Research Associate
JON Q. SANDERS, Senior Program Assistant (until June 2006)
JESSICA COHEN, Christine Mirzayan Science and Technology Policy Graduate Fellow (June to August 2006)
FOOD AND NUTRITION BOARD*
DENNIS M. BIER (Chair),
Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
MICHAEL P. DOYLE (Vice Chair),
Center for Food Safety, University of Georgia, Griffin
Center for Research on Dietary Botanical Supplements, Iowa State University, Ames
School of Public Health and Policy, Morgan State University, Baltimore, MD
Chemical Producers and Distributors Association, Alexandria, VA
NANCY F. KREBS,
Department of Pediatrics, University of Colorado Health Sciences Center, Denver
Department of Global Health, Emory University, Atlanta, GA
J. GLENN MORRIS, JR.,
Department of Epidemiology and Preventive Medicine University of Maryland School of Medicine, Baltimore
SUZANNE P. MURPHY,
Cancer Research Center of Hawaii, University of Hawaii, Honolulu
JOSE M. ORDOVAS,
Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
JIM E. RIVIERE,
College of Veterinary Medicine, North Carolina State University, Raleigh
NICHOLAS J. SCHORK,
Department of Psychiatry, Polymorphism Research Laboratory, University of California, San Diego
REBECCA J. STOLTZFUS,
Division of Nutritional Sciences, Cornell University, Ithaca, NY
JOHN W. SUTTIE,
Department of Biochemistry, University of Wisconsin, Madison
WALTER C. WILLETT,
Department of Nutrition, Harvard School of Public Health, Boston, MA
BARRY L. ZOUMAS,
Department of Agricultural Economics and Rural Sociology, Pennsylvania State University, University Park
LINDA D. MEYERS, Director
GERALDINE KENNEDO, Administrative Assistant
ANTON L. BANDY, Financial Associate
Independent Report Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance 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 report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
HEIDI ARTHUR, The Ad Council, New York, NY
BILL BEERY, Group Health Community Foundation, Seattle, WA
LORELEI DISOGRA, Nutrition and Health, United Fresh Fruit and Vegetable Association, Washington, DC
STEPHEN B. FAWCETT, Work Group for Community Health and Development/World Health Organization (WHO), University of Kansas, Lawrence
VANESSA NORTHINGTON GAMBLE, National Center for Bioethics in Research and Health Care, Tuskegee University, AL
DEBRA HAIRE-JOSHU, Department of Community Health, Saint Louis University School of Public Health, St. Louis, MO
SUSAN L. HANDY, Department of Environmental Science and Policy, University of California, Davis
CATHY KAPICA, former Global Director of Nutrition, McDonald’s Corporation, Oakbrook, IL
JOE THOMPSON, Surgeon General, State of Arkansas and Arkansas Center for Health Improvement, Little Rock
BRIAN WANSINK, Department of Applied Economics and Management, Cornell University, Ithaca, NY
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by CUTBERTO GARZA, Boston College. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
The remarkable growth of obesity in the young population in many parts of the world in a relatively short time span represents one of the defining public health challenges of the 21st century. At this early phase in addressing childhood obesity, action has begun on a number of levels to improve dietary patterns and increase physical activity in children and youth throughout the United States and in other countries. Schools, corporations, youth-related organizations, families, communities, foundations, and government agencies are working to implement a variety of policy changes, new programs, and other interventions. There is a great deal yet to be learned about how to evaluate these efforts and disseminate information on effective interventions. Additionally, lessons learned from other public health concerns such as the prevention of youth tobacco use and alcohol consumption can provide insights and directions for further efforts. However, the solutions to tobacco and alcohol consumption among our young people cannot be fully replicated due to the complexity of obesity and the ubiquity of food, sedentary habits, and familiar routines in our culture that contribute to the problem. A comprehensive response to the obesity epidemic requires connectivity, consistency, and continuity across multiple programs and sectors. Preventing childhood obesity will involve changes in social norms and the demand by the general public for healthier lifestyles and the products and opportunities that support physical activity and healthful diets. Innovations are needed that accelerate the pace of change that will move us toward these goals.
In 2002, the Institute of Medicine (IOM) responded to a congressional mandate by developing an action plan for preventing childhood obesity. The IOM report Preventing Childhood Obesity: Health in the Balance provided recommendations for further action by multiple stakeholders. As a natural outcome of that report, IOM established the Committee on Progress in Preventing Childhood Obesity in 2005 with support from the Robert Wood Johnson Foundation. The IOM committee was charged with undertaking a study to assess the nation’s progress in preventing childhood obesity. It was also asked to engage in a dissemination effort promoting the implementation of the report’s findings and recommendations through three symposia that were held in Atlanta, Georgia; Irvine, California; and Wichita, Kansas.
This report, Progress in Preventing Childhood Obesity: How Do We Measure Up?, places a specific focus on the evaluation of actions taken by all sectors of society and describes progress made toward the first report’s recommendations. Evaluation is vital to identify effective interventions that can be scaled up to statewide or nationwide efforts, while ineffective interventions can be replaced with more promising evidence-based efforts. As the Health in the Balance report acknowledged, we must draw from the best available evidence rather than waiting for the best possible evidence to mount an effective and sustained response. Along the way, we must ask whether the interventions to promote healthful eating and increase physical activity are reaching enough people to make a substantial difference, and whether the breadth of interventions are adequate to address the scope of the problem.
An expanded and diverse evidence base will provide the foundation for a sustained effort toward reversing the current childhood obesity trends and improving the health and well-being of America’s children and youth. We have made considerable progress in five years since the release of the Surgeon General’s Call to Action. However, there is a great deal more work that all of us collectively need to undertake in order to adequately address the impending obesity crisis and thereby chart a healthier course for our future generations.
Jeffrey P. Koplan, Chair
Committee on Progress in Preventing Childhood Obesity
It was a great pleasure to chair the Institute of Medicine (IOM) Committee on Progress in Preventing Childhood Obesity. The 13-member committee brought tremendous expertise to this important topic from a variety of perspectives and was actively engaged in the committee’s work. This report represents the result of six meetings, two public workshops, three regional symposia, and ongoing communication throughout the course of the study. It is also the result of a thoughtful analysis and interdisciplinary collaboration among the committee members who volunteered countless hours of their valuable time to complete this study. I would like to extend my sincere thanks to each of the committee members for their commitment to work through the issues addressed in this report.
This study was sponsored by the Robert Wood Johnson Foundation (RWJF). The committee and staff wish to thank RWJF staff including Risa Lavizzo-Mourey, James Marks, Kathryn Thomas, and Laura Leviton for their support and guidance on the committee’s task during the course of the study. The committee also benefited from discussions with individuals who presented at or attended the committee’s workshops, symposia, and meetings. We especially appreciate the contributions of Loel Solomon and Scott Gee from Kaiser Permanente; Susan Yanovski from the National Institute of Diabetes & Digestive & Kidney Diseases; Janet Collins from the Centers for Disease Control and Prevention (CDC); Penelope Royall from the U.S. Department of Health and Human Services (DHHS) Office of Disease Prevention and Health Promotion; Richard Kelly from the Federal Trade Commission; Eric Hentges from the U.S. Department of Agriculture; and Dana Carr from the U.S. Department of Education. I would especially like to
thank Kathryn Thomas at the RWJF; Marni Vliet, Steve Coen, and Deanna Van Hersh at the Kansas Health Foundation; Gary Nelson, Martha Katz, Meg Watson, and Allison Maiuri at the Healthcare Georgia Foundation; and Robert Ross, George Flores, and Marion Standish at The California Endowment for collaborating with the committee and staff to organize and co-host the regional symposia. The symposia agendas and speakers are listed in Appendixes F, G, and H.
Many individuals were instrumental in providing useful data to the committee that was included in the report. We greatly appreciate the work and insights of Shiriki Kumanyika and Donna Nichols who served as consultants to the committee. We thank Bill Dietz, Edward Hunter, and Lynda Williams from CDC. We also thank Alison Kretser and Marjorie Goldstein for providing useful information used in the report. We would like to especially thank Tim Lobstein from the International Obesity Taskforce in London for sharing information about other country strategies and action plans to promote healthful eating, physical activity, and prevent obesity. Enrique Jacoby, Juan Rivera, Carlos Monteiro, and Fernando Vio were helpful in guiding the committee to obesity prevention activities and strategies in Latin America. Francesco Branca, Elina Hirvikallio, Raija Kara, Tim Lang, Wolf-Martin Maier, Canice Nolan, Philippe Roux, and Alberto Galvão A. A. Teles provided useful information about obesity prevention activities, strategies, and action plans in Europe.
We appreciate the constructive input offered by the reviewers of this report who provided a technical review of sections of the report. Special thanks are extended to Michael McGinnis and Rosemary Dederichs for their technical review of selected chapters. We also acknowledge the financial oversight of Anton Bandy and Gary Walker. The committee benefited greatly from the skillful copyediting of the report by Michael Hayes, cover design by Samantha Razook Murphy, and chapter illustrations by Becky Heavner. Finally, a study of this scope is only possible with the assistance of the IOM staff. I would like to thank co-study directors, Cathy Liverman and Vivica Kraak, research associate Shannon Wisham, board director Linda Meyers, policy fellow Jessica Cohen, and senior program assistant Jon Sanders for their steadfast devotion to the study process and final report.
Progress in Preventing Childhood Obesity: How Do We Measure Up? presents recommendations relevant to implementing and evaluating obesity prevention interventions within and across many sectors—government, industry, communities, schools, and home—and urges all sectors and invested stakeholders to take the collective actions needed to improve the health and well-being of children and youth.
Jeffrey P. Koplan, Chair
Committee on Progress in Preventing Childhood Obesity