If local government officials were asked to describe their vision of what a healthy community looks like, they would probably cite many similar characteristics: effective and active schools; safe neighborhoods; clean parks and public spaces; and readily accessible services such as playgrounds, recreational facilities, libraries, and grocery stores. They might also paint a picture of healthy, happy children playing outside with their friends, walking to school, and eating healthy meals and snacks with their families and schoolmates.
This vision of healthy communities—places that promote the health and well-being of their residents—is a guidepost for childhood obesity prevention efforts. Taking actions that can make this vision a reality for all communities will help reverse and end this national epidemic. Childhood obesity has increased dramatically over the last three decades, and conditions in many communities continue to act as barriers to healthy eating and adequate physical activity. Childhood obesity is a serious health problem that has adverse and potentially long-lasting consequences for individuals, families, and communities. Perhaps most shocking, life expectancy for today’s children may be shortened in the United States because of the impact of childhood obesity (Olshansky and Ludwig, 2005).
The good news is that actions can be taken to prevent childhood obesity. Many of these actions, both policy and programmatic, can and should be taken at the local level. Two previous Institute of Medicine (IOM) reports take a comprehensive look at childhood obesity, present conclusions about likely causes and solutions, and offer recommendations for next steps (IOM, 2005, 2007). Many of these recommendations touch on the vital role of government actions at all
levels—federal, state, and local—in childhood obesity prevention. Local government leadership is critical to both reducing and preventing further increases in childhood obesity. The places in which people live, work, study, and play have a strong influence on their ability to consume healthy foods and beverages and engage in regular physical activity. Local governments make decisions every day that affect these environments. Thus, this report focuses on specific actions for local governments and is meant to be a tool for use by local government officials—mayors, managers, commissioners, council members, or administrators; elected, appointed, or hired; at the city, town, township, or county level—in planning, implementing, and refining childhood obesity efforts in their jurisdictions.
In 2008, the IOM Standing Committee on Childhood Obesity identified local government actions as key to front-line efforts addressing obesity prevention and requested a study to examine the evidence on such local government efforts, with a focus on identifying promising practices and developing a set of recommended actions. That committee was inspired by the recommendations in the previous IOM reports on childhood obesity and by the clear need for more detail at the local government level on which specific actions have the potential to make a difference. The IOM Committee on Childhood Obesity Prevention Actions for Local Governments was formed to address this task. The committee entered this project knowing that evidence on the best childhood obesity prevention practices is still accumulating and is limited in many important areas. However, the committee also knew that many local government officials want to act now on the best available information.
The committee reviewed the published literature, examined reports from organizations that work with local government, invited presentations from experts on the role of local government in obesity prevention, and explored a variety of toolkits that have been developed for communities. The committee worked to develop actionable recommendations for promoting healthy eating and physical activity and guided its decisions toward actions that are within the jurisdiction of local governments; are likely to affect children directly; are based on the experience of local governments or knowledgeable sources that work with local governments; and have the potential to make positive contributions to the achievement of healthy eating and/or optimum physical activity based on research evidence or, where such evidence is lacking or limited, a logical connection with the achievement of healthier eating and increased physical activity. The committee developed a set of criteria to consider in assessing the actions to recommend. Using the best evidence available, the committee took into account effectiveness and effect size;
outcomes, including those not directly related to obesity prevention; potential reach, impact, and cost; and feasibility (see Appendix C).
In this report, healthy eating refers to consuming the types and amounts of foods, nutrients, and calories recommended by the Dietary Guidelines for Americans (HHS and USDA, 2005). In the area of physical activity, current recommendations are for children to engage in such activity at least 60 minutes per day (HHS and USDA, 2008).
The committee targeted its recommendations to the food and physical activity environments outside the school walls and the school day. What takes place inside schools from the morning bell to the end of the last class and its impact on childhood obesity has been widely discussed (IOM, 2005, 2007; Story et al., 2006). By contrast, many other aspects of children’s environments, from the accessibility and maintenance of neighborhood playgrounds to the food and beverage choices offered in after-school programs, have not been discussed and publicized to the same extent. Therefore, the report generally focuses on nonschool issues. This focus does not imply that schools are unimportant in the prevention of childhood obesity. In fact, the involvement of schools in obesity prevention is vital; obesity prevention initiatives undertaken outside of schools will be stronger and have a greater impact if they are coordinated with and complement those of schools.
In this report, the committee recommends nine healthy eating strategies and six physical activity strategies that local governments should consider. These strategies are organized under three healthy eating goals and three physical activity goals. For each strategy, the report recommends a set of actions that have the potential to make a difference. The report also highlights 12 actions that the committee believes have the greatest potential, based on an assessment of the available research evidence and a logical connection with the achievement of healthier eating and increased physical activity. These 12 actions are highlighted in the list of goals, strategies, and actions at the end of this summary.
Evidence points to multisectoral initiatives (involving government, schools, the private sector, nonprofit organizations, and families) as being most effective in promoting and sustaining a healthy environment for children and youth (Economos et al., 2007; Sacks et al., 2008; Samuels and Associates, 2009). In many communities, however, policy makers may want to begin their obesity prevention efforts with some individual actions that they believe would be a good starting point, in preparation for later work on broader efforts.
While overall strategies can be recommended in accordance with evidence-based research, this information must be balanced with the need for community
participation in defining what is needed. The local context—including resources, demographics, culture, geographic location, and jurisdictional authority—will drive decisions on the policies and initiatives that can be implemented and sustained. While overall strategies can be recommended, and a range of potential actions to implement those strategies can be recommended, local officials and their community partners must use their own collective knowledge, judgment, and expertise to choose the best actions for their locality. Actions chosen must be a good fit for the community, and local government officials must be able to convince supporters and funders that these steps are important.
As local government officials work to understand the characteristics, needs, and assets of their communities, it will be critically important to involve concerned community members in examining, recommending, and building support for particular actions. These community members should include, among many others, parents, youth, and health providers. In addition, it will be important to partner with neighborhood-based grassroots nonprofit organizations, since they often have established networks for communication and outreach to residents. Active leadership is also key, and many mayors, city council representatives, and others have already taken the initiative to be prominently engaged in leading community efforts and involving community coalitions in promoting access to and availability of healthy choices and a healthy environment for their community.
Particular attention should be paid to conditions that result in unequal access to opportunities for healthy foods and beverages and physical activity. Factors such as poverty, poor housing, racial segregation, lack of access to quality education, and limited access to health care can influence access to healthy food and physical activity in negative ways. Understanding this interrelationship in the case of childhood obesity could lead local officials to note that many lower-income children in their jurisdiction do not engage in physical activity, and consequently to examine the equity of access to parks and recreational opportunities and safe neighborhoods and work to end these inequities. Local officials might observe inadequate consumption of fruits and vegetables among children in some parts of the community, and then consider and seek solutions to the unequal accessibility and affordability of healthy foods in these neighborhoods. Achieving health equity—“the fair distribution of health determinants, outcomes, and resources within and between segments of the population regardless of social standing” (CDC, 2007)—requires local governments to focus their obesity prevention efforts on historically disadvantaged communities with disproportionately high rates of obesity.
Finally, as obesity prevention actions are implemented, they will need to be evaluated. Local governments can contribute to the evidence base on what does and does not work by emphasizing and funding assessments of obesity prevention efforts. Partnerships with local universities can be particularly valuable in conducting these evaluations. Lessons learned through experimentation and formal evaluation can assist a community in making better decisions about future actions while helping other communities like them become more successful in preventing childhood obesity.
CDC (Centers for Disease Control and Prevention). 2007 (unpublished). Health Equity Working Group. Atlanta, GA: CDC.
Economos, C. D., R. R. Hyatt, J. P. Goldberg, A. Must, E. N. Naumova, J. J. Collins, and M. E. Nelson. 2007. A community intervention reduces BMI z-score in children: Shape Up Somerville first year results. Obesity 15(5):1325–1336.
HHS and USDA (U.S. Department of Health and Human Services and U.S. Department of Agriculture). 2005. Dietary Guidelines for Americans 2005. http://www.healthierus.gov/dietaryguidelines (accessed February 25, 2009).
HHS and USDA. 2008. Physical Activity Guidelines for Americans. http://www.health.gov/paguidelines/guidelines/default.aspx (accessed May 19, 2009).
IOM (Institute of Medicine). 2005. Preventing Childhood Obesity: Health in the Balance. Washington, DC: The National Academies Press.
IOM. 2007. Progress in Preventing Childhood Obesity: How Do We Measure Up? Washington, DC: The National Academies Press.
Olshansky, S. J., and D. S. Ludwig. 2005. Effect of obesity on life expectancy in the U.S. Food Technology 59(7):112.
Sacks, G., B. A. Swinburn, and M. A. Lawrence. 2008. A systematic policy approach to changing the food system and physical activity environments to prevent obesity. Australia and New Zealand Health Policy 5.
Samuels and Associates. 2009. Healthy Eating, Active Communities (HEAC) Phase 1 Evaluation Findings, 2005–2008. Executive Summary. http://samuelsandassociates.com/samuels/index.php?option=com_content&view=article&id=27&Itemid=11 (accessed July 13, 2009).
Story, M., K. M. Kaphingst, and S. French. 2006. The role of schools in obesity prevention. Future of Children 16(1):109–142.
Actions for Healthy Eating
(Bold denotes most promising action steps)
GOAL 1: IMPROVE ACCESS TO AND CONSUMPTION OF HEALTHY, SAFE, AND AFFORDABLE FOODS
Strategy 1: Retail Outlets
Increase community access to healthy foods through supermarkets, grocery stores, and convenience/corner stores.
Strategy 2: Restaurants
Improve the availability and identification of healthful foods in restaurants.
Strategy 3: Community Food Access
Promote efforts to provide fruits and vegetables in a variety of settings, such as farmers’ markets, farm stands, mobile markets, community gardens, and youth-focused gardens.
Strategy 4: Public Programs and Worksites
Ensure that publicly run entities such as after-school programs, child care facilities, recreation centers, and local government worksites implement policies and practices to promote healthy foods and beverages and reduce or eliminate the availability of calorie-dense, nutrient-poor foods.
Strategy 5: Government Nutrition Programs
Increase participation in federal, state, and local government nutrition assistance programs (e.g., WIC, School Breakfast and Lunch Programs, the Child and Adult Care Food Program, the Afterschool Snacks Program, the Summer Food Service Program, SNAP).
Strategy 6: Breastfeeding
Encourage breastfeeding and promote breastfeeding-friendly communities.
Strategy 7: Access to Drinking Water
Increase access to free, safe drinking water in public places to encourage consumption of water instead of sugar-sweetened beverages.
GOAL 2: REDUCE ACCESS TO AND CONSUMPTION OF CALORIE-DENSE, NUTRIENT-POOR FOODS
Strategy 8: Policies and Ordinances
Implement fiscal policies and local ordinances that discourage the consumption of calorie-dense, nutrient-poor foods and beverages (e.g., taxes, incentives, land use and zoning regulations).
GOAL 3: RAISE AWARENESS ABOUT THE IMPORTANCE OF HEALTHY EATING TO PREVENT CHILDHOOD OBESITY
Strategy 9: Media and Social Marketing
Promote media and social marketing campaigns on healthy eating and childhood obesity prevention.
Actions for Increasing Physical Activity
(Bold denotes most promising action steps)
GOAL 1: ENCOURAGE PHYSICAL ACTIVITY
Strategy 1: Built Environment
Encourage walking and bicycling for transportation and recreation through improvements in the built environment.
Strategy 2: Programs for Walking and Biking
Promote programs that support walking and bicycling for transportation and recreation.
Strategy 3: Recreational Physical Activity
Promote other forms of recreational physical activity.
Strategy 4: Routine Physical Activity
Promote policies that build physical activity into daily routines.
GOAL 2: DECREASE SEDENTARY BEHAVIOR
Strategy 5: Screen Time
Promote policies that reduce sedentary screen time.
GOAL 3: RAISE AWARENESS OF THE IMPORTANCE OF INCREASING PHYSICAL ACTIVITY
Strategy 6: Media and Social Marketing
Develop a social marketing campaign that emphasizes the multiple benefits for children and families of sustained physical activity.