The United States is experiencing an epidemic of childhood obesity. Recent national statistics show that almost one-third of U.S. children and adolescents are overweight or obese (Ogden et al., 2008). Approximately one of six U.S. children is classified as obese (≥ 95th percentile for weight), and one of ten is classified as very obese (≥ 97th percentile for weight). Childhood obesity pervades all sectors of society regardless of race, education level, or income. The current trajectory of the problem will affect the health of the U.S. population for decades to come, incurring substantial costs to the nation.
In 2002, Congress charged the Institute of Medicine (IOM) with developing a prevention-focused action plan for decreasing the number of obese children in the United States. In response, the IOM conducted an in-depth review of the literature on obesity prevention and a series of fact-finding workshops. Two reports resulted from these efforts. The first—Preventing Childhood Obesity: Health in the Balance, issued in 2004—identifies promising approaches for obesity prevention efforts and presents recommendations for a variety of stakeholders and sectors (IOM, 2005). The second—Progress in Preventing Childhood Obesity: How Do We Measure Up?, released in 2007—provides a progress report on efforts undertaken since the 2004 report, with a particular focus on minority and underserved populations, and recommends evaluation of prevention efforts (IOM, 2007). To sustain a nationwide call to action for childhood obesity prevention, the IOM, with support from The Robert Wood Johnson Foundation, maintains a Standing Committee on Childhood Obesity Prevention.
The present report summarizes the information gathered at a workshop held February 5–6, 2009, in Austin, Texas. Texas was chosen as a case study because of its childhood obesity statistics, demographics, size, and efforts to prevent and reduce obesity. At this workshop, committee members met with Texas lawmakers, public officials, and community leaders to exchange ideas and to view first-hand strategies that are being implemented effectively at the state and local levels to prevent and reverse childhood obesity.
The focus on obesity efforts in Texas is particularly appropriate given that state’s sobering statistics. Texas is home to three of the five cities with the highest obesity rates in the nation. In 2007, two-thirds of Texas adults and one-third of Texas high school students were either overweight or obese. Moreover, information released in January 2009 by the state demographer indicates that, absent preventive measures, the number of obese Texans will triple by 2040 to reach 15 million (Eschbach and Fonseca, 2009).
Texas leaders at the workshop expressed the strong belief that the state’s economic vitality and security depend on the health of its population. Accordingly, the state is no longer simply describing the personal, community, and financial costs of its obesity crisis; it is taking proactive steps to address the problem through strategic initiatives. An overarching strategy is to address obesity by targeting the state’s youth, in whom it may be possible to instill healthy behaviors and lifestyles to last a lifetime. A guiding principle of these efforts is that they should be evidence based, community specific, sustainable, cost-effective, and supported by effective partnerships. Moreover, the goal is for the responsibility to be broadly shared by individuals, families, communities, and the public and private sectors. A number of themes emerged from the workshop. These themes are summarized below.
Garnering Support for Childhood Obesity Initiatives
Obtaining Buy-in from the Public
Many individuals fail to understand the threat childhood obesity poses to society. Therefore, it was suggested that organizations targeting childhood obesity should consider including a public education component in their strategic plan.
Also essential is to engage members of the community in obesity prevention initiatives. The Paso del Norte Health Foundation has been highly
successful in implementing several programs in El Paso because it engages and draws support from community members by having business leaders, parents, and educators participate on its committees.
Obtaining Buy-in from Legislators
Childhood obesity does not resonate as a cause with some policymakers, perhaps because they find the idea of addressing the problem unattractive or the consequences too distant. Linking the problem to broader, more familiar issues, such as education and economic development, appears to be an effective approach.
Modeling Healthy Behaviors Throughout the Community
To extend anti-obesity efforts beyond its schools, Texas is offering incentives to businesses to institute workplace wellness programs. Such programs already established in a handful of Texas businesses have realized benefits in the form of fewer inpatient hospital admissions, reduced absenteeism, annual insurance savings, and reductions in health care costs, thus yielding a positive return on the workplace wellness investment. These employers have recognized that having a healthy workforce that is ready and able to work improves the fiscal bottom line. Texas has also implemented programs to encourage healthy behaviors among its state employees.
Leveraging the Power of Partnerships
Collaborative efforts often generate more momentum, resources, and influence than individual efforts. Representatives of nearly all organizations commented that community-based solutions to childhood obesity require a diverse array of partners, including elected officials; state agencies, such as the Department of State Health Services; worksites and schools; institutions of higher education; the food industry; community groups; providers and hospitals; urban planners, developers, and architects; and many other partners, such as city councils, county commissioners, the police, and nonprofit organizations. One of the most important partners is parents, since they serve as models for their children.
Implementing Comprehensive Approaches
Previous public health campaigns have demonstrated the need for a comprehensive approach. The Texas Tobacco Prevention Initiative, conducted in Austin/Travis County, taught leaders in the Health and Human Services Department that multicomponent interventions involving schools
and communities, the media, smoking cessation programs, and law enforcement are more effective than single-component interventions in reducing tobacco use.
Using Social Marketing
Speakers emphasized that organizations need to think and act like marketers when trying to promote the anti-obesity cause. Several groups well versed in social marketing stated that promoting healthy lifestyles rather than the prevention of childhood obesity is more powerful in influencing people to change their habits.
Identifying a Champion
During the workshop, it became clear that those programs that developed organically at the local level and were successful had individual champions advocating a specific cause, such as a better park system for the town or a walking marathon geared specifically to children. These champions, who can also be found at the state level, tend to be energizing individuals who lead by action and who spread their enthusiasm by communicating continually with others in the community. Their efforts unite people toward a common goal and leverage resources.
Recognizing the Power of Community Data
In culturally diverse states such as Texas, it is important to collect community data to measure the outcomes of interventions. Efforts that are effective in north Texas may not be influential in border communities in south Texas. The size and cultural diversity of Texas often necessitate customized interventions. Equally important is collecting state-level data that allow a state to compare its performance with that of others. This is one way to mobilize a call to action, particularly among policy makers.
Implementing Federal Policy Change
Representatives of some organizations, particularly those at the state level, advocated policy change at the federal level as a strategy for creating change at the community and state levels. This approach, it was argued, ensures that no communities or schools fall through the cracks with regard to nutrition and physical fitness standards. Moreover, instituting some basic changes at the federal level provides a foundation upon which states and communities can build.
Funding is an obvious need of all organizations targeting childhood obesity. Funders are sometimes risk averse, meaning that innovative initiatives can be overlooked for funding. One speaker requested that innovation be placed at the top of funding priorities and that success be redefined. He suggested that funders should also consider financing only projects that are scalable, adaptable, and sustainable so that successful programs can be translated to other locales.
Funding is needed not only to launch programs but also to sustain them, particularly at the local level. Many small organizations are focused so intently on getting their initiatives off the ground that they can lose sight of the resources needed to sustain their efforts.
Childhood obesity remains a major challenge facing the nation—one that threatens the immediate health of our children; the future stability of our health care system; and ultimately the long-term vitality of local, state, and national economies. Workshop speakers emphasized that the changes needed to reverse the obesity trend must be robust enough to counteract the factors that led to obesity in the first place. Collaborative involvement of multiple sectors and stakeholders at all societal levels is required to alter collective cultural norms that have contributed to the childhood obesity epidemic. The efforts undertaken in Texas serve as a case study of various streams of influence at the state and local levels that are merging to effect the prevention and reversal of childhood obesity across the state. The Standing Committee on Childhood Obesity Prevention can draw on the experiences shared and information gleaned during the Workshop on Childhood Obesity Prevention in Texas to initiate, foster, and sustain other obesity prevention efforts nationwide, with the aim of turning the tide on this public health crisis.
Eschbach, K., and V. Fonseca. 2009. Summary: Findings about the Obesity Epidemic in Texas. http://txsdc.utsa.edu/download/pdf/obesity/THI_Obesity_Summary.pdf (accessed July 21, 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.
Ogden, C. L., M. D. Carroll, and K. M. Flegal. 2008. High body mass index for age among U.S. children and adolescents, 2003–2006. Journal of the American Medical Association 299(20):2401–2405.