A Plan for Measuring Progress
Committee on Evaluating Progress of Obesity Prevention Efforts
Food and Nutrition Board
Lawrence W. Green, Leslie Sim, Heather Breiner, Editors
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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.
This study was supported by a grant between the National Academy of Sciences and the Michael & Susan Dell Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
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Suggested citation: IOM (Institute of Medicine). 2013. Evaluating obesity prevention efforts: A plan for measuring progress. Washington, DC: The National Academies Press.
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COMMITTEE ON EVALUATING PROGRESS OF OBESITY PREVENTION EFFORTS
LAWRENCE W. GREEN (Chair), Professor, Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
CHRISTINA BETHELL, Professor, Pediatrics, School of Medicine, Oregon Health and Science Center, Child and Adolescent Health Measurement Initiative, Portland
RONETTE R. BRIEFEL, Senior Fellow, Mathematica Policy Research, Washington, DC
ROSS C. BROWNSON, Professor, Epidemiology, Brown School and School of Medicine, Washington University in St. Louis
JAMIE F. CHRIQUI, Senior Research Scientist, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago
STEPHEN FAWCETT, Professor, Applied Behavioral Science, Director, Work Group for Community Health and Development, University of Kansas, Lawrence
BRIAN R. FLAY, Professor, Public Health, Co-Director, Promise Neighborhoods Research Consortium, Oregon State University, Corvallis
DEANNA M. HOELSCHER, Director and Professor, Michael & Susan Dell Center for Healthy Living, The University of Texas School of Public Health, Austin Regional Campus, TX
JAMES W. KRIEGER, Chief, Chronic Disease and Injury Prevention, Public Health–Seattle & King County, WA
LAURA C. LEVITON, Senior Advisor for Evaluation, Robert Wood Johnson Foundation, Princeton, NJ
K. M. VENKAT NARAYAN, Professor, Global Health and Epidemiology, The Rollins School of Public Health, Emory University, GA
NICO P. PRONK, Vice President & Chief Science Officer, HealthPartners, Inc., Bloomington, MN
LORRENE RITCHIE, Director of Research, Atkins Center for Weight and Health, University of California, Berkeley
ELSIE TAVERAS, Chief, Division of General Pediatrics, Director, Pediatric Population Health Management, Massachusetts General Hospital and Associate Professor, Department of Pediatrics and Population Medicine, Harvard Medical School, Boston, MA
LESLIE J. SIM, Senior Program Officer
LYNN PARKER, Scholar
HEATHER BREINER, Associate Program Officer
SARAH SIEGEL, Senior Project Assistant (from October 2012)
ELENA OVAITT, Senior Project Assistant (until August 2012)
SARAH SLIWA, Mirzayan Policy Fellow (September to November 2012)
FAYE HILLMAN, Financial Associate
ANTON L. BANDY, Senior Financial Officer
GERALDINE KENNEDO, Administrative Assistant
LINDA D. MEYERS, Director, Food and Nutrition Board (until May 2013)
CLYDE J. BEHNEY, Acting Director, Food and Nutrition Board (from May 2013)
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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:
David B. Allison, University of Alabama at Birmingham
Cheryl Aspy, University of Oklahoma
Jay Bernhardt, University of Florida
Don Bishop, Minnesota Department of Health
Jon Blitstein, RTI International
Jan L. Breslow, The Rockefeller University
Kelly Evenson, University of North Carolina, Chapel Hill
Mary Kay Fox, Mathematica
Tracy Fox, Food, Nutrition, and Policy, Consultants
Robert Hiatt, University of California, San Francisco
Pam Schwartz, Kaiser Permanente
Glorian Sorensen, Harvard University
Adolfo Valadez, Aetna
Karen Webb, University of California, Berkeley
Jean Wiecha, RTI International
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 Eileen T. Kennedy, Tufts University,
and Caswell A. Evans, University of Illinois at Chicago. Appointed by the Institute of Medicine; they were 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 history of successful public health progress in confronting and controlling complex threats to population health has been marked most significantly by the ability and agreement to conduct assessments of the outbreak, conduct surveillance of the movement of the threat over time and between places and populations, and to conduct evaluations of efforts to interrupt or control those threats. Effective evaluations have depended on the development of consensus on the specific indicators and measures for comparisons in time and space and between jurisdictions with their varied policies, programs, services, cultures, as well as distinct physical and social environments. This report attempts to offer a degree of consensus on these essential ingredients for successful monitoring and evaluation of progress on obesity in America.
We wish to thank the Michael & Susan Dell Foundation for sponsoring this study. We begin by thanking in particular Aliya Hussaini for her encouragement. The Foundation’s support and vision for the role that evaluation must play in accelerating progress toward obesity prevention offered inspiration. Its full support for urging common use of specific indicators in such evaluation was significant.
The Committee deeply appreciates the extensive contributions of Debra Haire-Joshu, Ph.D., Washington University in St. Louis, who was commissioned to provide practical recommendations on disparities, health equity, and obesity prevention to inform the decisions of the Committee. Also, the Committee benefited greatly from the invaluable and illuminating assistance on evaluating the effectiveness of community-wide obesity prevention initiatives and on common measures provided by Carol Cahill, M.L.S., Group Health Cooperative; Diana Charbonneau, M.I.T., Group Health Cooperative; Allen Cheadle, Ph.D., Group Health Cooperative; Elena Kuo, Ph.D., Group Health Cooperative; Suzanne Rauzon, M.P.H., University of California, Berkeley; and Lisa Schafer, M.P.H., Group Health Cooperative.
The opportunity for discussion with the individuals who made presentations and attended the Committee’s public session (see Appendix I) was critical to the Committee’s work. We also gained experience and insight from discussions with individuals from a variety of perspectives and sectors, including Philip Bors, Healthy Kids, Healthy Communities; Richard Conlin, Seattle City Council; Tracy Fox, Food, Nutrition, and Policy Consultants, LLC; Casey Korba, America’s Health Insurance Plans; Punam Ohri-Vachaspati, Arizona State University; Mary Ann Scheirer, Scheirer Consulting; Pam Schwartz, Kaiser Permanente; Nancy Sherwood, HealthPartners Institute for Education and Research; Sarah Strunk, Healthy Kids, Healthy Communities; and Michael Yedidia, Rutgers University.
The Committee could not have done its work without the outstanding guidance and support provided by the Institute of Medicine staff Leslie Sim, study director; Heather Breiner, associate program officer; and Lynn Parker, scholar. Sarah Siegel and Elena Ovaitt provided highly skilled logistical support. Linda Meyers’ guidance and counsel were invaluable throughout our deliberations. And last but not least, the report greatly benefited from the copyediting skills of Cori Vanchieri.
Lawrence W. Green, Chair
Committee on Evaluating Progress of Obesity Prevention Efforts