Progress Is Slow in Reversing Childhood Obesity Trend

Posted: September 18, 2006

Progress Is Slow in Reversing Childhood Obesity Trend; Actions Are Encouraging but Evaluation Needed to Identify Effective Policies and Programs

WASHINGTON — Government, industry, communities, schools, and families have developed many initiatives to respond to the growing problem of childhood obesity, but efforts remain fragmented. Moreover, most of the policies and programs are not being evaluated, making it difficult to identify effective interventions, according to a new report from the Institute of Medicine. National leadership on this public health issue is also lacking, said the committee that wrote the report.

Childhood and adolescent obesity rates are increasing. Currently, one-third of American children and youth are obese or at risk of becoming obese, the report says. Two years ago, the U.S. obesity rate for children and youth was 16 percent; it has since increased to 17.1 percent, and is projected to rise to 20 percent by 2010 if the current trajectory continues.

“The good news is that Americans have begun to recognize that childhood obesity is a serious public health problem, and initiatives to address it are under way,” said committee chair Jeffrey Koplan, vice president for academic health affairs, Emory University, Atlanta, and former director of the U.S. Centers for Disease Control and Prevention. Koplan added, “With that awareness and mobilization of efforts, we can make huge strides in beginning to halt and reverse the childhood obesity trend — if we have strong leadership, effective policies and programs that we know work, and sufficient resources.”

The report says that short-term outcomes are being achieved; several federal policies have been changed to encourage better nutrition and physical activity in schools, many communities have built sidewalks and bike paths to encourage physical activity, and national awareness of the problem is increasing. But positive changes in the health outcomes of children and youth, as measured by body mass index, will require years of sustained efforts, systematic evaluation, and adequate resources,the committee said.

To learn about innovative programs and policy changes being implemented throughout the nation, the committee held meetings in Wichita, Kan.; Atlanta; and Irvine, Calif. At each gathering the committee heard about the challenges that communities, schools, and industry face in implementing new programs and evaluating those efforts. Moreover, many environments do not support obesity prevention efforts. For example, in some neighborhoods, fresh fruits and vegetables are not readily available or affordable, and there are no safe places for children to play after school.

Promising Practices Found at all Levels

Many states and school districts are undertaking efforts to improve the nutritional quality of the foods and beverages available in schools. The committee saw promise in a new law that requires local school wellness policies to be in effect for the 2006-2007 school year. The policies call for nutrition standards for all foods and beverages served on school grounds, and require increased opportunities for physical activity. Evaluation of these efforts is needed, the report adds.

Another promising practice noted in the report is a joint initiative by industry, foundations, and government called the Alliance for a Healthier Generation. The alliance has established guidelines to limit children’s portion sizes and calories from sweetened beverages during the school day. An in-depth, multistep evaluation is planned to measure the effectiveness of these changes.

Some sectors of industry — food, beverage, restaurant, food retail, leisure and recreation, physical activity, and entertainment — have shown constructive responses to the childhood obesity problem, the report says. For example, physical gaming, which encourages children to jump, dance, and sing, is becoming increasingly available in arcades and play centers around the country. Entertainment companies have begun to license the use of popular cartoon characters by produce companies in order to promote kids’ consumption of fruits and vegetables. However, evaluations of these initiatives are lacking.

Some progress also is being made in the area of marketing to children and youth, the committee said. An industry working group is currently reviewing the guidelines of the Children’s Advertising Review Unit (CARU). The guidelines currently do not adequately address newer marketing techniques such as advergaming, product placement in television programs and movies, viral marketing, and text-message advertisements on cell phones.

Each community will need a combination of interventions in order to reduce weight in our young people, the report says. The same type of obesity-prevention intervention may not work for every community. In low-income and diverse communities, for example, the effectiveness of initiatives may be reduced by competing problems, lack of funds, overburdened local infrastructures, and cultural differences. Programs must be tailored to be more effective in these places.

The report also points out that CDC’s VERB campaign, a five-year social marketing campaign to promote physical activity in children ages 9 to 13, has had positive evaluation results. However, FY 2006 funding was not included in the federal budget, and the program will be discontinued this month.

Family-based obesity-prevention efforts have developed many promising practices such as enrolling children in after-school activities; limiting children’s recreational TV, videogame, and computer time; monitoring eating behaviors; emphasizing the importance of eating breakfast; and substituting noncaloric beverages for sugar-sweetened drinks.

Recommendations for Further Action

The committee’s recommendations to reduce childhood obesity focus on four key steps: increased and sustained leadership and commitment; broader implementation and evaluation of policies and programs; improved monitoring and surveillance of progress; and wider dissemination of promising practices.

Leadership

The report calls on federal, state, and local governments to provide the leadership and resources for a sustained effort to prevent childhood obesity. High-level task forces are needed at the federal, state, and local levels to identify priorities for action, coordinate public-sector efforts, and establish effective collaborations. Reiterating a recommendation set forth in the IOM’s 2005 report Preventing Childhood Obesity: Health in the Balance, the committee urged the president to request that the secretary of the U.S. Department of Health and Human Services convene a high-level task force involving the secretaries or senior officials from relevant federal government departments and agencies; no progress on this recommendation has been made so far.

The report also calls on the government to sustain successful programs such as the CDC’s VERB campaign, which has demonstrated its effectiveness in promoting physical activity in children. “The termination of a well-designed and effective program to increase physical activity and combat childhood obesity calls into question the commitment of both the government and many other stakeholders who could have supported the continuity of the VERB campaign,”stated Koplan.

Evaluating, Monitoring and Implementing Effective Programs

The committee recommended that the U.S. Congress, in consultation with industry and other stakeholders, support independent, periodic evaluations of industry’s efforts to promote healthier lifestyles. Given the increasing proportion of calories children and youth consume outside of the home, the report also recommends that the Food and Drug Administration be given the authority to evaluate full serve and quick serve restaurants’ food, beverage, and meal options to ensure that nutrition information is more accessible and relevant to young consumers.

Congress should designate an agency to periodically monitor and evaluate CARU’s self-regulatory guidelines in order to measure their effectiveness and assess how well they are enforced, the committee added.

The report recommends that a “community health index” be developed to help communities assess the extent to which children and youth have local access to opportunities for physical activity and to fruits, vegetables, and other foods and beverages that contribute to a healthful diet. Communities also should compile and widely share the results of program evaluations, lessons learned, and action plans that can help other cities and towns around the nation start their own initiatives.

The report also recommends that current school-based policies and programs be evaluated to aid future efforts. Schools should develop ways to evaluate how well nutrition and physical activity standards are being implemented, and make the results available to parents and community members.

In addition, the committee recommended that parents and caregivers take stock of their home environment to ensure that healthful foods and beverages are available and that physical activity is a family priority. Limits should be set on leisure time use of television, DVDs, videos, movies, videogames, and computers.

The report is a follow-up to Preventing Childhood Obesity: Health in the Balance, and was sponsored by The Robert Wood Johnson Foundation. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.

Pre-publication copies of Progress in Preventing Childhood Obesity: How Do We Measure Up? are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at www.nap.edu. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).