Efforts to combat childhood obesity are fragmented and too many programs are not being properly evaluated, making it difficult to identify which efforts are succeeding, according to a new report from the Institute of Medicine (IOM).
National leadership on this public health issue is also lacking, said the committee that wrote the report.
Consumer and parents groups should demand that politicians stop their handwringing and take strong action, said the Center for Science in the Public Interest (CSPI).
"Members of Congress, for instance, should show political courage by standing up to Coke, Pepsi and snack food makers and get soda and junk food out of schools," said CSPI Nutrition Policy Director Margo Wootan.
"Senators Harkin and Murkowski have legislation -- the Child Nutrition Promotion and School Lunch Protection Act -- that would give the U.S. Department of Agriculture the authority to do that," she said.
"Congress seems more interested in dishing out special legislative favors to the industry -- one bill that would block certain lawsuits against restaurants and food manufacturers, and another bill that would nullify state food safety and labeling laws," Wootan said.
The Institute of Medicine report found that 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. The U.S. obesity rate for children and youth increased from 16 percent in 2002 to 17.1 percent in 2004, 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.
Wootan said many solutions are obvious and could be implemented at minimal cost if only Congress would start protecting consumers instead of special interests.
"Calorie counts on fast-food menu boards would let parents know that the grilled chicken sandwich has as many calories as a Quarter Pounder, and that on childrens menus, the chicken tenders have more calories than the baby back ribs," she said.
The IOM 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.
Results could be achieved a lot more quickly than that, Wootan countered.
"We need major programs to get kids moving again, yet the Administration zeroed out funding for its youth media campaign, VERB, which has actually been shown to get kids to exercise. We dont need any new task forces, study groups, or blue ribbon panels. What we need now is the political will to take strong action," Wootan said.
The IOM 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.
Many environments do not support obesity prevention efforts, the report claimed. 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.
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.
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.
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.
