November 25, 2004
Combating Childhood Obesity: A Collective Effort
The schools, the family, communities, government, states, localities, industry - all have been implicated for the epidemic of obesity in American children and youth today, and all will be important players in any potential solution. So says the new report released by the Institute of Medicine (IOM) of the National Academies (September 30, 2004). While no single intervention or group acting alone is to blame or can stop it, the steps recommended by the committee aim to improve opportunities for children to engage in physical activity and eat a healthy diet. The responsibility, however, is everyone's if there is any hope of reversing an ominous statistical trend.
The report has taken on an issue that has captured the attention of every professional health care organization that cares about children, following the U.S. Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity (2001). At that time, Congress directed the Centers for Disease Control and Prevention (CDC) to request that the 1OM develop an action plan targeted at the prevention of obesity in children and youth in the united States. The primary emphasis of the charge was to examine the behavioral, social, cultural and broad environmental factors that influence childhood obesity and to search for promising approaches for prevention efforts. The report, delivered after 24 months of deliberation by the IOM committee of interdisciplinary experts, is ambitious, far reaching, comprehensive and multipronged in scope, underscoring the premise that the problem cannot be approached with simplistic, singular finger-pointing, and requires a positive and united attack at all levels.
The increasing prevalence of childhood obesity has led policy makers to rank it as a critical public health threat. Since the 1970s, obesity prevalence has more than doubled for preschool children and adolescents, and more than tripled for school age children. National statistics are profound and graphically make the case that the problem is no longer trivial, nor can it be explained away by cultural platitudes or social excuses - "Johnny's just pleasantly plump." There are considerable long-term risks to physical health. For children born in the U.S. in 2000, the lifetime risk of being diagnosed with type 2 diabetes is estimated at 30% for boys and 40% for girls. In addition to the pain of social stigma, obesity predisposes the child to health risks of future hypertension, cardiovascular and musculoskeletal problems. Childhood obesity is a serious nationwide health problem requiring urgent attention and a population-based prevention approach.
Complex Problems, Complex Causes: seeking Complex Considerations
What seems to be simple arithmetic - obesity results from more calories ingested (in) than energy expended (out) - does not take into account the multiple dimensions of the problem. Based on numerous studies that have sought causal links between genetics, environment, social, psychological and physical factors and the rapidly escalating obesity statistics, the 1OM committee reports that the causes are the result of complex interactions across a number of contexts that influence eating and physical activity. Many of these factors go beyond the whipped cream dessert and computer video game explanation of imbalance between eating and physical activity that are so easily implicated in the debate. In fact, there are many factors that contribute to obese children, including: environmental contributions of urban/suburban designs that discourage walking; pressures on families to minimize food costs, resulting in convenience foods that are high in calories and fat; reduced access to fresh fruits and vegetables; decreased opportunities for physical education at school; and changes in leisure time activities. Food industries such as soft drink makers, schools with their reduction in physical education, and communities with potentially unsafe neighborhoods all may play a role in the population changes seen today. However, the committee is adamant not to place blame but rather to foster a sense of collective cooperation to address the problem.
A Range of Recommendations
The action plan to prevent obesity consists of explicit goals and recommendations. It begins with acknowledging, especially by federal, state and local governments, that obesity is a serious health problem and prevention of obesity should be a national public health priority. The range of recommendations begins with a statement of national priority: that government at all levels should provide coordinated leadership for the prevention of obesity in children and youth. To implement this recommendation, the committee believes the federal government should strengthen and support a variety of surveillance activities, health education programs, and research activities, including an independent assessment of federal nutrition assistance programs and agricultural policies.
A second set of recommendations speaks to industry, seeking to encourage activities that promote children and youth to eat healthy, nutrient dense foods and minimize TV and computer or video leisure entertainment. This calls upon media messages to be inherently positive. Because children under 8 years old cannot distinguish between information and advertisement messages, the committee recommends the development of guidelines for advertising and marketing foods, sweet drinks, and sedentary activities aimed at young viewers. Industry should also promote clear and useful nutrition labeling, and sound policies related to advertising and marketing products.
The third group of recommendations aims to promote programs collaboratively among local governments, public health agencies, schools and communities. Local governments should foster the development of physical activity facilities, parks, playgrounds, sidewalks, etc. An ambitious set of recommendations for schools aims to encourage school officials to provide environments that are conducive to healthy eating behaviors and regular physical activity. Through government and local authorities, schools should by motivated to comply with a variety of nutritional standards for all competitive foods and beverages sold or served, and at the same time, offer school health curricula, physical activities, and school health services in obesity prevention, including an annual assessment of each student's weight, height, and gender/age specific BMl.
Let It Begin at Home
Because parents have a strong influence on their children and can foster certain values and attitudes, they play a fundamental role in their contribution to obesity prevention. Parents should choose healthy foods and facilitate physical activities of children when they are not in school. Limiting TV time, encouraging play, and serving as positive role models all play a role in reducing obesity. However, the best of the science still cannot tell us precisely how much or how often social or behavioral interventions contribute to good or poor eating behaviors. Therefore, the report offers the strongest case it can to recommend these all-encompassing, wide range of environmental interventions, acknowledging the ramifications of cost and political will, and the areas of uncertainty that will influence the success of reducing the problem in the long term.
There is no doubt that our children are collectively more obese than ever before. Obesity-associated annual hospital costs for children more than tripled in 20 years, rising from $35 million in 1979-1981 to $127 million in 1997-99. "Eat less" and "move more" are the messages from the 1OM report. However, it is important that we recognize that the problem of obesity is complex - and solutions are a matter of collective efforts from all levels.
Journal Philosophy Statement
Pediatrie Nursing presents information that is both theoretically grounded and clinically relevant to educate the novice, enrich the generalist, and advance the pdiatrie specialist toward providing professional care of the highest quality.
Preventing Childhood Obesity: Health in the Balance (2004, September 30). Committee on Prevention of Obesity in Children and Youth, Food and Nutrition Board and Board on Health Promotion and Disease Prevention. Institute of Medicine, Washington DC: National Academies Press. (www.nap.edu).
Veronica D. Feeg, PhD, RN, FAAN
Veronica D. Feeg, PhD, RN, FAAN
Copyright Anthony J. Jannetti, Inc. Sep/Oct 2004