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Major Recommendations: Childhood Obesity

Preventing childhood obesity should be considered a national public health priority, according to a new Institute of Medicine report, which called on schools, industry, health care workers and parents to each do their part in curbing the epidemic.

Released Sept. 30 at a Washington, D.C., news conference, “Preventing Childhood Obesity: Health in the Balance” lays out a plan of action for the fight against childhood obesity with recommendations for stakeholders across the societal spectrum. The report, authored by the IoM’s Committee on Prevention of Obesity in Children and Youth at the request of Congress, warned that although the United States made great strides in children’s health during the 20th century, “we begin the 21st century with a startling setback.”

“The great health advances made possible by genetics and other biomedical discoveries could be offset by the burden of illness, disability and death caused by too many people eating too much and moving too little over their lifetime,” said Jeffrey Koplan, MD, MPH, chair of the IoM authoring committee as well as chair of the Woodruff Health Sciences Center at Emory University, at the Washington, D.C., news conference.

Koplan noted that no single factor or sector of society can be blamed for childhood obesity, but all must help to solve it — even though it could take decades. The health epidemic is happening among boys and girls in every part of the country across all economic and ethnic groups, although populations such as blacks, Hispanics and American Indians are being disproportionately affected, according to the report. Currently, 9 million children older than 6 are considered obese, and during the past 30 years, obesity among children ages 6 to 11 has more than tripled. Limiting the future impact of a childhood obesity epidemic will take a tremendous investment in prevention, said Thomas Robinson, MD, MPH, an IoM committee member and associate professor of pediatrics and medicine at Stanford University.

“The federal government should demonstrate effective leadership by making a sustained commitment to support policies and programs that are commensurate to the scale of the problem,” the report stated.

In addition to making childhood obesity a national priority, the report lays out a comprehensive action plan for stakeholders. Among the recommendations are calls to food industry leaders to make childhood obesity prevention a priority by creating and promoting products that encourage healthy eating and regular physical activity. The report also called on the secretary of the U.S. Department of Health and Human Services to develop guidelines on food and beverage advertising toward children, and called for giving the U.S. Federal Trade Commission the power to monitor compliance. The current system of allowing food manufacturers to voluntarily and internally review their own advertising is not working, said Robinson, who urged food industry leaders to work with government officials and public interest groups to define advertising standards.

Also, local governments should find ways to increase opportunities for physical activity in their communities via zoning laws and improving sidewalk and street safety to encourage children to walk or bike to school, the report recommended. However, once children walk through the school doors, a number of changes will have to be made in order to sustain any improvements made outside of the school environment.

“This plan is going to happen at a community level,” said APHA member Shiriki Kumanyika, PhD, MPH, RD, an IoM committee member and associate dean for health promotion and disease prevention at the University of Pennsylvania.

Currently, only foods sold through the federal school lunch and breakfast programs must meet certain nutritional standards, while foods sold a la carte or via vending machines — known as “competitive” foods — do not. Competitive school foods often include soda, candy, potato chips, cookies and other high-fat, salty foods. Report authors recommended that federal, local and school authorities implement nutritional standards for all competitive foods and extend school meal funding to schools with large populations of children at high risk of obesity. They also urged authorities to ensure that all children and youth partake in at least 30 minutes of physical activity during the school day.

“Lunch is sold a la carte and kids are buying what they like,” Diana Zuckerman, PhD, president of the National Research Center for Women and Families, told The Nation’s Health. “None of us should really be shocked that when kids can choose, they are having lunches consisting of french fries and dessert. Kids will make really unhealthy choices if you let them.”

In fact, a September report from Action for Healthy Kids, which was founded by former U.S. Surgeon General David Satcher, PhD, MD, found that poor nutrition, inactivity and excess weight adverse-ly affect children’s academic performance and costs schools millions of dollars annually, as poor school attendance is linked to funding. For example, physical activity programs have been connected with increased concentration and improved math, reading and writing test scores.

Zuckerman noted that for some children, it’s hard to get outside and exercise due to harsh weather or unsafe neighborhoods, so exercising at school is essential.

“Federal school money could be tied to (physical education) in schools,” she said. “By not having recess and (physical education), we’re sending a very clear message that it’s not important.”

Zuckerman also called for educating parents, many of whom may not even realize their child would be considered obese or the health implications of being overweight. The IoM report urged parents to be pro-active in monitoring their children’s weight and lifestyle habits as well.

“We have to find ways to change our children’s diets and that’s going to have to start with what parents feed their families at home and when they go out,” Zuckerman said. “That’s going to be a big change.”

Such changes should include efforts at the national level as well, the IoM report said. HHS Secretary Tommy Thompson said the report was “affirmation that President Bush’s programs and initiatives are on the right track,” referring to millions of dollars in community grants as well as national educational campaigns on healthy living. However, Margo Wootan, DSc, nutrition policy director at the Center for Science in the Public Interest, disagreed.

“This report shows just the opposite — that the Bush administration’s response is anemic in comparison with the scope of the problem and the scope of IoM’s recommendations,” she told The Nation’s Health. “A couple of (public service announcements) and community grants don’t constitute an adequate response to what has become one of the most pressing health problems facing the country.”

Wootan praised the IoM report for laying out a comprehensive action plan to address childhood obesity from all segments of society, thus, “there are no more excuses for not acting.”

“People need to realize that in the current environment, it’s very difficult — that in order to maintain a healthy weight you have to act not only personally, but also politically,” said Wootan, an APHA member. “People need calorie labeling in restaurants, they need junk food out of schools, they need safe places to walk and bike. The food environment is so hostile to healthy eating that parents don’t stand a chance.”

Wootan also called on public health workers to get engaged in supporting policy and system changes that make it easier for Americans to eat well and be active.

“It’s going to take a grassroots movement to change policies because the political forces against change are considerable,” she said.

For the IoM report, visit .

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