Childhood obesity action plan
A service of the national library of medicine, national institutes of ute of medicine (us) committee on prevention of obesity in children and youth; koplan jp, liverman ct, kraak vi, editors. Preventing childhood obesity: health in the detailsinstitute of medicine (us) committee on prevention of obesity in youth; koplan jp, liverman ct, kraak vi, gton (dc): national academies press (us); tshardcopy version at national academies presssearch term < prevnext >. An action planthe committee was charged with developing an action plan focused on preventing obesity in children and youth in the united states. The aim of the plan was to identify the most promising approaches for prevention, including policies and interventions for immediate action and in the longer term. The critical elements of the action plan's development, described in this and subsequent chapters, were as follows:clarifying definitions related to key conceptsdeveloping a framework to guide the type and scope of data gatheredarticulating obesity prevention goals for children and youthidentifying criteria for conducting an in-depth review of the available evidencetranslating the findings from the best available evidence into specific recommendations that comprise an integrated action tions and terminologychildhood and adolescent obesitybody mass index (bmi) is an indirect measure of obesity based on the readily determined measures of height and weight. The exact percentage of body fat at which adverse consequences occur can vary widely across individuals and the consequences themselves— ranging from low self-esteem or mild glucose intolerance to major depression or nephropathy—show considerable variation as —calculated as weight in kilograms divided by the square of height measured in meters (kg/m2)—is the recommended indicator of obesity-related risks in both children and adults. Kg/m2 and obesity is defined as a bmi equal to or greater than 30 kg/m2 (nhlbi, 1998). Furthermore, children may experience functional impairment (physical or emotional) at different levels of body r, the term “obese” more effectively conveys the seriousness, urgency, and medical nature of this concern than does the term “overweight,” thereby reinforcing the importance of taking immediate action. Weight-for-length greater than the 95th percentile is used by cdc and the special supplemental nutrition program for women, infants, and children to define overweight for children in this age is important that government agencies, researchers, health-care providers, insurers, and others agree on the same definition of childhood obesity. Prevent” means simply to take prior anticipatory action to hinder the occurrence of a course or event.
More recent framework conceptualizes a spectrum of prevention based on where—from the individual to the broader environment—the prevention actions are directed. Childhood obesity) in which the progression is a continuum and the condition is both a risk factor for other chronic diseases and a health outcome in itself. The committee concluded that the well-established concept of primary prevention was most amenable to its assigned task of developing a broad-based action plan that addresses the social, cultural, and environmental factors associated with childhood obesity. Within this approach, the committee developed the majority of its recommendations as “population-based” actions—directed to the entire population instead of high-risk individuals. However, the committee acknowledges that obesity prevention will need to combine population-based efforts with targeted approaches for high-risk individuals and subgroups. Consequently, the report also contains specific actions aimed at high-risk populations affected by obesity, such as children and adolescents in particular ethnic groups with higher than average obesity-prevalence rates and communities in which there are recognizable social and economic disparities. Committee was not charged with, nor did it develop, recommendations directed specifically at obesity treatment or reducing excess weight in children and youth. However, it is likely that many of the suggested actions will also benefit children and youth who are already obese, even if the interventions are insufficient to produce enough short-term weight loss for achieving normal weight status. For example, obese children can benefit from healthful choices in the school tion of obesity, particularly among those at high risk, may seem very similar to treatment in that screening is involved and individualized intervention is often delivered in clinical settings. Although treatment approaches may include relatively extreme behavioral changes over the short term, preventive strategies usually necessitate long-term committee's approach to obesity prevention is similar to the range of prevention efforts that have been used to address many other public health problems.
Some efforts directly change the physical environment but require no purposeful action on the part of the target population (e. B provides a glossary of terms used throughout this ork for actionusing an ecological perspective, the committee developed a framework to depict the behavioral settings and leverage points that influence both sides of the energy balance2 equation—energy intake and energy expenditure. Age, gender, genetic profile) but also by interactions with the larger social, cultural, and environmental contexts in which they live (e. This framework, which emphasizes the need for obesity prevention efforts to leverage the interests and actions of a number of stakeholders working within and across multiple settings and sectors, guided the review of evidence and the development of recommendations in this 3-2framework for understanding obesity in children and youth. Note: in this diagram energy intake is depicted as excessive when compared to energy expenditure, leading to a positive energy balance (or energy imbalance) resulting in obesity. Obesity prevention goalsclear specification of obesity prevention goals is essential in shaping an action plan and evaluating its success. Pertinent issues for setting obesity prevention goals for populations include concepts of optimum population bmi and healthy weight levels, potential effects on food intake and patterns of physical activity and inactivity (the primary modifiable determinants of obesity), as well as attitudes and social norms related to food and eating, physical activity and inactivity, body size, and dietary restrictions (who, 2000; kumanyika et al. For children and youth, these considerations must be framed not only within the context of healthy physical, psychological, and cognitive development but in recognition that the increased prevalence of childhood obesity has broadened the emphasis of dietary guidance to address the overconsumption of energy-dense foods and beverages and physical activity patterns (ada, 2003, 2004). Individual children and youth, obesity prevention goals focus on maintaining energy balance (calories consumed versus calories expended). Will be noted throughout this report, changing the social, physical, and economic environments that contribute to the incidence and prevalence of childhood obesity—especially in populations in which the problem is longstanding and highly prevalent—may take many years to achieve.
The ultimate aim of obesity prevention in children and youth, however, is to create, through directed social change, an environmental-behavioral synergy that promotes positive outcomes both at the population and individual levels. Box 3-1 summarizes these long-term and intermediate goals, which will be discussed in greater detail throughout the 3-1goals of obesity prevention in children and youth. The goal of obesity prevention in children and youth is to create—through directed social change—an environmental-behavioral synergy that promotes for the population of children and youth (more... Population weight goals for obesity prevention in adults can also be stated in terms of decreasing the proportion that exceed the threshold of 30 kg/m2, although this goal includes both preventing new cases of obesity and reducing weight among those already over the same principles are appropriate for assessing the population of children in the united states in pursuit of the committee's primary objective: to stop, and eventually reverse, current trends toward higher bmi levels. Population weight goals for childhood obesity prevention should be stated in terms of changes in the mean bmi and in the shape of the entire bmi distribution. Therefore, it is not known whether an individual child's height, weight, or bmi should be expected to follow along the same percentile curve over time in order to maintain health or whether there are health implications of variations throughout childhood (e. Balanceobesity prevention involves maintaining energy balance at a healthy weight while protecting overall health, growth and development, and nutritional status. Are several concepts regarding energy balance and weight gain in children and youth that the committee determined were important to clarify:genetics is a factor in excess weight but it is not the explanation for the recent epidemic of obesity (koplan and dietz, 1999). Although inherited tendencies toward weight gain may be a partial explanation for excess weight in children, as discussed below, there have been no measurable changes in the genetic composition of the population during the recent decades that could explain the significant increases in spurts do occur at several points throughout childhood and adolescence, but it cannot be assumed that a child will lose his or her excess weight at those times. Thus, for example, after the age of about 4 years, normally growing children who are in the 20th or 50th or 65th percentile for weight would be expected to remain around these same percentiles for weight, during the remainder of their childhood.
However, the identifiable medical conditions that cause childhood obesity are rare and are not the principal underlying causes of the current obesity epidemic in the perceptions of what healthy children should “look like” differ among generations, cultures, and individuals. However, it is important that obesity not become the norm in society for children and youth as it poses serious health risks during childhood that can continue throughout adult the simplest terms, energy balance represents calories consumed versus calories expended, although as noted above, many individual variables can affect that balance. Furthermore, greater understanding is needed regarding the relative contribution of energy intake and energy expenditure to the energy imbalance that is driving the obesity epidemic. The increasing prevalence of obesity among children and youth in the united states could be the result of an upward shift in energy intake, a downward shift in energy expenditure, or the occurrence of both trends concurrently (hill and peters, 1998; harnack et al. Has been hypothesized that obesity can result from very small excesses in energy intake relative to expenditure and that the average weight gain in u. This is an area requiring further following sections provide a brief overview of the context for energy balance and the complexities that researchers and policy makers face in these c variation and biological considerationsobesity has long been recognized to occur in families, and having overweight or obese parents increases a child's risk of being obese. After age 3, parental obesity is a stronger predictor of a child's future obesity as an adult than is the child's current weight (whitaker et al. With any precision the specific contributions of each of these factors to the development of obesity has been difficult, despite a variety of studies in nuclear families, in families with identical twins reared together or reared apart, and in families with adopted children. More than 400 genes, markers, and chromosomal regions have been linked to obesity phenotypes, 208 quantitative trait loci for human obesity have been identified, and 41 mendelian disorders manifesting obesity have been genomically mapped (snyder et al. However, only six single-gene defects resulting in obesity have been found, and in fewer than 150 individuals (snyder et al.
Thus, even though these monogenetic disorders have provided significant insight into the pathophysiology of obesity (cummings and schwartz, 2003; o'rahilly et al. Nonetheless, genome-wide scans in widely varying populations have identified several genomic regions containing common quantitative trait loci for obesity phenotypes, suggesting that there may be shared genetic factors predisposing individuals of different ethnic origins to excessive storage of body fat (bouchard et al. What is clear, however, is that the genetic characteristics of human populations have not changed in the last three decades, while the prevalence of obesity has approximately doubled. Thus, the recent population rise in body weight reflects the interaction of genotypes that predispose individuals to obesity with detrimental behavioral and environmental animals, the evidence is strong for such gene-environment interactions affecting body weight and energy balance (barsh et al. Furthermore, although the system has now been characterized extensively in rodents and in adult humans, little is known about its development during the fetal period, infancy, or childhood (box 3-3). A low hei score suggests a poor diet and is also associated with overweight and obesity (guo et al. 2002; sturm, 2005), and much remains to be learned about the dietary factors that contribute to the obesity epidemic in these challenges remain in conducting research on children's dietary intake. One of the joys and benefits of childhood is that being physically active is often a natural and fun part of playing and interacting with family and friends and does not generally involve a conscious decision to exercise. Health and quality-of-life benefits associated with regular moderate physical activity extend beyond the prevention of obesity (cdc, 1997) (box 3-6). This matrix of environmental levels and types can also be developed to facilitate consideration of influences on obesity-related variables such as the availability of education and counseling and broader health promotion about weight gain prevention (physical environment), cost of preventive services (economic), and coverage of preventive services by third-party payers (policy environment).
As discussed in the following sections, in the sociocultural domain, attitudes about body size and obesity are also critical contextual considerations when designing obesity prevention erations regarding stigmatizationone of the concerns that arises in discussions regarding the prevention of childhood obesity is how to effectively focus on the behaviors that contribute to obesity without stigmatizing obese children and youth. Furthermore, our society often accommodates obesity as the social norm, for example, by resizing clothing, expanding the width of seating in public areas, and retrofitting ambulances to accommodate larger girth (newman, 2004). Just as there are social and emotional consequences of stigmatization, there are also social and health consequences for obesity becoming the accepted social norm. This tension between stigmatization and normalization can be addressed, as it has been for other public health concerns, by focusing on the behaviors that can be changed to promote health rather than on the individual and his or her is important to note that the lessons learned from tobacco prevention and control efforts are not entirely applicable to obesity prevention. Bans against smoking in public buildings, on airplanes, and at other locations have encouraged some people to quit smoking due to the added inconvenience and public disapproval of this behavior. There is also concern that obesity prevention efforts will lead to inappropriate weight concern, dieting preoccupation, or unhealthful weight control practices among children and youth. Years) in 13 northern california elementary schools, and reported that concerns about being obese and dissatisfaction with body size were highly prevalent, increased with increasing bmi, and present—although to varying degrees—in all socioeconomic strata and ethnic groups. Furthermore, a study of 4,700 adolescents in minnesota public schools (grades 7 through 12; mean age was 15 years) found high body satisfaction (versus low or moderate) in only 20 percent of girls and 34 percent of boys (neumark-sztainer et al. Studies have examined potential correlates of body image dissatisfaction and weight concerns or dieting practices, particularly gender, ethnicity, and socioeconomic status. Most of the studies that have examined ethnic differences consistently find less weight concern, less body size dissatisfaction, and a heavier ideal body size in african-american girls compared with white girls, but not necessarily boys, and sometimes demonstrate significant differences within african americans across different socioeconomic levels (e.
These findings in children and adolescents are generally parallel to the numerous studies in adults indicating a relatively lower level of weight concern and higher level of body satisfaction in black women compared to white women; even considering the higher weight levels of the black women (flynn and fitzgibbon, 1998). Data for native americans in the minnesota study (which were adjusted for grade level, socioeconomic status, and bmi) indicated a similar level of body satisfaction to that in white girls, but a significantly lower level of concern about controlling their weight (neumark-sztainer et al. Statussocioeconomic status has generally been inversely associated with obesity prevalence (see chapter 2) and children with obese mothers and low family income were found to have significantly elevated risks of becoming obese, independent of other demographic and socioeconomic factors (strauss and knight, 1999). When compared with food-insufficient households of higher income, low-income food-insufficient households had more obese children; however, food insufficiency by itself was not associated with self-reported measures of childhood obesity (casey et al. Other studies have not been able to show a clear relationship between childhood obesity and food insufficiency or food insecurity8 after adjusting for other confounding variables (alaimo et al. Of the variables in tables 3-1 and 3-2 may be potential mediators of the relationship between socioeconomic inequities and childhood obesity. Addressing childhood obesity in these contexts will require attention to root causes, and attempts to mitigate the underlying social and environmental adversity will be needed (travers, 1997). And ethnic disparitiesthe substantially higher prevalence of obesity in adults, children, and youth in some african-american, hispanic, american-indian, and pacific islander populations (see chapter 2) generates considerations across the entire ecologic framework (see figure 3-2). A relatively high obesity prevalence in some hispanic and american-indian groups was noted prior to the obesity epidemic (kumanyika, 1993); the pattern of excess weight gain and accelerated rates of obesity prevalence in african-american children and youth is a more recent development. However, the different historical and geographical trajectories of these social and politically defined groups are associated with some differences in gene frequencies that may be linked with obesity development.
Regardless, as discussed earlier in this chapter, the predominant factors responsible for the expression of obesity as a general population phenomenon are the linked behavioral and environmental factors outlined in the framework in figure factors that potentially mediate racial and ethnic differences and predispose minority children and youth to high obesity risks can be postulated across physical, economic, sociocultural, and policy/political environments (tables 3-1 and 3-2). Variables that need to be considered when approaching obesity prevention to reduce racial and ethnic disparities include traditional cuisines and any aspect of the attitudes, beliefs, and values (referred to in tables 3-1 and table 3-2 as the ethos or climate) that may facilitate or inhibit the promotion of healthful eating, physical activity, and weight control patterns in children and youth in these communities (kumanyika and morssink, 1997; kumanyika, 2002, 2004). The normative presence of the problem) as well as high levels of obesity-related health problems. In addition, to the extent that a history of discrimination or marginalization based on race or ethnicity becomes intertwined with other sociocultural factors, a certain level of skepticism or distrust relative to mainstream information and initiatives, including health information, may influence the receptivity to obesity prevention messages—particularly when these messages seem to conflict with pre-existing attitudes and of the evidencethe committee identified a primary prevention, population-based approach to be the most viable long-term strategy for reducing obesity and its chronic disease burdens. Predictability depends on a properly implemented intervention producing expected outcomes, a clear understanding of the intervention's elements, and a cause-and-effect interaction among those elements (tang et al. An evidence-based medicine approach has been adopted by federal and scientific institutions to guide obesity treatment in adults (nhlbi, 1998). But given the complex environment in which multiple social, economic, cultural, and political elements interact to produce change in population-wide problems such as obesity, causality may not always be established for the relationships among the various interventions (mcqueen, 2002; tang et al. Conclusion that results from these well-established principles is that while scientists can strive to clarify causal relations and reduce uncertainty, they are incapable of recommending specific actions (or inaction) without making implicit value judgments (nrc, 1978, 1996). Developing recommendations based on an integrated approach to the evidencethe committee faced a significant challenge in deciding what types of evidence to use in formulating recommendations for obesity prevention in children and youth. A review of randomized controlled interventions for obesity prevention and treatment among children and adolescents identified only 35 such studies (campbell et al.
Due to the limited number of rcts in obesity prevention efforts and methodological issues, including small sample sizes and high attrition rates of study participants, there is a paucity of rct data from which to generalize results to broader populations (nhs centre for reviews and dissemination, 2002). Committee, therefore, developed guidelines for an integrated use of the available evidence to inform population-based obesity prevention interventions and on which to base its recommendations. Childhood obesity is a serious public health problem calling for immediate reductions in obesity prevalence and in its health and social consequences, the committee strongly believed that actions should be based on the best available evidence—as opposed to waiting for the best possible different types of evidence that the committee used in developing the report's recommendations are illustrated in table 3-5, and the following principles guided the committee's process:table 3-5proposed components of evidence-based obesity prevention. Evidence is needed to inform and guide policy and programmatic decisions, justify a course of action, and evaluate the effectiveness of interventions that support obesity gh the strength of the evidence is a basis for policy development, other considerations—including the fiscal and sociopolitical climate within which governments, institutions, and communities operate—must also be taken into account (tang et al. Of experimental evidence does not indicate a lack of causation or the ineffectiveness of an obesity prevention intervention. The significant shortage at present of experimental evidence to guide programs and policies, and the fact that many societal variables of interest have not been well addressed in controlled experimental studies as moderating or mediating factors, obesity prevention will require an evidence-based public health approach that continues to draw on rcts, quasi-experiments, and observational studies as important sources of information (victora et al. That obesity is a serious health risk, preventive actions should be taken even if there is as-yet-incomplete scientific evidence on the interventions to address specific causes and correlates of obesity. However, there is an obligation to accumulate appropriate evidence not only to justify a course of action but to assess whether it has made a y, for interventions that have minimal potential risk and require few resources, formative and process evaluations may be sufficient to provide a “preponderance” of evidence (robinson et al. In examining the literature, the committee focused on studies that examined weight and body composition outcomes, but it also broadened its scope to include studies that looked at changes in physical activity (or sedentary behavior) levels and in dietary intake examining the evidence on obesity-related prevention interventions, the committee considered the methodologies used by individual studies. Other factors considered by the committee included the feasibility of implementing the recommended actions, the opportunities for making changes, and the past success of parallel public health and social change efforts.
Soft drinks, chips, candy); and highlights the improvements needed and actions that can promote energy balance rather than addressing any one industry (e. For individuals, obesity prevention involves maintaining energy balance at a healthy weight while protecting overall health, growth and development, and nutritional status. Energy balance (calories consumed versus calories expended) is an extraordinarily complex concept when considering the multitude of genetic, biological, psychological, sociocultural, and environmental factors that affect both sides of the energy balance equation and the interrelationships among these specification of obesity prevention goals is essential in shaping an action plan and evaluating its success. Relevant issues for setting obesity prevention goals for populations include concepts of optimum population bmi and healthy weight levels, potential effects on food intake and patterns of physical activity and inactivity, as well as attitudes and social norms related to food and eating, physical activity, inactivity, body size, and dietary restrictions. This chapter discusses a variety of influences on children's diets and physical activity patterns including genetic variation and biological considerations, and sociocultural and other environmental an ecological systems theory model and a primary prevention evidence-based public health approach, this report focuses on how changes in the individual child's behaviors are affected not only by individual factors but also through interactions with the larger social, cultural, and environmental contexts in which he or she lives (e. Overweight concerns and body dissatisfaction among third-grade children: the impacts of ethnicity and socioeconomic status. Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity. International references such as the international obesity task force or cole bmi values allow for cross-cultural comparisons. Viewcite this pageinstitute of medicine (us) committee on prevention of obesity in children and youth; koplan jp, liverman ct, kraak vi, editors. Disable glossary linksin this pagedefinitions and terminologyframework for actionobesity prevention goalsenergy balancereview of the evidencesummaryreferencesother titles in this al academies collection: reports funded by national institutes related informationpmcpubmed central citationspubmedlinks to pubmedrecent activityclearturn offturn ondeveloping an action plan - preventing childhood obesitydeveloping an action plan - preventing childhood obesityyour browsing activity is ty recording is turned recording back onsee more...
The work of the ation global estimates of child and adolescent obesity released on world obesity day. October 2017 - the number of obese children and adolescents has increased tenfold in the last 40 years, according to a study published in the lancet ending childhood obesity implementation plan guides policy-makers on the recommended actions to prevent and treat childhood childhood obesity: securing the future for our children. May 2016 – the report of the commission on ending childhood obesity formed the basis for a side event, hosted by ghana, malaysia and mexico, along with new zealand and zambia during the sixty-ninth world health sion presents its final report, calling for high-level action to address major health challenge. January 2016 -- the commission on ending childhood obesity (echo) presented its final report to the who director-general today culminating a two-year process to address the alarming levels of childhood obesity and overweight globally. The echo report proposes a range of recommendations for governments aimed at reversing the rising trend of children aged under 5 years becoming overweight and on the final sion on ending childhood obesity seeks comments on report from around the the first meeting of the commission on ending childhood obesity in july 2014, the commissioners decided it would be important to engage with a broad range of stakeholders. In addition, the commissioners have heard from non-state actors, both through international and regional more about the report global estimates of child and adolescent obesity released on world obesity childhood obesity: securing the future for our sion presents its final report, calling for high-level action to address major health sion on ending childhood obesity seeks comments on report from around the world. Millionchildren and adolescents are obese – a tenfold increase in the last four and figures on childhood 1 in 5children and adolescents are overweight or y and on childhood monitoring framework for noncommunicable global monitoring 7: halt the rise in tor 13: overweight and obesity in tor 23: marketing of foods to who child growth reference data for 5-19 ing of foods and non-alcoholic beverages to ended levels of physical activity for tion-based approaches to childhood obesity tizing areas for action in the field of population-based prevention of childhood policy ight and sion on ending childhood of the commission on ending childhood obesity: implementation plan: executive sion on ending childhood mmes and region of the south-east asia eastern mediterranean western pacific up for who sion on ending childhood sion on ending childhood obesity (echo). Millionchildren and adolescents are obese – a tenfold increase in the last four and figures on childhood 1 in 5children and adolescents are overweight or y and on childhood monitoring framework for noncommunicable global monitoring 7: halt the rise in tor 13: overweight and obesity in tor 23: marketing of foods to who child growth reference data for 5-19 ing of foods and non-alcoholic beverages to ended levels of physical activity for tion-based approaches to childhood obesity tizing areas for action in the field of population-based prevention of childhood policy ight and sion on ending childhood of the commission on ending childhood obesity: implementation plan: executive sion on ending childhood mmes and region of the south-east asia eastern mediterranean western pacific up for who updates.