lated culture, such as the drug culture; coordinated interest group advocacy; and targeting of groups or industries contributing to the problem) are not yet fully in place for obesity prevention or may not be relevant to this issue (Kersh and Morone, 2002; Haddad, 2003).

The additional impetus that is needed is the political will to make childhood obesity prevention a national public health priority. Effective prevention efforts on a nationwide basis will require federal, state, and local governments to commit sufficient resources for surveillance, research, programs, evaluation, and dissemination.

As the nation focuses on obesity as a health problem and begins to address the societal and cultural issues that contribute to excess weight, poor food choices, and inactivity, many different stakeholders will need to make difficult trade-offs and choices. Industries and businesses must reexamine many of their products and marketing strategies. Governments at the local, state, and national levels must consider this issue in setting priorities for programs and resources. Schools need to ensure that consistent messages regarding energy balance are a basic part of the school environment. Community organizations and numerous other stakeholders must examine the ways in which local opportunities for a healthful diet and physical activity are made accessible, available, affordable, and acceptable to children, youth, and their parents. Families need to make their homes more conducive to a healthful diet and daily physical activity. Many of these changes will be challenging because they present Americans with difficult trade-offs. However, as institutions, organizations, and individuals across the nation begin to make changes, societal norms are likely to change as well; in the long term, we may become a nation where proper nutrition and physical activity that support energy balance at a healthy weight will become the standard.

Within the United States and globally, attention is being focused on obesity prevention efforts. A number of interest groups, coalitions, national governments, and intergovernmental organizations have examined the rising obesity and chronic disease problems in a variety of contexts, recognized its complicated nature, and proposed actions to reduce its prevalence both nationally and globally (e.g., WHO, 2000, 2003; DHHS, 2001; Health Council of the Netherlands, 2003; National Board of Health, 2003; New South Wales Department of Health, 2003; Canadian Institute for Health Information, 2004; Lobstein et al., 2004; Raine, 2004; United Kingdom Parliament, 2004; Willett and Domolky, 2004). Many of the strategies and action plans that have been developed from these efforts do not differ greatly from the recommendations in this report. The committee has gained insights from these efforts, and in this report draws together the evidence on obesity prevention, nutrition, and physical activity with the lessons learned from other public health issues (Box 4-2) to develop an action plan for childhood obesity prevention that is as informed, responsive, and realis-

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