As with many health issues, there are high-risk populations, including low-income and ethnic minority communities, for which obesity prevention initiatives will need to be particularly focused. Resources will need to address a range of issues such as safety, language barriers, limited access to food and health services, income differentials, and the influence of culture on food selection and preferences for available physical activities.
Tough choices will have to be made at all levels of society. There will be trade-offs in convenience, in cost, in what’s “easy,” in pushing one’s self and one’s organization, in choosing between priorities, in devising new laws and regulations, and in setting limits on individuals and on industries.
Science can best help by integrating a traditional biomedical approach to such health concerns with behavioral and social science research. Effective solutions lie not in a magical “eat all you want” pill but rather in intensive, often laborious, and long-term improvements in the environments that surround children in their homes, schools, communities, commercial markets, and modes of entertainment. While biology may often encourage us to eat more than we need to, biological solutions are not the answer from an ethical or practical perspective. Nor is genetics the primary problem or the sole determinant. Rather, it is the complex interplay among an individual’s knowledge, attitudes, values, behaviors, and environments that play the most influential roles in promoting obesity.
In reviewing the available evidence to inform this report, there was an abundance of scientific studies on the causes and correlates of obesity but few studies testing potential solutions within diverse and complex social and environmental contexts, and no proven effective population-based solutions. Moreover, a concern of the committee is that even if many of the recommended actions are implemented, research should contain a better balance between studies that continue to address the underlying causes of the obesity epidemic and studies that test potential solutions—that is, identifying appropriate methodologies for effectively promoting healthful eating and physical activity and reducing sedentary behaviors that will support obesity prevention in children and youth.
Recognizing the multifactorial nature of the problem, the committee deliberated on how best to prioritize the next steps for the nation in preventing obesity in children and youth. The traditional method of prioritizing recommendations of this nature would be to base these decisions on the strength of the scientific evidence demonstrating that specific interventions have a direct impact on reducing obesity prevalence and to order the evidence-based approaches based on the balance between potential benefits and associated costs including potential risks. However, a robust evidence