5
Industry

The Institute of Medicine’s (IOM’s) Health in the Balance report presented a set of comprehensive recommendations to guide industry’s collective actions to support childhood obesity prevention goals (IOM, 2005). The report recommended that industry prioritize obesity prevention in children and youth by “developing and promoting products, opportunities, and information that will encourage healthful eating behaviors and regular physical activity.” The report also recommended that “industry should develop and strictly adhere to marketing and advertising guidelines that minimize the risk of obesity in children and youth” (IOM, 2005, p. 166). The development of clear and useful nutrition labeling was a third area in which the report offered guidance to industry and the U.S. Food and Drug Administration (FDA) so that they may help parents and youth make informed purchases in the marketplace and select foods, beverages, and meal options that contribute to healthful diets (Box 5-1) (IOM, 2005).

After the release of the Health in the Balance report, another IOM committee released a related report, Food Marketing to Children and Youth: Threat or Opportunity?, which provides findings on the influence of marketing on children’s and adolescents’ food and beverage preferences, choices, purchase requests, dietary practices, and health-related outcomes (IOM, 2006). It also offers expanded recommendations for numerous industry stakeholders including food retailers, trade associations, entertainment companies, food and beverage companies, restaurants, and the media (Box 5-2).

This chapter explores the current and potential strategies that industry stakeholders use or could use to make progress toward meeting the recommendations made in those reports. The chapter provides examples of



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Progress in Preventing Childhood Obesity: How Do We Measure Up? 5 Industry The Institute of Medicine’s (IOM’s) Health in the Balance report presented a set of comprehensive recommendations to guide industry’s collective actions to support childhood obesity prevention goals (IOM, 2005). The report recommended that industry prioritize obesity prevention in children and youth by “developing and promoting products, opportunities, and information that will encourage healthful eating behaviors and regular physical activity.” The report also recommended that “industry should develop and strictly adhere to marketing and advertising guidelines that minimize the risk of obesity in children and youth” (IOM, 2005, p. 166). The development of clear and useful nutrition labeling was a third area in which the report offered guidance to industry and the U.S. Food and Drug Administration (FDA) so that they may help parents and youth make informed purchases in the marketplace and select foods, beverages, and meal options that contribute to healthful diets (Box 5-1) (IOM, 2005). After the release of the Health in the Balance report, another IOM committee released a related report, Food Marketing to Children and Youth: Threat or Opportunity?, which provides findings on the influence of marketing on children’s and adolescents’ food and beverage preferences, choices, purchase requests, dietary practices, and health-related outcomes (IOM, 2006). It also offers expanded recommendations for numerous industry stakeholders including food retailers, trade associations, entertainment companies, food and beverage companies, restaurants, and the media (Box 5-2). This chapter explores the current and potential strategies that industry stakeholders use or could use to make progress toward meeting the recommendations made in those reports. The chapter provides examples of

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Progress in Preventing Childhood Obesity: How Do We Measure Up? BOX 5-1 Recommendations for Industry from the 2005 IOM report Preventing Childhood Obesity: Health in the Balance Industry should make obesity prevention in children and youth a priority by developing and promoting products, opportunities, and information that will encourage healthful eating behaviors and regular physical activity. To implement this recommendation: Food and beverage industries should develop product and packaging innovations that consider energy density, nutrient density, and standard serving sizes to help consumers make healthful choices. Leisure, entertainment, and recreation industries should develop products and opportunities that promote regular physical activity and reduce sedentary behaviors. Full serve and fast food restaurants should expand healthier food options and provide calorie content and general nutrition information at point of purchase. Industry should develop and strictly adhere to marketing and advertising guidelines that minimize the risk of obesity in children and youth. To implement this recommendation: The Secretary of the Department of Health and Human Services should convene a national conference to develop guidelines for the advertising and marketing of foods, beverages, and sedentary entertainment directed at children and youth with attention to product placement, promotion, and content. Industry should implement the advertising and marketing guidelines. The Federal Trade Commission should have the authority and resources to monitor compliance with the food and beverage and sedentary entertainment advertising practices. Nutrition labeling should be clear and useful so that parents and youth can make informed product comparisons and decisions to achieve and maintain energy balance at a healthy weight. To implement this recommendation: The Food and Drug Administration should revise the Nutrition Facts panel to prominently display the total calorie content for items typically consumed at one eating occasion in addition to the standardized calorie serving and the percent Daily Value. The Food and Drug Administration should examine ways to allow greater flexibility in the use of evidence-based nutrient and health claims regarding the link between the nutritional properties or biological effects of foods and a reduced risk of obesity and related chronic diseases. Consumer research should be conducted to maximize use of the nutrition label and other food guidance systems. SOURCE: IOM (2005).

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Progress in Preventing Childhood Obesity: How Do We Measure Up? BOX 5-2 Recommendations from the 2006 IOM Report Food Marketing to Children and Youth: Threat or Opportunity? Food and beverage companies should use their creativity, resources, and full range of marketing practices to promote and support more healthful diets for children and youth. To implement this recommendation, companies should: Shift their product portfolios in a direction that promotes new and reformulated child- and youth-oriented foods and beverages that are substantially lower in total calories, lower in fats, salt, and added sugars, and higher in nutrient content. Shift their advertising and marketing emphasis to child- and youth-oriented foods and beverages that are substantially lower in total calories, lower in fats, salt, and added sugars, and higher in nutrient content (see later recommendations on public policy and monitoring). Work with government, scientific, public health, and consumer groups to develop and implement labels and advertising for an empirically validated industry-wide rating system and graphic representation that is appealing to children and youth to convey the nutritional quality of foods and beverages marketed to them and their families. Engage the full range of their marketing vehicles and venues to develop and promote healthier appealing and affordable foods and beverages for children and youth. Full serve restaurant chains, family restaurants, and quick serve restaurants should use their creativity, resources, and full range of marketing practices to promote healthful meals for children and youth. To implement this recommendation, restaurants should: Expand and actively promote healthier food, beverage and meal options for children and youth. Provide calorie content and other key nutrition information, as possible, on menus and packaging that is prominently visible at the point of choice and use. Food, beverage, restaurant, retail, and marketing industry trade associations should assume transforming leadership roles in harnessing industry creativity, resources, and marketing on behalf of healthful diets for children and youth. To implement this recommendation, trade associations should: Encourage member initiatives and compliance to develop, apply, and enforce industry-wide food and beverage marketing practice standards that support healthful diets for children and youth. Provide technical assistance, encouragement, and support for members’ efforts to emphasize the development and marketing of healthier foods, beverages, and meals for children and youth.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Exercise leadership in working with their members to improve the availability and selection of healthful foods and beverages accessible at eye level and reach for children, youth, and their parents in grocery stores and other food retail environments. Work to foster collaboration and support with public sector initiatives promoting healthful diets for children and youth. The food, beverage, restaurant, and marketing industries should work with government, scientific, public health, and consumer groups to establish and enforce the highest standards for the marketing of foods, beverages, and meals to children and youth. To implement this recommendation, the cooperative efforts should: Work through the Children’s Advertising Review Unit (CARU) to revise, expand, apply, enforce, and evaluate explicit industry self-regulatory guidelines beyond traditional advertising to include evolving vehicles and venues for marketing communication (e.g., the Internet, advergames, branded product placement across multiple media). Assure that licensed characters are used only for the promotion of foods and beverages that support healthful diets for children and youth. Foster cooperation between CARU and the Federal Trade Commission in evaluating and enforcing the effectiveness of the expanded self-regulatory guidelines. The media and entertainment industry should direct its extensive power to promote healthful foods and beverages for children and youth. To implement this recommendation, media and the entertainment industry should: Incorporate into multiple media platforms (e.g., print, broadcast, cable, Internet, and wireless-based programming) foods, beverages, and storylines that promote healthful diets. Strengthen their capacity to serve as accurate interpreters and reporters to the public on findings, claims, and practices related to the diets of children and youth. SOURCE: IOM (2006). current private-sector efforts that support obesity prevention, including the efforts of food and beverage manufacturers; full serve restaurants and quick serve restaurants (QSR);1 food retailers; trade associations; the media; corpo- 1 A QSR is a category of restaurants characterized by foods, beverages, and meals that are supplied quickly after ordering, with minimal service, and may be consumed at the restaurant or served as takeout.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? rate and private foundations; and the leisure, recreation, and sedentary entertainment industries. The strategies that industry uses to address childhood obesity prevention include product development and reformulation, product packaging, enhancing physical activity opportunities, advertising and marketing communications, public-private partnerships, employee wellness initiatives, and corporate social responsibility and public relations.2 The chapter discusses the challenges in assessing the progress made by the private sector and recommends next steps for strengthening evaluation efforts. A substantial amount of the discussion in this chapter focuses on the food, beverage, and restaurant industries, with fewer examples from the physical activity, leisure, recreation, and sedentary entertainment industries. This imbalance in coverage is due in part to the attention that has been placed on the responses to the obesity epidemic by the food, beverage, and restaurant industries. It is also possible that the segments of industry whose efforts are directly or indirectly related to changing physical activity behaviors may not perceive themselves to be part of the obesity prevention discourse or they may not want to be a focus of attention for this issue. Although a number of corporations are actively engaged in increasing opportunities for physical activity, there is need for further involvement. The committee also benefited from the work of the prior IOM committee on food marketing but did not have a similar compendium of recent efforts related to physical activity. A comprehensive review of the efforts by the physical activity, leisure, recreation, and sedentary entertainment industries3 is needed, as there are many opportunities to increase and coordinate actions within and across this sector to promote physical activity among children and youth. OPPORTUNITIES AND CHALLENGES In December 2005, the committee held a symposium in Irvine, California that focused on the efforts by industry to engage in and contribute to childhood obesity prevention (Appendix H). This IOM symposium explored the challenges and opportunities that exist in forging alliances between the public health community and industry. Acknowledging the po- 2 A list of acronyms and a glossary of definitions are provided in Appendixes A and B. Box 5-3 provides the definitions of common marketing terms. 3 Examples of active leisure and recreation industries include companies that promote sporting goods, fitness, gyms, and dance. Sedentary entertainment requires minimal physical activity. Examples of sedentary entertainment industries include companies that promote spectator sports, broadcast and cable television, videogames, DVDs, and movies (IOM, 2006; Sturm, 2004).

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Progress in Preventing Childhood Obesity: How Do We Measure Up? tential tension among stakeholder groups, it is important to nurture and strengthen partnerships supporting obesity prevention efforts by Conveying consistent, appealing, and specific messages to children, adolescents, and adults; Ensuring transparency through the sharing of data between the public health community and industry; Making long-term commitments to obesity prevention; Ensuring company-wide commitments (large corporations in particular need to ensure that the entire organization and not just isolated sectors of the business is engaged in obesity prevention efforts); Balancing the free market system with protecting children’s health. While public health advocates acknowledge the values and realities of the competitive marketplace and recognize that many companies are making positive changes, companies should accept responsibility for engaging in marketing practices that promote healthy lifestyles for children and youth; Understanding the interactions between companies, marketing practices, and consumer demand; Exploring potential avenues of impact. One area that has not been fully examined is the potential impact that business leaders can have in advocating for policy changes and initiatives that promote improvements in diet and increased levels of physical activity; and Making a commitment to monitor and evaluate efforts. UNDERSTANDING THE MARKETPLACE Companies use a variety of integrated marketing strategies to influence consumer preferences, stimulate consumer demand for specific products, increase sales, and expand their market share. Integrated marketing is a planning process designed to ensure that all promotional activities of a company—including media advertising, direct mail, sales promotion, and public relations—produce a unified, customer-focused promotion message that is relevant to a customer and that is consistent over time. The allocation of companies’ marketing budgets differs on the basis of the nature and the size of the company. Food companies usually spend approximately 20 percent of their total marketing budgets for advertising, 25 percent for consumer promotion, and 55 percent for trade promotion (GMA Forum, 2005; IOM, 2006) (Box 5-3). The committee had no data with which it could assess how the leisure, recreation, and entertainment industries allocate their marketing budgets. The U.S. Department of Agriculture (USDA), which tracks trends in

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Progress in Preventing Childhood Obesity: How Do We Measure Up? BOX 5-3 Industry Definitions Marketing A set of processes for creating, communicating, and delivering value to customers and for managing customer relationships in ways that benefit an organization and its stakeholders. Marketing encompasses a wide range of activities including conducting market research; analyzing the competition; positioning a new product; pricing products and services; and promoting products and services through advertising, consumer promotion, trade promotion, public relations, and sales. All of these activities are integral tools used by companies in the marketplace that can be potentially directed toward healthier products, diets, and lifestyles. Advertising Advertising represents the paid public presentation and promotion of ideas, goods, or services by a company or sponsor and is intended to bring a product to the attention of consumers through various media channels. It is often the most recognizable form of marketing. Consumer Promotion Consumer promotion is a marketing activity distinct from advertising. It is also referred to as “sales promotion” and represents companies’ promotional efforts that have an immediate impact on sales. Examples of consumer or sales promotion include coupons, discounts and sales, contests, point-of-purchase displays, rebates, gifts, incentives, and product placement. Trade Promotion Trade promotion is a type of marketing that targets intermediary industry stakeholders such as supermarkets, grocery stores, convenience stores, and other food retail outlets. Examples of trade promotion strategies include in-store displays, agreements with retailers to provide specific shelf space and product positioning, free merchandise, and sales contests to encourage food wholesalers or retailers to sell more of a specific company’s branded products or product lines. Public Relations Public relations are a company’s communications and relationships with various groups including customers, employees, suppliers, stockholders, government, and the public. Proprietary Data Proprietary data consist of information obtained from private companies or firms that hold the exclusive rights to distribute those data, which are often collected for specific commercial purposes intended for a targeted audience. They may be available to customers who can purchase the data, and are usually not widely available to the public due to the expense. SOURCES: AMA (2005); Boone and Kurtz (1998); IOM (2006).

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Progress in Preventing Childhood Obesity: How Do We Measure Up? food and beverage marketplace expenditures, estimated that in 2005, total food and beverage sales in the United States were $1.023 trillion. The growth in food expenditures has been steady since 1967, with a growth of nearly 6.4 percent per year (ERS/USDA, 2006).4 Between 1987 and 2001 there was also considerable growth in the industries associated with leisure and recreation (e.g., sporting goods, spectator sports, and entertainment) (Sturm, 2004), but the committee was unable to find recent data that accurately quantified the total expenditures made by these industries. In 2004, marketing expenditures for all products—including food, beverages, and other manufactured items—totaled $264 billion, which included $141 billion for advertising in measured media5 (Brown et al., 2005). The IOM Committee on Food Marketing and the Diets of Children and Youth found that corporations spent more than $10 billion in 2004 to advertise foods, beverages, and meals to children and youth, of which $5 billion of the total was for television advertising (IOM, 2006). The total advertising spending by companies in measured media for selected categories of products was used to approximate the amount spent by the food, beverage, and restaurant industries in 2004. An estimated $6.84 billion was spent on advertising in the food, beverage, and candy category and $4.42 billion was spent on advertising for restaurants and fast food, for a total of $11.26 billion. An additional $10.89 billion was spent on advertising for toys and games; sporting goods; media; and sedentary entertainment, including movies, DVDs, and music (Brown et al., 2005). Company data on how marketing budgets are allocated are often proprietary, however, and are thus not available to the public. Therefore, industry data that can be used to assess recent investments in healthful products are not widely available. As discussed later in the chapter, despite the high level of product innovation toward healthier choices that has been forecasted by industry analysts, most companies do not provide publicly accessible information on the investments that they make in research and development on healthier products (Lang et al., 2006). Furthermore, there is currently limited evidence that companies with product portfolios comprised largely of less healthful products are merging with or acquiring companies with healthier products (Insight Investment, 2006). 4 The USDA differentiates food sales from food expenditures. The latter includes noncash sales in the Economic Research Service food expenditure series. The Bureau of Labor Statistics Consumer Price Index for Food grew at a rate of 4.6 percent from 1967 to 2005 so more than half of the growth in food sales was due to higher retail prices (ERS/USDA, 2006). 5 Measured media represent the categories of media tracked by media research companies, including television (e.g., major networks; national spots; and cable, syndicated, and Spanish-language networks), radio (e.g., network, national spot, and local radio), magazines (e.g., local and Sunday magazines), business publications, newspapers (e.g., local and national newspapers), outdoor advertising, direct mail, telephone directory advertising, and the Internet.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Branding is a goal of most companies and involves providing a name or symbol that legally identifies a company, a specific product, or a product line and that distinguishes it from other companies or similar products in the marketplace (Roberts, 2004). Branding has become a normalized part of life for American children and adolescents (Schor, 2004). The rate of brand loyalty is highest among adolescents, especially for carbonated soft drinks and QSRs. Brand loyalty may be related to the increased trend over the past 20–30 years in sweetened beverage consumption and the proportion of calories that children and youth receive from away-from-home foods, beverages, and meals, especially those purchased and consumed at full serve restaurants and QSRs. These products often contain higher amounts of fat and total calories than those products consumed at home (IOM, 2006). After reviewing the available literature on branding and young consumers, the IOM Committee on Food Marketing to Children and Youth concluded that children are aware of particular food brands when they are as young as 2 to 3 years of age and that preschoolers demonstrate the ability to recognize particular brands when they are cued by spokes-characters and colorful packages. The committee also found that a majority of children’s food requests are for branded products. Although the use of child-oriented licensed cartoon and other fictional or real-life spokescharacters to promote the consumption of low-nutrient and high-calorie food and beverage products has been a prevalent practice over the past several decades, the use of licensed characters to promote foods and beverages that contribute to healthful diets, particularly for preschoolers, is relatively recent (IOM, 2006). Preliminary evaluation and research results from the Sesame Workshop suggests that preschoolers may view fruits, vegetables, and other foods that contribute to a healthful diet more favorably if they are endorsed by familiar and appealing spokes-characters or mascots (Appendix H). More recently, businesses, institutions, and communities are using branding to promote behavioral changes, often called lifestyle branding or behavioral branding. Such branding encourages individuals to associate a brand or a product line with a specific behavior, lifestyle, or social cause (Holt, 2004; IOM, 2006; Roberts, 2004; Tillotson, 2006a). Examples of initiatives that promote this type of branding are Active Living by Design (RWJF, 2006), Balanced Active Lifestyles (McDonald’s Corporation, 2006), Healthy Eating, Active Living (Kaiser Permanente, 2006), Health is Power! (PepsiCo, 2006a), Fruits and Veggies—More Matters!™ (PBH, 2006), the VERB™ campaign (Wong et al., 2004) (Chapter 4), and the American Legacy Foundation’s truth® campaign (Evans et al., 2005). Given the growing concerns linking corporate marketing practices and the obesity epidemic among children, youth, and adults in the United States

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Progress in Preventing Childhood Obesity: How Do We Measure Up? (Dorfman et al., 2005; Freudenberg, 2005; Kreuter, 2005) and internationally (Lang et al., 2006; WHO, 2003, 2004; Yach et al., 2005), industry and individual companies should be involved in changing how they conduct business to address social and economic pressures and consumer demands. This is what marketers refer to as the “strategic inflection point” (Parks, 2002). The Health in the Balance report emphasized that market forces may be influential in changing both consumer and industry behaviors. To lead healthier and more active lifestyles, young consumers and their parents will need to make positive changes in their own lives, including developing preferences for and selecting foods and beverages that contribute to healthful diets and regularly engaging in more active pursuits. All industries—the food, beverage, restaurant, recreation, entertainment, and leisure industries—should share responsibility for supporting consumer changes and childhood obesity prevention goals. These industries can be instrumental in changing social norms throughout the nation and internationally so that obesity will be acknowledged as an important and preventable health outcome and healthful eating and regular physical activity will be the accepted and encouraged standard (IOM, 2005). The childhood obesity epidemic needs to reach a “tipping point” (Gladwell, 2000), which is the point at which the collective changes made by industry, in concert with efforts in other sectors and by other stakeholders, will produce a large effect to make healthy behaviors and lifestyles the social norm. It is important to recognize that corporations as employers have an interest in a healthy workforce with healthy families, and many employers are placing an increasing emphasis on obesity prevention and improved employee well-being. Corporate responsibility, health care costs, and lost productivity are key drivers in the development and promotion of employee wellness opportunities. Such employee benefits may include the provision of discounts for health club memberships or gyms at the workplace; offering foods and beverages that contribute to healthful diets in cafeterias, vending machines, and at meetings; and the promotion of walking breaks or physical activity during the work day. Although this chapter primarily focuses on corporations as the producers and the deliverers of goods and services, corporations are also major consumers of health care and have an increasing interest in the outcomes and impact of obesity on their current and future workforces and their families. EXAMPLES OF PROGRESS Building consumer demand for regular physical activity and for foods and beverages that contribute to a healthful diet is an ongoing process that

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Progress in Preventing Childhood Obesity: How Do We Measure Up? is moving forward through the efforts of corporations that are willing to make changes to engage consumers in achieving healthy lifestyles. This will require the broad involvement of many sectors and stakeholders, including food, beverage, and restaurant companies; food retailers; trade associations; the leisure, recreation, and fitness industries; the entertainment industry; and the media (IOM, 2005, 2006). Wansink and Huckabee (2005) have proposed three phases for the food and restaurant industries’ and trade associations’ response to the obesity epidemic. The first phase is to deny that they have a contributing role in the obesity epidemic by associating increasing obesity rates with the rising levels of physical inactivity and sedentary lifestyles. The second phase is to appeal to consumer sovereignty by emphasizing moderation and consumer choice in their food and beverage intake, promoting physical activity, and asserting the rights of customers to decide on the appropriate selections for their own or their families’ lifestyles. The third phase is to develop win-win strategies that are profitable and that therefore satisfy company shareholder needs while concurrently meeting consumers’ needs for healthful products, portion control, and other steps that can lead them toward healthy lifestyles. Wansink and Huckabee (2005) have suggested several different types of changes that food, beverage, and restaurant companies can consider making and pilot testing to offer products that are both healthful to consumers and profitable (Table 5-1). Several groups have offered suggestions and guidelines to the food industry and restaurant sector to help them provide healthier food, beverage, and meal options. The American Heart Association’s 2006 Diet and Lifestyle Recommendations provide several tailored recommendations specifically for these industry sectors (Lichtenstein et al., 2006; Box 5-4). The Keystone Forum on Away-From-Home Foods, supported by the FDA, also provides detailed recommendations on how consumers can make more healthful choices and what restaurants and food retailers can do to cater to consumer choices (Keystone Center, 2006). The following sections highlight some examples of changes that are in progress, many of which need to be evaluated. The committee highlights promising practices and raises issues relevant to increasing corporate involvement in this issue. Product and Meal Development and Reformulation Many industry leaders are testing a variety of new product development strategies, such as incorporating more nutritious ingredients into products (e.g., whole grains) and expanding healthier meal options at full serve restaurants and QSRs (e.g., fruit, salads, and low-fat yogurt). Making small changes to existing products to improve their healthfulness and continuing

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Progress in Preventing Childhood Obesity: How Do We Measure Up? obesity prevention policies, programs, and interventions. Data sharing will need to balance many considerations including transparency, public accessibility, the demands of the competitive marketplace, and legal issues. In certain cases, it might be appropriate for the data to be released after a time lag to keep the public informed with relatively recent data. The committee recommends that the public and private sectors engage in a collaborative process that will assist relevant stakeholders in sharing proprietary data for the public good. SUMMARY AND RECOMMENDATIONS Changes in the development and promotion of products and services that contribute to healthy lifestyles are under way. However, much remains to be done. Most of the attention to date has focused on changes in the food and beverage industries. Indeed, changes in product formulations, packaging, labeling, and marketing are occurring as the result of corporate initiatives and government efforts, as well as through collaborations between industry and community partners. Independent evaluations of these changes are critical, as is the broader engagement of a wider array of relevant industries. In addition to the changes made by the food and beverage industries, innovative approaches to encouraging and promoting physical activity are being explored, however further efforts and creative advances are greatly needed in this area. Strengthening the alliances between the public health community and industry will bring the strengths of all groups to bear on preventing childhood obesity. Recommendation 1: Government, industry, communities, schools, and families should demonstrate leadership and commitment by mobilizing the resources required to identify, implement, evaluate, and disseminate effective policies and interventions that support childhood obesity prevention goals. Implementation Actions for Industry Industry should use the full range of available resources and tools to create, support, and sustain consumer demand for products and opportunities that support healthy lifestyles including healthful diets and regular physical activity. To accomplish this, Industry should continue to support and market product innovations and reformulations that promote energy balance at a healthy weight for children and youth and that are compatible with obesity prevention goals.

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Progress in Preventing Childhood Obesity: How Do We Measure Up? Industry should support the review of the existing self-regulatory guidelines for advertising directed to children. It should also expand the guidelines to advertising vehicles beyond those used in traditional advertising to include evolving vehicles and venues for marketing communication and apply and enforce the guidelines for the traditional and expanded vehicles. Companies should consider developing their own advertising and marketing guidelines for children that are consistent with the industry-wide guidelines. Recommendation 2: Policy makers, program planners, program implementers, and other interested stakeholders—within and across relevant sectors—should evaluate all childhood obesity prevention efforts, strengthen the evaluation capacity, and develop quality interventions take into account diverse perspectives, that use culturally relevant approaches, and that meet the needs of diverse populations and contexts. Implementation Actions for Industry Industry should partner with government, academic institutions, and other interested stakeholders to undertake evaluations to assess its progress in preventing childhood obesity and promoting healthy lifestyles. To accomplish this, Industry should evaluate its progress in developing and promoting affordable foods, beverages, and meals that support a healthful diet; physical activity products and opportunities; storylines and programming that promote healthy lifestyles; and advertising and marketing practices directed to children and youth. Industry should provide resources and expertise to local businesses and community-based organizations to implement and evaluate initiatives that provide opportunities for consumers to engage in healthful eating and regular physical activity, especially for children and youth in racially and ethnically diverse groups and high-risk populations. Recommendation 3: Government, industry, communities, and schools should expand or develop relevant surveillance and monitoring systems and, as applicable, should engage in research to examine the impact of childhood obesity prevention policies, interventions, and actions on relevant outcomes, paying particular attention to the unique needs of diverse groups and high-risk populations. Additionally, parents and

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Progress in Preventing Childhood Obesity: How Do We Measure Up? caregivers should monitor changes in their family’s food, beverage, and physical activity choices and their progress toward healthier lifestyles. Implementation Actions for Industry The U.S. Congress, in consultation with industry and other relevant stakeholders, should appropriate adequate funds to support independent and periodic evaluations of industry’s efforts to promote healthier lifestyles. To accomplish this, The FDA should be given the authority to evaluate full serve and quick serve restaurants’ expansion of healthier food, beverage, and meal options; the effectiveness of the restaurant sector in providing nutrition labeling and nutrition information at the point of choice; and the effect of this information on consumers’ purchasing behaviors. The CDC should evaluate the effectiveness of corporate-sponsored physical activity programs, energy-balance education programs, and the use of branded physical activity equipment (e.g., physical videogames) on children’s leisure-time preferences and physical activity behaviors. The U.S. Congress should designate a responsible agency to conduct the periodic monitoring and evaluation of the self-regulatory guidelines of CARU, which should include an assessment of CARU’s effectiveness, impact, and enforcement capacity. The food retail sector, the restaurant sector, and relevant trade associations should collaborate with the USDA and DHHS to provide marketing data on pricing strategies, consumer food purchases, and consumption trends from proprietary retail scanner systems, household scanner panels, household consumption surveys, and marketing research. The collaborative work should examine the quality of the data, consider reducing the cost to make the data more accessible, and establish priorities for applying the information to promote healthful diets. Industry should demonstrate corporate responsibility by sharing marketing research findings that may help public health professionals and community-based organizations develop and implement more effective childhood obesity prevention messages, policies, and programs. Recommendation 4: Government, industry, communities, schools, and families should foster information-sharing activities and disseminate

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Progress in Preventing Childhood Obesity: How Do We Measure Up? evaluation and research findings through diverse communication channels and media to actively promote the use and scaling up of effective childhood obesity prevention policies and interventions. Implementation Actions for Industry Industry should collaborate with the public sector and other relevant stakeholders to develop a mechanism for sharing proprietary data and a sustainable funding strategy that can inform and support childhood obesity prevention interventions. To accomplish this, The private sector (e.g., industry and foundations) and the public sector (e.g., government and nonprofit organizations) should partner to develop a mechanism for the sharing proprietary data (e.g., product sales information, marketing research data, and the results of evaluations of industry-supported programs) that can inform research efforts and assist in developing a healthy lifestyles social marketing campaign. A long-term funding strategy should be established to sustain the campaign. Such a strategy should include a dedicated government appropriation and a dedicated set-aside from relevant industries. Government and other interested stakeholders should develop incentives and rewards for industry stakeholders that collaborate on this endeavor. REFERENCES AAAA (American Association of Advertising Agencies). 2006. Inside the AAAA: About Us. [Online]. Available: http://www.aaaa.org/eweb/DynamicPage.aspx?Site=4A_new&WebKey=d94ac5ca-e68d-4587-be89-5a8e7ea82e39 [accessed August 1, 2006]. AAF (American Advertising Federation). 2006. About AAF. [Online]. Available: http://www.aaf.org/about/index.html [accessed July 24, 2006]. Ad Council. 2006a. About Ad Council. [Online]. Available: http://www.adcouncil.org/default.aspx?id=68 [accessed July 24, 2006]. Ad Council. 2006b. Coalition for Healthy Children: Combating Childhood Obesity. [Online]. Available: http://healthychildren.adcouncil.org/about.asp [accessed July 24, 2006]. Aetna. 2006. 2006 Regional Community Health Grants Program. [Online]. Available: http://fconline.fdncenter.org/pnd/10001192/aetna [accessed March 13, 2006]. Alliance for a Healthier Generation. 2005. Nickelodeon, Clinton Foundation and American Heart Association Announce Partnership to fight Childhood Obestiy [Online]. Available: http://www.healthiergeneration.org/docs/afhg_nr_lets_just_play_10-20-05.pdf/ [accessed August 3, 2006]. Alliance for a Healthier Generation. 2006a. Alliance for a Healthier Generation and Industry Leaders Set Healthy School Beverage Guidelines for U.S. Schools. [Online]. Available: http://www.healthiergeneration.org/docs/afhg_ nr_school_beverage_5-3-06.pdf [accessed May 8, 2006].

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