The types of questions that are being asked by decision makers interested in obesity prevention cannot be answered without broadening the concept of evidence to include new ways of using traditional or existing information; information drawn from a wider range of sources; and newly generated evidence that is more focused on the design, implementation, and outcomes of policies and programs to prevent obesity—whether initiated in research or practice settings.

THE NEED FOR A NEW FRAMEWORK

The scenarios in Boxes S-1 and S-2, respectively, illustrate the need to assist decision makers in finding evidence to inform decisions and to help researchers determine useful areas of study. Considerable progress has been made in building on the strengths of methods used in evidence-based medicine to develop research methods and evidence standards applicable to decision making about other population-level health problems. Leveraging these accomplishments holds the potential to advance understanding of how to develop and evaluate evidence for use in decision making on obesity prevention.

The Institute of Medicine Committee on an Evidence Framework for Obesity Prevention Decision Making was formed to address these challenges. The overall charge of the committee was to develop a framework for evidence-informed decision making in obesity prevention, with a focus on assessing policy, environmental, and

Box S-1

The Need for Evidence to Support Decision Making on Obesity Prevention

Imagine that you are the mayor, or a health commissioner, in a city in which both children and adults have high rates of obesity—perhaps higher than in some peer cities that appear to have a better handle on the problem. You need to decide which of a spectrum of actions to take and how to justify these actions against some inevitable opposition from various stakeholders. Consumer advocates are calling for policies that require posting of calories on the menu boards of fast food restaurants. Some city council members are calling for taxes on soft drinks to lower consumption levels but also to raise revenue to offset budget deficits. The school board is debating whether to make the collection of child weight-for-height data mandatory and to send the information home to parents.


Ideally, among the many considerations factoring in to your decision making, you or your staff would readily find or have at hand a rich and frequently replenished set of reports to support your decision about a particular strategy or a choice among options. These reports would relate to the types of policy and environmental changes you are considering and provide an idea of their pros and cons—for example, estimated benefits, unintended adverse consequences, costs, and the practicalities of implementation. You would find few such reports, however.



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