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Early Childhood Obesity Prevention Policies (2011)

Chapter: Appendix A: Methods

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Suggested Citation:"Appendix A: Methods." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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A

Methods

Formulation of policy recommendations calls for careful consideration of the evidence associated with one course of action or another. The Committee on Obesity Prevention Policies for Young Children carefully considered both direct and indirect evidence regarding the likely impact of a given policy on reducing childhood obesity. We also considered evidence pertaining to the potential for unintended adverse effects. Although we did not conduct a comprehensive, systematic evidence review on each important policy-related question, our collective expertise and consideration of the most pertinent studies yielded recommendations that are consistent with the evidence base. In areas in which the committee identified a need for additional information, outside experts were called upon at a public workshop held on June 2, 2010, in Washington, DC, titled “Emerging Issues, Programs, and Policy Needs in Early Childhood Obesity Prevention.”

The ideal evidence to support policy recommendations would be a series of experimental studies testing the impact of various policies on childhood obesity in representative settings. Given the rarity of such studies and the urgent need to address the enormous health impacts of obesity, however, we could not restrict ourselves to making recommendations in the few areas in which such firm evidence exists. Observational studies are easier to conduct and thus far more common, and we gave strong studies of this type serious consideration. Although we recognize that conclusions regarding causality that can be drawn from such studies are less firm, we believe that evidence from

Suggested Citation:"Appendix A: Methods." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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repeated, well-conducted observational studies can provide sufficient support for policy recommendations. We also were receptive to evidence that a policy would be likely to affect a determinant of childhood obesity even if not studied for its direct influence on obesity. That is, we recommend policy changes expected to increase physical activity or promote more healthy eating in children because such intermediate outcomes are themselves associated with prevention of childhood obesity.

Our recommendations are predicated on the belief, supported by evidence, that a change in the target of a policy will produce the desired change in obesity or its behavioral risk factors (e.g., a policy resulting in reduced consumption of soft drinks would contribute to obesity prevention). This belief reflects an informed judgment that considers the quality of the studies and the results they generate.

Another important consideration is the possibility that a policy intended to reduce childhood obesity could have unintended adverse consequences. For example, policies to promote physical activity among children must take into account the potential for increased risk of injury. Because many important developmental processes occur during gestation and early childhood, it is essential to be as certain as possible that none of the recommended policy changes could have irreversible adverse effects during these critical periods. Lacking direct evidence in most cases, we relied on more subjective consideration of the plausibility of such consequences. We also considered ways to mitigate potential adverse consequences, such as environmental design to reduce playground injuries among young children.

In the report we note the current state of the scientific evidence pertinent to the recommended policies, including both uncertainties and areas in which research is needed. Ultimately, our recommendations take full account of the scientific data but also reflect our collective best judgment. We have attempted to be consistent in our approach to combining scientific evidence and expert judgment, holding policy options to the same standards. The urgency of addressing obesity in young children requires taking action rather than waiting for more conclusive research—applying the “best available” rather than the “best possible” evidence. Research in this context includes studies of more effective means of implementing or enforcing policy changes to reduce childhood obesity. Some of our policy recommendations (or our unwillingness to make recommendations) fall on the cusp of the scientific evidence, barely or almost sufficient, and those are issues for which more research could well tip the balance in one direction or another.

Suggested Citation:"Appendix A: Methods." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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As new policies to prevent childhood obesity are implemented, it is important that those policies be evaluated to (1) support further action where success can be demonstrated; (2) ensure that policies that fail to act in the intended manner are reconsidered; and particularly (3) assess any unintended adverse consequences. As new evidence emerges, it will be important to reexamine our policy recommendations and make any necessary revisions. Thus it is essential to act aggressively based on what is known now while putting in place the necessary processes for research and policy evaluation to ensure that action can be taken even more wisely and effectively in the future.

Suggested Citation:"Appendix A: Methods." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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Suggested Citation:"Appendix A: Methods." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
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Suggested Citation:"Appendix A: Methods." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
×
Page 150
Suggested Citation:"Appendix A: Methods." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
×
Page 151
Suggested Citation:"Appendix A: Methods." Institute of Medicine. 2011. Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. doi: 10.17226/13124.
×
Page 152
Next: Appendix B: Emerging Issues in Early Childhood Obesity Prevention »
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Childhood obesity is a serious health problem that has adverse and long-lasting consequences for individuals, families, and communities. The magnitude of the problem has increased dramatically during the last three decades and, despite some indications of a plateau in this growth, the numbers remain stubbornly high. Efforts to prevent childhood obesity to date have focused largely on school-aged children, with relatively little attention to children under age 5. However, there is a growing awareness that efforts to prevent childhood obesity must begin before children ever enter the school system.

Early Childhood Obesity Prevention Policies reviews factors related to overweight and obese children from birth to age 5, with a focus on nutrition, physical activity, and sedentary behavior, and recommends policies that can alter children's environments to promote the maintenance of healthy weight. Because the first years of life are important to health and well-being throughout the life span, preventing obesity in infants and young children can contribute to reversing the epidemic of obesity in children and adults. The book recommends that health care providers make parents aware of their child's excess weight early. It also suggests that parents and child care providers keep children active throughout the day, provide them with healthy diets, limit screen time, and ensure children get adequate sleep.

In addition to providing comprehensive solutions to tackle the problem of obesity in infants and young children, Early Childhood Obesity Prevention Policies identifies potential actions that could be taken to implement those recommendations. The recommendations can inform the decisions of state and local child care regulators, child care providers, health care providers, directors of federal and local child care and nutrition programs, and government officials at all levels.

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