most closely related to higher energy expenditure (increased physical activity) and lower energy intake (lower caloric consumption)—the two components of energy balance. If achieved, they should affect the overarching indicators of accelerating progress in obesity prevention.
Process indicators are more distal and relate to policies and environmental strategies designed to result in increasing the likelihood of energy balance. Examples include increasing the proportion of states and municipalities that adopt policies promoting enhancements to the physical and built environment that support increased physical activity.
Finally, foundational indicators relate to actions even further upstream that influence the broader dynamics involved in accelerating progress in obesity prevention (e.g., adoption of federal legislative and regulatory policies to increase domestic production of fruits and vegetables). Foundational indicators also relate to actions designed to specifically address health disparities for population subgroups disproportionately affected by obesity, physical inactivity, or excess caloric intake (e.g., reduced consumption of sugar-sweetened beverages among populations with higher rates of consumption of such beverages, including non-Hispanic blacks, Mexican Americans, and lower-income individuals).
The committee carefully reviewed each recommended strategy against existing data sources to identify indicators of progress at each level of the above framework. Additionally, the committee held a public workshop in March 2011 to obtain input on potential indicators and to identify areas in which systems for tracking progress on a given indicator are clearly needed. Because of the committee’s emphasis on accelerating progress in obesity prevention nationwide, the focus was on identifying national data sources as the primary sources for proposed indicators that currently exist. As indicated in the committee’s charge, however, indicators do not yet exist for many of the strategies recommended in this report. Therefore, it was necessary to identify new indicators that must rely heavily on commercial data or require the development of new data sources. The proposed indicators (both existing and new) are identified after each recommended strategy (throughout Chapters 5 through 9) and for the system of recommendations (near the conclusion of Chapter 10). Additionally, because many of the proposed indicators do not yet exist, the committee has identified this as an area in which additional work is clearly needed moving forward (see Chapter 10).
Finally, in conjunction with the identification of indicators of progress, the committee believes an important opportunity exists to create a research frame-