likelihood of shifting physical activity, eating, and weight management toward energy balance in the population as a whole, including those groups and individuals at high risk of becoming obese. In this report, primary prevention is viewed as relevant to the continuum of excess weight—prevention of the progression from normal weight to overweight, from overweight to obesity, and from mild or moderate to more severe obesity.

The logic of beginning obesity prevention during childhood is self-evident. At every life stage, from infancy onward, sustained excess weight and obesity increase the risk of longer-term obesity. In adults, obesity prevention targets those who enter adulthood with weight in the normal range, as well as those who may already be somewhat overweight or obese, to limit the severity of obesity and obesity-related health and social consequences. The need for effective preventive strategies is heightened by the seemingly intractable nature of established obesity, making the reduction of incidence—new cases of obesity—a priority. Effective treatments for established obesity continue to be elusive despite decades of research on treatment strategies, an active commercial weight loss industry, and a majority of U.S. adults trying to lose or maintain their weight at any given time. However, the need for prevention would persist even if effective treatments were available. In the absence of prevention, there would be a continual influx of people needing treatment (i.e., a majority of the population) such that the demand for treatment would exceed the supply.

Goals for Children and Adolescents

Goals for children and adolescents outlined in the Institute of Medicine (IOM) report Preventing Childhood Obesity: Health in the Balance (IOM, 2005) continue to inform actions at the national and community levels (see Box 3-1). For children and adolescents, obesity prevention means maintaining a healthy weight trajectory and preventing excess weight gain while growing, developing, and maturing (IOM, 2010). Goals include prevention of obesity and its adverse consequences during childhood, as well as longer-term prevention of obesity in adulthood, because children who are obese may remain so throughout life. Given the general increase in media attention to obesity as a result of the epidemic (see Chapter 2, Figures 2-7 and 2-8) and the potential for an increased focus on body size to foster inappropriate weight concern or dieting (Davison et al., 2003; Ikeda et al., 2006), an explicit goal has been added to those originally stated by the IOM (2005) to highlight the importance of maintaining a positive body image and avoiding excessive weight concern.

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