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7 Final Observations I n the wrap-up session, William Dietz, Director of the Division of Nutri- tion, Physical Activity, and Obesity at the Centers for Disease Control and Prevention, synthesized remarks made at the workshop into several overarching observations. His comments should not be seen as consensus conclusions of the workshop, but they suggest potentially fruitful directions for obesity prevention. Dietz began by recalling Imig’s observation that contentious campaigns become social movements when the actors are tightly connected, when they share understandings and values, when they act collectively for change, and when the campaigns are sustained. By that measure, the movement to prevent childhood obesity is still in a nascent stage, he said. First, obesity is still marked by a lack of understanding and widespread denial. Parents may acknowledge that their children are overweight, but they think other children are obese, even when their own children are at the 95th or 96th percentile (on the age- and sex-specific Centers for Disease Control and Prevention [CDC] body mass index growth charts). As a result, parents do not feel a sense of imminent threat. Also, the movement lacks a specific opponent. Is the opponent the food industry, fast food, sugar-sweetened beverages, the Farm Bill, or the agricul- tural production system? “Until there is more focus on what the opponent is, I’m not sure that we can build the kind of support or campaign that will lead us to act collectively for change,” said Dietz. Confusion over the causes of obesity also hinders action. One message is that parents are responsible, and another is that a toxic environment is to blame. To achieve successful mobilization, Dietz said, the message must 49
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50 ALLIANCES FOR OBESITY PREVENTION be that parents have a responsibility but that they also need support to par- ent effectively, and the environment needs to be modified to make it easier for them to protect their children. “Moving from the frame of personal responsibility to the broader frame of changing the environment to change behavior is a significant challenge,” he noted. Further, the people and organizations involved in the movement still are unclear: “Who is the we?” asked Dietz. Many groups are involved, but how can these groups come together to spearhead a movement? One unifying element, Dietz observed, has been the First Lady’s office. “Her efforts have done more to include and galvanize the general public, a key element of the social movement, than anything else.” Finally, which groups have the greatest potential to have an impact? Dietz pointed to groups that influence what he called “the triple bottom line,” a movement or activity that affects health, the environment, and economics. The environmental movement falls into this category, as do community development groups. In addition, Dietz mentioned a category of groups that were scarcely discussed at the workshop, consisting of local groups with an interest in children, such as local health departments, pedia- tricians, local foundations, and other community groups. As an example of these local initiatives, Dietz pointed to the movement to connect the use of parks and schools. Perhaps this strategy can be revisited in an economic climate where houses undergoing foreclosure and vacant lots could be used to recreate park systems in cities, he suggested. Dietz also pointed to the community programs initiated under the American Reinvestment and Recovery Act of 2009 and the Community Transformation Grants under the Patient Protection and Affordable Care Act of 2010. These initiatives, focused on nutrition, physical activity, and tobacco control, provide a model for building a social movement by com- bining top-down support and bottom-up local initiatives. Whether the funding for these initiatives will survive remains to be seen, said Dietz, but funding is slated to grow to $2 billion by 2015 for investments in commu- nity initiatives around nutrition and physical activity. Dietz closed by observing that the groups represented at the workshop illustrate the diversity of potential allies. The challenge, he said, is to build commitments, establish a sense of identity, and take collection action.