Preventing Childhood Obesity Health in the Balance (2005) / Chapter Skim
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Appendix D: Lessons Learned from Public Health Efforts and Their Relevance to Preventing Childhood Obesity
Appendix D: Lessons Learned from Public Health Efforts and Their Relevance to Preventing Childhood Obesity
Pages 343-376
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From page 343... ...
While the problem clearly exists, the causes are less clear. There is little clarity about the relative importance of possible causative factors such as changes in dietary patterns, increases in fast food and soft drink consumption, increases in portion size, decreases in physical activity, increases in television viewing, or most likely, a mix of all these factors.
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From page 344... ...
It is likely that this approach will be as relevant for the prevention of childhood obesity as it is for other contemporary public health challenges. However, as previously stated, the purpose here is not to propose a comprehensive intervention program for childhood obesity, but rather to identify the factors associated with success in other public health areas, both as a result of planned interventions and also corresponding to social, cultural, or temporal factors.
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From page 345... ...
Gielen and Sleet (2003) reviewed the injury prevention literature and concluded that a simplistic belief that imparting information would result in behavior change and injury risk reduction resulted in an overreliance on engineering solutions alone as the basis for injury prevention programs.
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From page 346... ...
A preliminary review of the MMWR reports reveals a pattern of categories of interventions that appear to have played a role in accomplishing multiple achievements. The goal was to identify instances, across achievements, of community intervention categories found an the past to have strong evidence of effectiveness with multiple health behaviors or problems.
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From page 347... ...
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From page 348... ...
The task force has completed the analysis of the evidence in nine major areas. More reports, including those central to preventing childhood obesity (e.g., school-based programs, community fruit and vegetable consumption, consumer literacy, and food and nutrition policy)
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From page 349... ...
Based on the experience to date from The Guide to Cominunitv Preventive Services, it appears that comprehensive programs that involve communities, schools, mass media, health providers, and laws and regulations are most likely to be effective for a number of health problems. It is reasonable to assume that some or all of the types of interventions may have utility in preventing childhood obesity Lessons Learned Across Multiple Public Health Problems The focus on "internal validity" has greatly improved the practice of public health and the implementation of evidence-based approaches shown to be effective for specific health problems.
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From page 350... ...
looked at the recently adopted Framework Convention on Tobacco Control (FCTC) in terms of its possible implications for improving global dietary and physical activity levels (Yach et al., 2003)
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From page 351... ...
These core factors include: · A persuasive science base documenting a socially and scientifically credible threat to the public health with important economic implications; · A supportive partnership with the media; · Strategic leadership and a prominent champion; · A diverse constituency of highly effective advocates; and · Enabling and reinforcing laws, regulations, and policies. It is not clear whether all these factors need to be present for each public health campaign, or if there is a preferred sequence of activities, although the order presented above corresponds roughly to the tobacco control movement and exhibits some face validity for these core concepts.
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From page 352... ...
are more likely to be associated with success in health-related social movements, if only serving to create a "tipping point" for social change (Gladwell, 2000) AN ORGANIZING FRAMEWORK FOR PUBLIC HEALTH INTERVENTIONS To learn from the lessons of other public health experiences and determine whether there is any utility or relevance for preventing childhood obesity, it is useful to have a conceptual framework to organize the experiences, principles, and strategies.
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From page 353... ...
notes that government's power to alter the informational environment is one of the major ways in which governments can "assure the conditions for people to be healthy." The article goes on to describe that governments can alter the informational environment in a number of ways, including by sponsoring health education campaigns and other persuasive communications, requiring product labeling, and restricting harmful or misleading advertising. Most of the effort in altering the information environment has been done in relation to children and adolescents, particularly when it is believed that the information being conveyed may be harmful or misleading to children (Strasburger and Donnerstein, 1999)
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From page 354... ...
At most, manufacturers may concede that marketing may influence the selection of a particular brand of a product but that there is little evidence that marketing contributes to the initiation or use of a product, or causes an overall increase in demand for that product. Despite the lack of existence of the single, definitive, experimental study that Inarguably proves that advertising affects the health behaviors of young people, including the initiation and continuation of consumption, most public health authorities agree that the overall weight of the scientific evidence points inescapably to this conclusion.
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From page 355... ...
, and an association between television viewing and the consumption of fast foods (French et al., 2001)
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From page 356... ...
356 PREVENTING CHILDHOOD OBESITY Blame TV" where he stated, "Banning junk food ads on kids' programming is impractical, ineffective and illegal" (Muris, 2004)
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From page 357... ...
In fact, nearly every retail and commercial outlet sells gums, candies, crackers, cookies, and soft drinks. However, in reviewing the literature on the influence of availability on food choices, French and colleagues (1997)
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From page 358... ...
The American Public Health Association (2003) has called for the development of school policies for the promotion of healthful eating environments and the prohibition of soft drinks and other low-nutrition foods during the school day.
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From page 359... ...
This approach of excise tax increase and earmarking for prevention programs could be considered to help prevent childhood obesity, especially because one of the most frequently heard argument for not removing vending machines and soft drinks from schools is concerns about loss of much-needed revenue. It is likely that the same strategy for calorie-dense and low-nutritionalquality foods would have the same effect as seen for tobacco—as price increases, consumption falls.
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From page 360... ...
With respect to laws related to preventing childhood obesity, there is little related federal legislation, other than efforts to provide liability protection to food and soft drink manufacturers. Therefore, most of the legislative initiatives have occurred at the state level.
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From page 361... ...
The lack of regulation of tobacco products and the public health communities' call for meaningful FDA regulatory authority may provide a useful framework for the potential that product regulation may play in preventing childhood obesity. Despite substantial progress in reducing tobacco use, tobacco products continue to be relatively unregulated, although the tobacco industry has made protestations to the contrary (Eriksen and Green, 2002)
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From page 362... ...
So, it is unlikely that traditional FDA or FTC authority would help in the area of greatest concern regarding marketing unhealthful food products to children. If governmental regulation is not likely or possible, mandatory industry standards could be considered to guide minimum nutrient content, portion size, and marketing of products targeted to children.
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From page 363... ...
. With respect to food-related litigation, there have been some initial attempts to sue fast food restaurants based on the claim that they are at least partially responsible for the epidemic of childhood obesity, and for other reasons, such as consumer safety (e.g., excessive temperature of coffee resulting in customer harm)
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From page 364... ...
Vending machine policies, school breakfast and lunch programs, and required physical activity programs are all significant components to childhood obesity prevention programs in which schools can play a constructive role. Media Campaigns Mass-media efforts that build on sophisticated marketing approaches can also be effective in improving dietary behavior and increasing physical activity levels among young people.
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From page 365... ...
Similarly, it is important to understand the relative importance of self-help versus medical or health professions intervention in the prevention and treatment of childhood obesity. Because of the lifestyle behaviors associated with obesity (diet and physical activity)
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From page 366... ...
At this point in time, it is not clear how the food industry will respond to social and public health pressures to limit marketing of unhealthful products to children and to assume at least partial responsibility for the epidemic of childhood obesity in this country and around the world (Daynard, 2003)
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From page 367... ...
that calls for multisectoral collaboration to address the increasing global prevalence of obesity. SUMMARY Efforts to address contemporary public health problems are often difficult to evaluate for a number of reasons including the urgency and need for a rapid response, the lack of classical experimental design, often not having an unexposed control group, difficulty in measuring social factors, and not understanding the dynamics between social forces and health behaviors (McQueen, 2002)
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From page 368... ...
For example, when one compares the prevention of tobacco use to the prevention of childhood obesity, the first and most obvious difference is that tobacco use, from a public health standpoint, is a behavior to be avoided; it presents a serious health risk and no health benefit. Diet and physical activity, on the other hand, are essentials of life, cannot be avoided, and must be kept in balance to ensure good health.
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From page 369... ...
This same debate is central to our efforts in preventing childhood obesity (Marsh and Morone, 2002; Zernike, 2003)
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From page 370... ...
From a macroperspective, and although progress has taken decades, tobacco control is relatively simple compared to the complexities presented by childhood obesity. Accordingly, childhood obesity prevention strategies should be developed with an appreciation for this complexity The Role of the Food Indusny is Optical but Uncertain Part of the success of the tobacco control movement has been the attacks on and marginalization of the tobacco companies.
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From page 371... ...
For tobacco control, we may not know all the answers, but we know enough to make a difference. Research underlies tobacco control guidelines and recommendations, and similar research, recommendations, and guidelines are being developed for preventing childhood obesity.
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From page 372... ...
U.S. considets food labels with whole-package data.
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From page 373... ...
2001. Fastfoodtestautant use among adoletcents: Associations with nut lent intake, food choices and behaviotal and psychological vatiables.
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From page 374... ...
2000. Small taxes on soft drinks and snack foods to ptomote health.
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From page 375... ...
2002. The conttibmion of expanding potuon c~es to the US obesity epidemic.
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