Bridging the Evidence Gap in Obesity Prevention A Framework to Inform Decision Making (2010) / Chapter Skim
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2 Obesity Prevention Strategies in Concept and Practice
2 Obesity Prevention Strategies in Concept and Practice
Pages 35-54
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From page 35... ...
Accomplishing this will require that adults at a healthy weight maintain that status and that children maintain a healthy weight trajectory and avoid excess weight gain. • Obesity prevention takes place in diverse settings that provide access to whole populations or high-risk subpopulations.
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. A 1995 IOM report on criteria for evaluating weight management programs emphasizes the importance of giving greater priority to obesity prevention in light of the increases in population weight levels and obesity prevalence (IOM, 1995)
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Treatment relies on the creation of negative energy balance through substantial reductions in caloric intake and increases in physical activity to produce an observable reduction in body weight. Prevention strives to create caloric balance (or caloric intake that sup ports appropriate growth patterns in children)
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. It is also difficult to measure or, from the individual's perspective, to be reassured that people are making the small changes in caloric intake and physical activity that may facilitate the prevention of excess weight gain.
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Upstream approaches are also more likely than downstream approaches to reduce disparities for socially and economically disadvantaged populations because they improve access to opportunities for healthful eating and physical activity (Kumanyika et al., 2008)
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of body weight." These groups specify targets for obesity prevention based on population behaviors that may predispose to excess caloric intake or inadequate physical activity. These targets, sup ported by evidence with varying degrees of certainty, are summarized in Box 2-1.
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c WHO, 2004. d World Cancer Research Fund and American Institute for Cancer Research, 2007.
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For the most part, such population-based initiatives are not "proven." That is, they are not yet supported by a strong evidence base showing that they will bring about improved dietary habits, increased physical activity, or reduced obesity at the population level; rather, they are based on extrapolations from clinical trials, expert opinion, previous experience, or promising practices (Brownson et al., 2006; IOM, 2009a; Khan et al., 2009)
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The appeal of such setting-based approaches includes the ability to work with a "captive audience"; provide age- and developmentally appropriate activities; and influence social norms within the setting, with possible transfer to behavior outside of the setting. Approaches Designed to Foster Changes in Communities and Neighborhoods Many obesity prevention efforts are undertaken at the local or community level; those focusing on childhood obesity have tended to concentrate on local, district, or state school policies that impact nutrition and/or physical activity opportunities.
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. For most of the strategies, the evidence is insufficient to determine effectiveness in changing caloric intake, physical activity, and/ or obesity prevalence; for some of the strategies, there is no evidence, only theoretical projections.
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In addition, insurance coverage could be expand ed to cover behavioral and nutritional counseling. Whether increased screening for obesity and increased preventive counseling about diet and physical activity will lead to reduced obesity is not yet known.
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. Like tobacco control initiatives, multilevel, multisector approaches combining programmatic and policy interventions with strategic, culturally appropriate, high impact messages can change the social norms around eating, physical activity, and life style behaviors.
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that reinstated and mandated minimum physical education requirements for elementary and middle school students in public schools and required physical fitness testing of youth in grades 3-12. It is worth not ing how this was accomplished, which illustrates the importance of jurisdictional oversight in accomplishing such goals.
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common goal, leverage resources incentivize change Recognizing Collect local, community All politics are local; mobilize a call Measure outcome of interventions, the power of data; culturally adapt; to action among decision makers compare local and state community data collect state data performance Implementing Advocate federal policy Develop a foundation for states to Support federal school nutrition, federal policy change build upon; create support for change physical education and fitness change at the community and state levels standards Securing funding Needed to launch and Projects should be scalable, Government (federal, state, local) , sustain programs; adaptable, and sustainable; funders private foundations, universities, innovation important, tend to be risk-averse colleges, business community often overlooked SOURCE: IOM, 2009c.
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From page 49... ...
The state will be guided in developing best practices for the prevention and con trol of obesity by ensuring that these coordinated school nutrition, physical education, and health initiatives are implemented in all Texas schools; continuing to improve nutrition education and access to healthful foods; promoting worksite wellness pro grams; supporting comprehensive evidence-based community initiatives; and monitor ing the impact of these efforts. A starting point for policy adoption, the Texas Obesity Policy Portfolio, was created by the Texas State Health Services Department to pro vide a basis for a comprehensive approach to decision making (Texas Department of State Health Services, 2006)
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Provide • Tobacco package warning label • Post calorie information on menus information • Alcohol warning label Use pricing • Tobacco tax • Tax sugar-sweetened beverages • Alcohol tax • Tax snacks • AIDS -- free condoms, free needle exchange • Subsidize fruits and vegetables • Remove subsidies for sugar-sweetened beverages and infant formula Limit advertising • Ban tobacco ads on television, radio • Restrict food advertising to children and youth Restrict access to • Tobacco and alcohol -- restrict sales to minors • Restrict sale of high-calorie, low-nutrient foods products • Limit placement of products to behind the and beverages in schools counter Protect public • Tobacco -- clean indoor air legislation for • Restrict fast food outlets near schools from second-hand schools, restaurants, bars, worksites • Offer candy-free checkout lines in grocery stores exposure • Alcohol -- ban stores near schools • Restrict candy and sugar-sweetened beverages in schools Require insurance • Tobacco -- cessation treatment programs, • Obesity prevention: nutrition and physical coverage for nicotine replacement therapy, quit lines activity counseling treatment or • Obesity treatment: behavioral weight loss prevention counseling Frame as public • Change social norms • Incorporate routine physical activity breaks into health problem; − Smoking restrictions in public places the workday change social − Laws requiring seat belt and child car seat • Provide fresh fruits and vegetables to school norms and use children in classrooms expectations − Designated driver campaigns Bridging the Evidence Gap in Obesity Prevention 0
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Atlanta, GA: U.S. Department of Health and Human Services, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
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2008. Population-based prevention of obesity: The need for comprehensive promotion of health ful eating, physical activity, and energy balance: A scientific statement from American Heart Association Council on Epidemiology and Prevention, Interdisciplinary Committee for Prevention (formerly the Expert Panel on Population and Prevention Science)
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Martinez, CA: Contra Costa Health Services. Obesity Prevention Strategies in Concept and Practice
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2004. VERB™ -- a social marketing campaign to increase physical activity among youth.
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