Department of Health and Human Services' Office of Disease Prevention and Health Promotion; centers for disease control and prevention; National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute; National Institute of Child Health and Human Development; and the Division of Nutrition Research Coordination of the National Institutes of Health. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of distinguished members of appropriate professions in the study of policy issues concerning public health. National Institute of Child Health and Human Development; Division of Nutrition Research Coordination of the National Institutes of Health;.
National Priority
EXECUTIVE SUMMARY 7 healthy dietary intake and physical activity levels for all children and youth. Develop and evaluate pilot projects within the nutrition assistance programs that will promote healthy dietary intake and physical activity and scale up those found to be successful. Children's health-related behaviors are influenced by exposure to media messages that include food, drink, and physical activity.
Industry
Research has shown that television advertising can especially influence children's food knowledge, choices and consumption of certain food products, as well as their food purchase decisions that are made directly and indirectly (by parents). Because young children under the age of 8 often cannot distinguish between information and the persuasive intent of advertising, the committee recommends the development of guidelines for advertising and marketing of food, beverages and seated entertainment to children. Public education messages in various types of media are needed to generate support for policy changes and provide messages to the general public, parents, children and adolescents.
Nutrition Labeling
There is great potential for the media and entertainment industry to encourage a balanced diet, healthy eating habits and regular physical activity, thereby influencing social norms about childhood and youth obesity and helping to drive the actions needed to address it. prevent, encourage. The Food and Drug Administration should revise the Nutrition Facts panel to prominently display the total calorie content for items typically consumed at one meal, in addition to the standardized calorie serving and the percent Daily Value. Consumer research should be conducted to maximize the use of the nutrition label and other food guidance systems.
Advertising and Marketing
The Food and Drug Administration should explore ways to allow greater flexibility in the use of evidence-based nutrition and health claims regarding the relationship between the nutritional properties or biological effects of foods and a reduced risk of obesity and related chronic diseases.
Multimedia and Public Relations Campaign The DHHS should develop and evaluate a long-term national multi-
Encouraging children and young people to be physically active involves providing them with places where they can safely walk, cycle, run, skate, play games or engage in other energy-consuming activities. Specific attention should be given to children and youth who are at high risk of becoming obese; this includes children in populations with higher obesity prevalence rates and long-standing health disparities such as African Americans, Hispanic Americans, and American Indians, or families of low socioeconomic status. As advisors to both children and their parents, they have the access and influence to discuss the child's weight status with the parents (and child by age) and make credible recommendations about dietary intake and physical activity throughout children's lives.
Community Programs
Community action should engage child and youth-focused organizations, social and civic organizations, faith-based groups, and many other community partners. Community organizations focused on children and youth should promote healthy eating behaviors and regular physical activity through new and existing programs that will be sustainable over the long term. Community assessment tools should include measures of the availability of opportunities for physical activity and healthy eating.
Built Environment
Private and public efforts to eliminate health disparities should include obesity prevention as one of their key areas of focus and support community-based collaborative programs to address social, economic and environmental barriers that contribute to the increased prevalence of obesity among certain population groups. Work with local governments to change their planning and capital improvement practices and place a higher priority on physical activity opportunities. Fund community-based research to investigate the impact of changes in the built environment on physical activity levels in relevant communities and populations.
Health Care
In addition, many schools across the country have reduced their commitment to providing students with regular and adequate physical activity, often due to budget cuts or pressure to increase academic course offerings, even though it is generally recommended that children accumulate a minimum of 60 minutes of moderate to vigorous physical activity every day. Since children spend more than half of their day in school, it is not unreasonable to expect them to participate in at least 30 minutes of moderate to vigorous physical activity during the school day. Schools offer many other opportunities to learn and practice healthy eating and physical activity behaviors.
Schools
Ensure that all children and young people engage in at least 30 minutes of moderate to vigorous physical activity during the school day. Economic constraints and time constraints, as well as the stresses and challenges of everyday life, can make healthy eating and increased physical activity a daily reality for many families. They make daily decisions about recreational opportunities, food availability at home, and child benefits; they determine the setting for food eaten at home; and they implement numerous other rules and policies that influence the extent to which different members of the family eat healthily and exercise.
Home
In 2003, almost all children (99 percent) aged zero to six lived in a home with a television set and the average number of VCRs or digital video discs (DVDs) in these young children's homes was 2.3 (Rideout et al., 2003 ) ). Additionally, there has been a tenfold increase over the same period in the percentage of American homes with three or more television sets (Rideout et al., 2003). SCOPE AND CONSEQUENCES OF CHILDHOOD BUSY 55 adolescent obesity is equated to the proportion of those at the upper end of the BMI distribution—specifically, at or above the age- and sex-specific 95th percentile of the Centers for Disease Control and Prevention's (CDC's ) BMI charts for children and youth aged 2 to 19 years2 (Kuczmarski et al., 2000) (see Chapter 3 for a more extensive discussion on the use of terms for childhood overweight and childhood obesity).
The obesity epidemic affects both boys and girls and has occurred in all ages, races, and ethnic groups across the United States (Ogden et al., 2002a). Indian children and youth, although not reported separately in NHANES data, are also particularly affected by obesity (Caballero et al., 2003). RATE AND CONSEQUENCES OF CHILDHOOD OBESITY 67 obesity, regardless of actual body weight, appears to be a primary factor associated with depressive symptoms in preadolescent girls (Erickson et al., 2000).
The increased prevalence of obesity among adults of all ages has also been associated with a similar increase in the prevalence of diabetes (Mokdad et al., 2001). For example, depressed mood in children and adolescents may precede rather than simply follow the development of obesity (Pine et al., 2001; Goodman and Whitaker, 2001). Annual health care expenditures in the United States related to obesity are estimated at $75 billion ( in 2003), with approximately half of the expenditures funded by Medicaid and Medicare (Finkelstein et al., 2004).
The direct health care costs of physical inactivity, which contribute to the obesity epidemic, are estimated at over $77 billion per year (Pratt et al., 2000). National investments in preventing disease and promoting health are estimated at only 5 percent of total annual health care costs (DHHS, 2001b; Kelley et al., 2004). These references use different populations and slightly different techniques for developing cut-offs (Flegal et al., 2001).
Child or Adolescent
Population weight measures for childhood obesity prevention should be reported in terms of changes in mean BMI and in terms of the entire BMI distribution. Some researchers have suggested that most of the effect can be attributed to excessive energy intake (Sturm, 2005), while others have focused on the decrease in regular physical activity and the increase in sedentary behavior (Cutler et al., 2003). However, the overall effectiveness of the Dietary Guidelines for Americans in disease prevention requires further research (Guo et al., 2004).
This focus should be taken into account when designing the range of interventions discussed in this report. Included in the sociocultural environment are high prevalence of obesity (eg, normative presence of the problem) as well as high rates of obesity-related health problems. The use of body mass index (BMI) as a measure of overweight in children and adolescents.
It is in the best interest of the nation's children that all relevant stakeholders make obesity prevention efforts a priority. In particular, state and local public health agencies constitute the front line of the public health system. Energy density is a determinant of the effects of foods and macronutrients on satiety (Rolls et.
A NATIONAL PUBLIC HEALTH PRIORITY 163 10 of the restaurants offered free refills only for soft drinks (Hurley and Liebman, 2004). Advertising and promotion have long been intrinsic to the marketing of the American food supply (Gallo, 1999). For example, it is worth considering the policy changes that were important in the success of the anti-tobacco movement (Kersh and Morone, 2002; . Daynard, 2003; Yach et al., 2003; see Appendix D).
