Preventing Childhood Obesity Public Briefing

Public Briefing
Sept. 30, 2004

Opening Statement
by

Jeffrey Koplan, M.D., M.P.H.

Vice President for Academic Health Affairs, Emory University, Atlanta
and
Chair, Committee on Prevention of Obesity in Children and Youth

Good morning. We look forward to taking any questions you have about the blueprint we have developed for reducing the prevalence of obesity among America's children and youth. But first, I would like to provide a brief overview of the IOM study and our report's recommendations.

This study was undertaken at the request of members of Congress who saw the need for a national action plan that is prevention-focused and grounded in science. The report we are releasing today results from the work of a committee composed of 19 members with expertise in pediatrics, nutrition, public health, public policy, school administration, and other relevant fields. Over the past two years, we carefully examined all of the evidence about the factors involved in childhood obesity and interventions that show promise for improving eating habits and increasing physical activity. While many reputable organizations and individuals have previously recommended specific steps to address various aspects of the obesity problem, this report provides the first comprehensive, evidence-based action plan for tackling the epidemic of childhood obesity on multiple fronts.

The report contains recommendations for actions that should be taken concurrently by all who have a stake in reversing this problem -- from individuals, families, and communities to schools, industries, and governments. No single factor or sector of society bears all of the blame for the problem, and no single group or sector acting alone can solve it. Because the epidemic has taken years to develop, it will require a sustained commitment of effort and resources spanning many years -- possibly decades -- to effectively address the problem.

We call for action to be taken immediately, given the alarming rate at which the incidence of childhood obesity is growing in America. Over the past three decades, we have witnessed an unparalleled increase in obesity's prevalence in children and youth. The rate has more than doubled for preschool children and adolescents and has more than tripled for children ages 6 to 11 years old. Approximately 9 million American children over 6 years of age are now considered obese. Furthermore, the amount of weight carried by the heaviest children is greater than it was 30 years ago. These trends mirror a profound increase in the rates of obesity among adult Americans, as well as a concurrent rise internationally, in developed and developing countries alike. Obesity carries significant ramifications for children's physical and emotional health, in both the short and long terms, particularly given the increased risk of developing diabetes and other chronic conditions that are associated with obesity. The great health advances made possible by genetics and other biomedical discoveries could be offset by the burden of illness, disability, and death caused by too many people eating too much and moving too little over their lifetimes.

Reducing rates of childhood obesity essentially requires that children achieve and maintain a healthy energy balance -- that is, the balance between amount of calories consumed and the amount expended. All the recommendations in this report focus on the two keys to preventing obesity, namely promoting healthful eating behaviors and regular physical activity.

Naturally, we call on parents and families to make progress toward a more active lifestyle. Parents have a responsibility to encourage their children to engage in regular physical activity, to provide them with healthful foods, and to serve as good role models. We recommend that parents limit television and other recreational screen time to no more than two hours a day.

However, parents and families acting alone cannot reverse the climbing rates of obesity. Changes are needed in our schools and communities, as well as at the national level. Just as it was imperative to make changes across society to protect youth from the hazards of tobacco smoking, it is now critical to alter social norms and attitudes so that healthful eating behaviors and regular physical activity become a daily part of life for our children and youth.

Among the specific recommendations in this report is a call for schools at all levels, from preschool through high school, to implement nutritional standards set at the national level for all foods and beverages served on school grounds, including those dispensed by vending machines. Schools also should expand opportunities for all students to engage in at least 30 minutes of moderate to vigorous physical activity each day. Coordinated changes in the curriculum, the advertising that is done in schools, school health services, and after-school programs all offer the potential to help prevent obesity.

The report also calls on the food, beverage, and entertainment industries to voluntarily develop and implement guidelines for advertising and marketing directed at children and youth. Congress should give the Federal Trade Commission the authority to monitor compliance with the guidelines and establish external review boards to prohibit ads that fail to comply.
Restaurants should continue to expand their offerings of nutritious foods and beverages, and should provide calorie content and other nutrition information.

Community organizations and local and state governments should identify opportunities to expand programs that promote physical activity and healthful eating. Furthermore, they should focus on improving the built environment -- roads, bike paths, sidewalks, and playgrounds -- by prioritizing these components for capital investment and examining zoning ordinances.

Health care professionals also have a vital role to play in preventing childhood obesity. They have the access and influence to discuss a child's weight status with his or her parents, and can make credible recommendations on dietary intake and physical activity. Training in using body mass index (BMI) charts and counseling patients and families on weight issues should be made a part of the curriculum in health professional schools. Of course, putting this counseling into practice is a two-way street. We call on parents to actively discuss their children's weight with their health care providers.

The federal government must provide the leadership that is needed to make obesity prevention a national public health priority. The report recommends pilot programs to explore changes in federal food assistance programs that could promote healthful eating. It also urges an increase in resources devoted to obesity prevention programs, surveillance, and research.

Specific attention must be given to children and youth who are at high risk for becoming obese, especially children in populations with higher obesity rates and long-standing health disparities. These populations include African Americans, Hispanic Americans, and American Indians, or families of low socioeconomic status. Children with at least one obese parent are also at high risk. Obese children and adolescents are at high risk for becoming obese adults with many costs to society. The national direct and indirect health care expenditures related to adult overweight and obesity range from $98 billion to $129 billion.

As the nation focuses on obesity as a health problem and begins to address the societal and cultural influences that contribute to excess weight, poor food choices, and physical inactivity, many different groups, industries, and organizations will need to make difficult trade-offs and choices. This report is calling for fundamental changes in our society. This is a collective responsibility and we, as a nation, need to move toward providing a healthier environment in which our children and youth can grow up.

That concludes my statement. My colleagues on the committee and I would be happy to answer your questions. Please come to one of the microphones to ask your question or use the e-mail link on the National Academies Web site, and be sure to first identify yourself by name and affiliation. Thank you.