Preventing Childhood Obesity - Evidence Policy and Practice.pdf

CHAPTER 34
Preventing c hildhood o besity: l ooking f orward
William H. Dietz
Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA,
USA
Introduction
As the foregoing chapters indicate, obesity has become
a prevalent disease among children and adolescents
worldwide and in most countries, the prevalence continues
to increase. The causes of childhood and adolescent
obesity are multiple and are still being
elucidated but, as indicated, the rises in prevalence
have been accompanied by marked changes in the
food supply, opportunities for physical activity and
media use. These shifts in the food and physical environments
have changed in developed and developing
countries. For example, in the United States, fast food
restaurants have become ubiquitous, family meals
have declined, soft drink consumption, television
viewing and other screen time have increased dramatically,
and the likelihood that children or adolescents
walk to school or participate in physical
education programs in school has declined. While
these changes have accompanied the rise in the prevalence
of obesity, and most of these changes have been
associated with obesity in cross - sectional or longitudinal
studies, few studies have shown that interventions
directed at these targets successfully reduce the
prevalence of obesity. It seems likely that no single
Preventing Childhood Obesity. Edited by
E. Waters, B.A. Swinburn, J.C. Seidell and R. Uauy.
© 2010 Blackwell Publishing.
change in the food, physical activity or media environment
can account for the current epidemic. Because
it also seems unlikely that any single change in any of
the aforementioned behaviors will be powerful enough
to reduce the prevalence of obesity, efforts to address
multiple factors within the food, physical activity and
media environments simultaneously would seem the
most appropriate strategy to address the epidemic. To
change these environments will probably require
major shifts in social norms which will not be likely
without a social movement of the breadth and scale of
other social movements, 1 such as that which reduced
tobacco consumption.
In this chapter, I use lessons learned from the efforts
to control tobacco consumption as a potential model
for obesity prevention and control. I compare and
contrast the current status of efforts to prevent and
control obesity to outline the needs and options for
the way forward. Although this analysis focuses on the
United States, parallels to experiences elsewhere may
inform the way forward.
Recognition of the h ealth e ffects
One of the first lessons from tobacco control was that
as the prevalence of the adverse consequences of
cigarette consumption were increasingly well -
documented, efforts to increase public awareness of
the health effects also grew, and generated an increased
awareness of the adverse effects of smoking on health. 2
The rise and fall of cigarette consumption is shown in
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