Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 34
with a plateau in cigarette consumption, but not a
decline. With respect to obesity, the stabilization of
prevalence suggests we may be at or approaching a
similar turning point.
The r ole of p olicy and
e nvironmental c hange
Although initiatives in the United States to change
tobacco policy began at the state or local level, a
number of federal reports helped provide the impetus
for change. 10 For example, the 1964 Surgeon General ’ s
report on smoking and health compiled the evidence
on the adverse consequences of smoking. Subsequent
efforts by Surgeons General to focus on the health
impact of tobacco use provided the scientific rationale
for local efforts at control. Likewise, the Federal Trade
Commission (FTC) ruled in 1964 that warning labels
were required on cigarette packs, and that tobacco
advertising should be strictly regulated. Although
Congressional legislation temporarily pre - empted the
FTC ’ s authority to regulate tobacco advertising, the
battle around advertising had begun. Eventually, a
ruling mandating counter - advertising on television
and, subsequently, a ban on tobacco advertising on
television, was a very visible indication to the public
that the adverse effects of tobacco were being addressed
at the federal level.
However, the successful reduction in per capita
cigarette consumption resulted from the implementation
of a variety of policy initiatives in multiple settings.
3 These included the restriction of smoking in
public buildings, evidence - based school curricula,
counter - marketing, increased taxes on cigarettes,
enforcement of laws that prohibited sales of cigarettes
to minors, and smoking cessation programs. Almost
all of these initiatives resulted from local or state -
based efforts. For example, Arizona passed the first
statewide ban on smoking in public places in 1973,
and by 1975 similar legislation had been passed in 10
states. 10
With respect to obesity, although a number of
behaviors have been targeted for change, such as
sugar - sweetened beverage intake, fruit and vegetable
intake, television time, intakes of high - energy density
foods, breastfeeding and physical activity, the portfolio
of successful policy and environmental strategies
to address these behaviors is limited. However, a
number of communities in the United States and elsewhere
have initiated efforts to begin to prevent and
control obesity, and surveys like the School Health
Policies and Programs Survey in the USA suggest that
changes at multiple levels have begun in US schools. 11
Like the early efforts at tobacco control, these activities
are local, but it is not yet clear how consistently
these behaviors are being targeted, what policy initiatives
are being employed, what critical mass of policy
change is necessary to change the prevalence of
obesity, and whether these topics are consistently the
focus of evaluation.
Perception of a c ommon t hreat
Another characteristic of social movements is the perception
of a common threat. In 1967, as described
above, application of the Fairness Doctrine to tobacco
advertising led to radio and television counter -
advertising of cigarettes. 12,13 The advertisements about
the adverse health effects of cigarettes produced a
decrease in cigarette consumption, 10 which led the
tobacco industry to negotiate the elimination of radio
and television advertising for cigarettes. Somewhat
later, the public became aware of the efforts of the
tobacco industry to conceal their knowledge of the
health effects of tobacco and to market their products
to adolescents. 14 These actions on the part of industry
contributed to the recognition of cigarette smoking as
a threat to youth, and passive smoke exposure as a
threat to the health of non - smokers. 2 The efforts of
the cigarette companies to persuade adolescents to
smoke, to obscure the health effects of tobacco, and
to resist efforts to control tobacco use quickly made
them a common enemy.
Although survey data confirm that a 40% of
Americans consider childhood obesity a serious
problem, 15 and 27% of adults consider obesity the
most important health issue for children, 16 many
parents of obese children do not recognize that their
child is obese. 17 – 19 These observations indicate that a
disjunction exists between the public ’ s concern about
childhood obesity and the recognition that their child
shares the problem. Use of the term “ obesity ” may
contribute to the perception that obesity is not an
immediate threat, because the term has a pejorative
connotation, and in common use generally refers to
individuals with severe obesity. The pejorative con-
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