Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Preventing childhood obesity: looking forward
notation of the term obesity may also explain why
obesity is not an acceptable term for providers to use
to discuss excess weight in adolescent 20 or adult
patients. 21 Therefore, one of the earliest challenges in
the evolution of a movement to address obesity is the
need to identify a common frame that mobilizes
support for policy initiatives or promotes behavior
change. Because obesity is perceived as a social concern
but not necessarily a personal threat, and because the
term obesity is not a term that can be used to personalize
the threat, further emphasis on the obesity epidemic
or the health effects of obesity may not generate
the commitment necessary to mobilize the public
around environmental change.
A second issue with respect to the threat posed by
obesity is the lack of a single readily identifiable widely
accepted cause. Tobacco in any quantity is harmful,
whereas the same cannot be said about food.
Furthermore, efforts in the United States to identify
fast food, sugar - sweetened beverages, television time,
or television advertising as the factor(s) responsible
for the epidemic of childhood obesity have not generated
the political will necessary to change them,
suggesting that they are not widely perceived as a significant
threat.
A c ommon f rame
Consistent themes that led to efforts to control tobacco
were the public ’ s health, especially the need to protect
youth, and the health of non - smokers. 2 With tobacco,
the tobacco companies and their products quickly
became the targets of efforts to reduce smoking.
Limiting their ability to advertise and using economic
strategies such as tobacco taxes to reduce purchases
were readily accepted strategies. In contrast, it follows
from the lack of perception of obesity as a common
or immediate threat that other reasons to change the
nutrition and physical activity environments may
provide more persuasive incentives for a broad population
approach to obesity. For example, many of the
strategies to improve the diet and physical activity are
shared with efforts to reduce global warming. Farm -
to - market strategies may provide fruits and vegetables
at lower cost without incurring the costs of fuel and
the production of carbon dioxide that result from the
transportation of fruits and vegetables across the
country. Likewise, use of public transportation 22 or
23
walk - to - school programs reduce car use and increase
physical activity. Both of these examples engage
groups that may not see these strategies as obesity
prevention and control strategies, but might embrace
them because of their impact on global warming.
Another alternative may be to frame the nutrition
and physical activity strategies to address obesity in
terms of social justice. In the United States, significant
ethnic disparities exist with respect to access to parks
and recreation facilities, 24 or supermarkets that
provide healthy choices of fruits, vegetables, or other
lower calorie food choices. 25 Access and the promotion
of parks and recreation facilities is a recommended
strategy to increase physical activity, 26 and
access to supermarkets may improve food choices in
neighborhoods where the population relies on corner
shops for much of their food supply. 27 Characterization
of access to healthy food choices and physical activity
facilities as a reflection of social inequity may provide
a more compelling rationale to generate change than
the potential contribution of these inequities to
obesity.
Although wellness is a more elusive concept than
obesity, good nutrition and physical activity are generally
recognized as important components of wellness.
In the United States, the economic costs
associated with chronic diseases have led to a growing
interest in wellness as a way to contain those costs. A
recent estimate suggested that 12% of the rise in
medical costs between 1987 and 2000 were attributable
to obesity related illnesses. 28 The observation that
one third of children born in the year 2000 in the
United States will develop Type 2 diabetes mellitus at
some time during their lifetime 29 and the costs associated
with this disease are likely to overwhelm an
already burdened medical care system.
In 2005, US medical costs were approximately 15%
of the gross domestic product ( GDP ), and by 2015,
were expected to rise to 20% of the GDP. 30 The CEO
of General Motors recently stated that medical costs
paid by his company added to the costs of GM cars
and, therefore, impaired GM ’ s international competitiveness.
31 Furthermore, the rise in medical costs has
increasingly led employers to begin shifting the
payment of insurance plans to their workforce, 32 but
also to the exploration and investment in worksite
wellness programs. However, whether efforts in
the business sector are sufficient to mobilize broader
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