Preventing Childhood Obesity

Three years ago the Institute of Medicine
(IOM) issued a call to action in response to the rapidly escalating problem of
childhood obesity in the United States. It challenged all stakeholders—the
federal government, industry and media, state and local governments, healthcare
professionals, community and nonprofit organizations, schools and families—to
take significant measures to prevent childhood obesity (Koplan 2005). That
same year, IDEA challenged you—the fitness professionals on the frontlines in the
United States and around the world—to get involved and “shape a healthier
future for America’s children.” Recently, the IOM assessed the nation’s
progress in preventing childhood obesity. We thought it also appropriate to see
how we are measuring up and to share the stories of individual, facility and
industry-wide efforts underway to reverse the alarming trend of obesity among
our youth.

The Challenge

It is no secret that the United States
faces an epidemic of childhood obesity. Obesity prevalence among children
increased from 5% in the 1960s to 17% in 2004 (Ogden et al. 2006). African
American girls (24%), Mexican American boys (22%) and children from
lower-income communities (≥ 40% in some cases) with little access to healthful
foods and physical activity opportunities suffer the highest rates (Ogden et
al. 2006; Yancey & Kumanyika 2007). But the problem is not limited to
American children. If we don’t do enough, over 20% of kids worldwide will be
overweight or obese by 2010 (Kosti & Panagiotakos 2006). While genes and
environment both contribute to obesity risk, the increasing prevalence of
childhood obesity has occurred too rapidly to be explained by a genetic shift;
rather, changes in physical activity and nutrition are responsible (Barlow
2007).

As with adults, behavior-based weight loss and subsequent weight
maintenance prove to be extremely challenging for children. In fact, obesity in
childhood, especially among older children and those with the highest body mass
index (BMI), is likely to persist into adulthood (Whitaker et al. 1997). Social
marginalization, type 2 diabetes, cardiovascular disease and myriad other
morbidities are real threats for overweight children during childhood and into
their adult years (Lobstein, Baur & Uauy 2004). Alarmed by these sobering
statistics, stakeholders—including fitness professionals—have responded by
developing numerous policies, programs and interventions designed to prevent
childhood obesity.

Efforts Underway

Individuals and
groups at every level, from state and federal governments to academia,
communities and industry, have developed innovative programs for preventing childhood obesity. For example:

• Last fall the United
  States Office of the Surgeon General launched the Childhood Overweight and
  Obesity Prevention Initiative to coordinate and expand the government’s
  existing programs for preventing childhood obesity and to
  launch the National Center for Physical Development and Outdoor Play, which
  will help Head Start programs evaluate their playgrounds and educate children
  and families about healthful nutrition and regular physical activity (U.S.
  Department of Health and Human Services [HHS] 2007).
• Researchers from Tufts
  University partnered with community leaders in three cities in Massachusetts to
  launch “Shape Up Somerville.” Various community-wide improvements such as
  repainting crosswalks to encourage walking and adding healthier menu choices in
  school cafeterias and at local restaurants led to a decrease in BMI in children
  in first through third grades in the intervention community compared to
  controls. This successful program is currently being adapted to reach children
  in both urban and rural communities (Friedrich 2007).
• Founders of Overtime
  Fitness Inc., in Mountain View, California, launched a fitness facility
  tailored to the special interests and needs of teens. The gym offers a mix of
  conventional training equipment and teen-friendly features, such as a
  rock-climbing wall, cheerleader conditioning sessions, academic tutoring and a
  surplus of active video games similar to Dance
  Dance Revolution (Associated Press 2007).
• The article “Kids in
  Motion Stay in Motion” in the February issue of IDEA
  Fitness Journal (Williams 2008) offered many more examples of
  creative interventions led and inspired by fitness professionals, as well as
  tips for starting your own program.

These programs are simply a miniscule sampling of the thousands
of programs and initiatives underway in communities across the U.S.

Where We Stand

Here’s the
problem: we don’t know which of the thousands of efforts really work. In its
report “Progress in Preventing Childhood Obesity: How Do We Measure Up?”
(2007), the IOM Committee on Progress in Preventing Childhood Obesity concluded
the following:

• While the country is
  starting to recognize the problem of childhood obesity, the current level of
  investment by the public and private sectors—including the fitness industry—is
  insufficient.
• Current data and
  evidence are inadequate to allow a comprehensive assessment of the progress
  made in the prevention of childhood obesity in the United States.
• Evaluation is a
  critical component to any intervention in that it helps to guide improvements
  and fosters collective learning, accountability, responsibility and
  cost-effectiveness.
• Government, industry,
  communities, schools and families have responded to the epidemic by
  implementing a variety of policies, programs and interventions, but it is
  unclear which programs are most effective, as few include an evaluation
  component.
• Stakeholders should
  conduct evaluations to assess and stimulate short-term, intermediate-term and
  long-term progress in reversing the childhood obesity trend and improving the
  health of the nation’s youth.

So what does this mean for fitness professionals and the
efforts—both big and small—of the fitness industry to make a difference?

A Call to Action

First, we need to keep doing what we’re
doing. That is, we must continue to invest time, energy and resources in
helping our children move more, eat better and participate in maintaining their
own health. But we can do more, and we can do it more effectively, if we heed
the advice of the IOM and maximize the quality and effectiveness of our efforts
at the industry, community and personal levels.

Industry Initiative

The IOM recommends that industry “utilize
the full range of available resources and tools to create, support and sustain
consumer demand for products and opportunities that support healthy lifestyles,
including healthful diets and regular physical activity” (Committee on Progress
in Preventing Childhood Obesity 2007). The increasing trend among fitness
facilities to design programs and initiatives to prevent childhood obesity is
encouraging. How­­ever, more important than the quantity of programs offered is
the quality of the programming. If you are involved in an obesity prevention
activity, the IOM recommends that you ask yourself the following questions to
help guide your program design (Committee on Progress in Preventing Child­hood
Obesity 2007):

• How does the activity
  contribute to preventing childhood obesity? What are the rationale and
  supporting evidence for this particular action as a viable obesity prevention
  strategy, particularly in a specific context? How well does the planned program
  or intervention match the specific setting or population being served?
• What are the quality
  and reach or power of the action as
  designed?
• How well is the action
  carried out? What are the quality and the reach or power of the action as implemented?
• What difference has the
  activity made in terms of increasing the availability of foods and beverages
  that contribute to a healthful diet and providing opportunities for physical
  activity? Are there other indicators that this program encourages a healthful diet
  and physical activity and improves health outcomes for children and youth?

Further, industry is encouraged to partner with government,
academia and other interested stakeholders to develop effective programs and to
evaluate progress in preventing childhood obesity and promoting healthy
lifestyles. IDEA’s collaboration with the Alliance for a Healthier Generation
is an example of such a partnership. (See the sidebar “IDEA Teams With Alliance
for a Healthier Generation” for more information on how you can get involved.)
Beyond forging partnerships and evaluating programs, industry can help maximize
the reach and impact of programs by loudly broadcasting program findings,
successes and opportunities for improvement.

Community Effort

Facility owners, fitness professionals
and health advocates all should feel empowered to get involved in community
efforts to prevent childhood obesity. Work with your community leaders to
strengthen local policies, coalitions and collaborations to make the community
a haven for physical activity and healthful nutrition.

For instance, you and other community stakeholders can pursue one
or more of the following advocacy efforts. In a commentary in The Journal of the American Medical
Association, Risa Lavizzo-Mourey (2007) of the Robert Wood Johnson
Foundation recommended these steps as crucial ways to combat childhood obesity:

• Demand that schools
  offer healthier nutrition options and physical activity opportunities.
• Campaign your local
  politicians for sidewalks, playgrounds, bike paths and recreational facilities.
• Call for adequate
  numbers of supermarkets in local low-income neighborhoods.
• Insist that nearby
  hospitals eliminate fast-food outlets.
• Advocate healthy
  lifestyles and healthy communities using public venues.

Many communities throughout the country have started childhood
obesity prevention coalitions that are well positioned to advocate these
changes. A list of some of the largest ones is included in the sidebar
“Large-Scale Childhood Obesity Prevention Efforts”; a quick Internet search or
call to local stakeholders may help you locate one in your community. Challenge
your local coalition to spend as much time in the community taking action as it
spends in meetings making plans.

Evaluate the programs that you pursue. Consider developing
partnerships with government agencies, foundations and academic institutions
that have the resources and know-how to conduct comprehensive and reliable
assessments of the program’s effectiveness. Share your results with members of
your own and other communities. The IOM also strongly advises communities to
develop a validated community self-assessment tool to identify strengths and
gaps in childhood obesity prevention efforts (Committee on Progress in
Preventing Childhood Obesity 2007).

Personal Commitment

As a parent or relative, you can set an
example for the children in your life by promoting healthful eating and regular
physical activity. Are the foods and beverages available in your home healthful
and served in reasonable proportions? Is physical activity a family priority?
Do you have rules in place limiting screen time? Don’t underestimate your
influence—programs that specifically target parents as the exclusive agent of
change have demonstrated superior outcomes (Golan & Crow 2004). You can
take it to the next level by organizing a coalition of parents to initiate
“walking school buses” along safe routes in your community and by taking a
proactive role in promoting healthy practices at your children’s schools.

Consider evaluating your efforts by arranging a system to assess
your family’s progress in achieving positive lifestyle changes. This could mean
simply keeping track of weekly physical activity, fruit and vegetable
consumption or television viewing. Then, share your “findings” along with what
works and what does not with all of your friends and relatives so that they,
too, may implement family changes to foster healthier living.

To be sure that the best programs and innovations spread and
reach the most children, it is important (1) to incorporate some evaluation
component to assess whether an intervention works and (2) to share with anyone
who will listen what has worked for you and what has not.

The Future

While health
and quality-of-life projections for our youth are grim, these projections are
not yet reality. We still have the chance to reverse the childhood obesity
epidemic and its ugly consequences. Whether you choose to team with IDEA and
the Alliance for a Healthier Generation, join your local obesity prevention coalition,
start and evaluate a youth fitness program at a gym or limit screen time for
your own children, as a fitness professional—the exercise expert of the
team—you play a vital and essential role in preventing childhood obesity. But to be successful, we must act now and we must be
effective. Together we can help shape a healthier generation.

SIDEBAR: IDEA Teams With Alliance for a Healthier
Generation

“Fitness professionals have the desire, knowledge base
and expertise to be at the forefront of solving this national crisis, and IDEA
members are ready to show their support by providing time, resources and
leadership.”

—Peter Davis, chief
executive officer of IDEA Health & Fitness Association

To combat the growing epidemic of childhood obesity, the
American Heart Association and the William J. Clinton Foundation joined
together in 2005 to form the Alliance for a Healthier Generation
(www.healthiergeneration.org/). The Alliance is working to stop the nationwide
increase in childhood obesity by 2010 by taking bold, innovative steps to help
all children live longer and healthier lives.

The Alliance formed a
partnership with IDEA, creating numerous opportunities for IDEA members to take
part in preventing childhood obesity. Here is an update on some of the
Alliance’s achievements so far and how IDEA members can get involved.

Two of the Alliance’s
initiatives include the Healthy Schools Program, which aims to improve schools
in the areas of nutrition, physical activity and staff wellness, and the Kids’
Movement, which is a “by kids for kids” effort working with youth to help them
take control of their health and actively strive to make their communities and
families healthier.

IDEA members can get involved
with the Alliance in various ways, including

• recruiting kids to pledge to
  Go Healthy at www.igohugo.org;
• offering group exercise or
  personal training services at Alliance events or offering these
  services—including before- or after-school programs—at schools enrolled in the Healthy
  Schools Program;
• donating fitness equipment to
  schools enrolled in the Healthy Schools Program;
  offering discounted
  membership rates to staff and students in schools enrolled in the Healthy
  Schools Program;
• and
  offering personal training
  services to students who are identified as overweight or obese in school-based
  health centers associated with schools enrolled in the Healthy Schools Program.

More than 1,000 IDEA members
have pledged to contribute their time and expertise to improve physical activity
opportunities in their communities. You can join them, and this industrywide
effort, to prevent childhood obesity. Go to www.ideafit.com and click on the
Alliance for a Healthier Generation icon to learn more, to find out about
classes you can provide in schools and to sign up. You will receive a webinar
training on how to best work with the schools and then you will be matched with
a local school that is a member of the Healthy Schools Program, or you can
recruit schools to join the Healthy Schools Program.

SIDEBAR: Large-Scale Childhood Obesity Prevention Efforts

The following organizations and coalitions can help you
make a difference in the lives of children. See what these groups are already
doing in your community or how you can start new local efforts.

• Action for
  Healthy Kids, www.actionforhealthykids.org.
  This national nonprofit organization is devoted to optimizing school-based
  efforts to address childhood obesity. Chapters are active in all 50 states and
  the District of Columbia.
• Alliance for a
  Healthier Generation, www.healthiergeneration.org/.
  Founded by the American Heart Association and the William J. Clinton Foundation, and collaborating with
  IDEA, the Alliance created the Healthy Schools Program to improve school
  nutrition and physical activity. It has also played a key role in convincing
  food and beverage companies to institute healthier guidelines for snacks and
  beverages sold in schools.
• Arkansas Center
  for Health Improvement, www.achi.net/. Arkansas was the first state
  to require all its schools to measure and report body mass index. The Arkansas
  Center for Health Improvement oversees the program and supports several
  evidence-based, health-related policy efforts.
• Center for Weight
  and Health, University of California, Berkeley, cnr.berkeley.edu/cwh/resources/childrenandweight.shtml. The Center for Weight and Health offers
  myriad resources including a “how-to” guide offering technical assistance to
  community leaders who wish to launch a local task force dedicated to preventing
  overweight in children.
• Coalition for
  Healthy Children, www.adcouncil.org/healthychildren/about.html.
  The Coalition for Healthy Children is the Ad Council’s partnership with
  industry, media, nonprofit organizations, government and foundations. All member
  organizations agree to incorporate strategic messages related to nutrition,
  physical activity and role models into marketing materials.
• The Food Trust, www.thefoodtrust.org. The Food Trust works on
  initiatives to expand food access, education and marketing campaigns aimed at
  improving health. It also supports public policies to advance these
  initiatives.
• Girls on the Run,
  www.girlsontherun.org. This program offers women an opportunity to coach girls
  between the ages of 8 and 13 as they develop self-respect and healthy
  lifestyles through running.
• Kids Walk to
  School Initiative, www.walktoschool-usa.org.
  Part of the International Walk to School program, this initiative has sponsored
  Walk to School events in all 50 states. Get a step-by-step guide to starting a
  neighborhood walking program.
• National
  Coalition for Promoting Physical Activity (NCPPA), www.ncppa.org. The NCPPA provides legislative
  updates and news related to nutrition, physical activity and obesity.
• We Can! (Ways to
  Enhance Children’s Activity & Nutrition), www.nhlbi.nih.gov/health/public/heart/obesity/wecan/. We Can!
  is a valuable resource for all stakeholders to gain information, discover
  opportunities for involvement and connect with local resources.
• Community-Based
  Obesity Prevention Coalitions. Below is a sampling of active and
  innovative obesity prevention coalitions that are community based:
• Chicago—CLOCC: Consortium to
  Lower Obesity in Chicago Children, www.clocc.net/
• Lexington, Kentucky—Lexington
  Tweens Nutrition and Fitness Coalition, www.fitky.org
• South Carolina—SCCOPE: SC
  Coalition for Obesity Prevention Efforts, www.sccope.org/
• San Diego—Coalition on
  Children and Weight San Diego, www.ccwsd.org

Natalie
Digate Muth, MPH, RD, CSCS, is a fourth-year medical student at the University
of North Carolina at Chapel Hill. She is planning to pursue a residency in
pediatrics.

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