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Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press

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Michelle K Mcguire at Washington State University
Michelle K Mcguire
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REPORTS FROM THE AGENCIES
Institute of Medicine. 2012.
Accelerating Progress in Obesity
Prevention: Solving the Weight of
the Nation. Washington, DC: The
National Academies Press
Shelley McGuire
School of Biological Sciences, Washington State
University, Pullman, WA
Background and process
Obesit y is blind to age, race, ethnic ity, and socioeconomic
status, costs w$190 billion annually, and lurks as the driving
force behind myriad chronic diseases and devastating disa-
bility. With two-thirds of U.S. adults and almost one-third of
U.S. children overweight or obese, there is no debating that
America has a serious problem in this regard. Although
some progress has been made over the past few decades in
preventing and treating obesity, rates continue to increase.
In response, the Robert Wood Johnson Foundation recently
teamed up with the Institute of Medicine (IOM) to identify
catalysts that might speed progress in obesity prevention.
The Committee on Accelerating Progress in Obesity Pre-
vention, chaired by Daniel Glickman (executive director of
congressional programs at the Aspen Institute and senior
fellow at The Bipartisan Policy Center) was charged by the
IOM with developing a set of recommendations for accel-
erating progress toward obesity prevention over the next
decade and proposing potential measures of progress toward
this goal. After identifying nearly 800 previously published
recommendations and associated strategies and actions re-
lated to obesity prevention, the committee filtered out those
that could work together most effectively, reinforce one an-
other’s impact, and be used to achieve the goal of nation-
wide obesity reduction. The committee then used a systems
approach to develop 5 goals encompassing 5 “environ-
ments” needing immediate public action. Details concern-
ing these goals, the environments, and the committee’s
associated recommendations and strate gies are available in
the committee’s final report, Accelerating Progress in Obesity
Prevention: Solving the Weight of the Nation (The National
Academies Press, 2012).
Overview of goals and recommendations
The committee’s goals are summarized below. It is noteworthy
that, although they ar e presented individually and in a linear
fashion, the committee suggested that the goals be thought
of as unfolding simultaneously, so tha t they can interactiv ely
influence each others’ success. In this way , it is hoped that
these initiatives will work synergistically, acc elerating obesity
reductionatanevenmorerapidpacethanwouldbeexpected
if each goal were tackled in sequential order.
Goal 1: Make physical act ivity an integral and
routine part of life. The committee recommended that
communities, transportation officials, community plan-
ners, health professionals, and governments make pro-
motion of physical activity a priority by substantially
increasing access to venues and opportunities for such.
Strategies related to this goal include enhancing our
physical and built environments, providing and sup-
porting programs that increase access to activity, requir-
ing childcare providers to adopt more rigorous physical
activity standards, and providing support for the science
and practice of physical activ ity (including science
translation).
Goal 2: Create food and beverage environments that
ensure that healthy food and beverage options are
the routine, easy choice. Governments and decision
makers in the business and private sectors were urged
to decrease unhealthy food and beverage options and
increase the availability of healthier, affordable choices.
This might entail the adoption of policies to reduce
consumption of sugar-sweetened beverages, increasing
the availabilit y of lower calorie f ood and beverages
sold in restaurants, applying more r igorous nutri-
tio nal standards to all foods and beverages, reforming
U.S. agriculture policy and research to improve the
American diet, and ensuring availability of affordable,
healthy food for all people.
Goal 3: Transform messages about physical activity
and nutrition. The committee recommended that im-
portant stakeholders act “quickly, aggressively, and in a
sustained manner” to renovate their communications
regarding physical activity, food, and nutrition. Sug-
gested strateg ies include: laun ching nati onwide so-
cial media campaigns, developing and implementing
more stringent standards for marketing foods and bev-
erages to children, expanding and improving across-
the-board nutrition labeling, and ensuring that federal
food programs are consistent with the Dietary Guide-
lines for Americans.
Goal 4: Expand the role of health care providers,
insurers, and employers in obesity prevention.At-
tainment of this goal would involve increasing support
structures among health care and health service pro-
viders, employers, and insurers to achieve better pop-
ulation health and obesit y prevention. This might
entail improved standards of practice regarding obesity
prevention, screening, and treatment; ensuring cover-
age of, access to, and incentives for obesity-related
708 ã2012 American Society for Nutrition. Adv. Nutr. 3: 708–709, 2012; doi:10.3945/an.112.002733.
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medical care in regard to health insurance; worksite
initiatives that support wellness; and supporting pro-
grams that encourage healthy weight gain during preg-
nancy and provide breastfeeding-friendly environments.
Goal 5: Make schools a national focal point for
obesity prevention. Government entities were urged to
work coordinately with parents, teachers, and the busi-
ness community to make educational facilities more ac-
cessible and effective centers for health enhancement.
This might involve requiring additional opportunities
for physical education and rigorous activity in schools,
the provision of only healthy foods and beverages in
educational facilities, and offering more extensive nu-
trition science education to students.
Related resources
Althoug h this report provides an exh austive discussion
concern ing strategies, possible actions for implementation,
and indicators of success for accelerating obesity preven-
tion, it is merely one component of a much broader, more
extensive network of related resources. These include an
unprecedented, 4-part documentar y entitled The Weight
of the Nation, a joint project of Home Box Office (HBO),
the IOM, the CDC, the NIH, the Michael and Susan
Dell Foundation, and Kaiser Permanente. This made-for-
television miniser i es (a great resource for the classroom
and other educational venues) features case studies and
myriad interviews with leading obesit y exper ts as well as
individuals and their families struggling with obesit y. The
CDC’s Division of Nutri tion, Physical Activity, and Obesity
also sponsored the Weig ht of the Nation 2012 Conference
on May 7–9, 2012 in the nation’s capital.
Conclusion
As stated by IOM President Harvey V. Fineberg, “Obesity is
both an individual and societal concern, and it will take action
from all of us—individuals, communities, and the nation as a
whole—to achieve a healthier society.” This report and its
allied resources represent a multifaceted blueprint by which
we might move collectively toward this goal.
For More Information
Free copies of this report (and information about ordering a
paperback version) are available at http://www.iom.edu/R eports/
2012/Ac celerating-Pr ogress-in-Obesity-Prevention.aspx.
The 4 films associated with this publication (broadcast
May 14–15, 2012 on HBO) can be viewed free of charge at
http://theweightofthenation.hbo.com/.
To learn more about the Weig ht of the Nation 2012 Con-
ference, which took place on May 7–9, 2012 in Washington,
DC, go to http://www.weightofthenation.org/.
Reports from the Agencies 709
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... These results reveal that schools should be considered as focal points for interventions to prevent childhood obesity [45,46]. Students devote 50% of their time and eat at least one-third of their everyday calories at school, and current facilities can be used by educational institutions to prevent obesity without major alterations to the timetable or lifestyle of the child [46]. ...
... These results reveal that schools should be considered as focal points for interventions to prevent childhood obesity [45,46]. Students devote 50% of their time and eat at least one-third of their everyday calories at school, and current facilities can be used by educational institutions to prevent obesity without major alterations to the timetable or lifestyle of the child [46]. A blended diet and PA approach were implemented by most of the school-based RCTs, which showed a positive or mixed result. ...
Systematic Review of Setting-Based Interventions for Preventing Childhood Obesity
Article
Full-text available
Introduction. Child obesity is recognized as one of the major public health problems globally, which demands multicomponent and comprehensive interventions. The objective of this systematic review is to evaluate, synthesize, and combine the existing evidence of various setting-based interventions across developed and developing countries that aim to prevent childhood obesity. Methods. An electronic and systematic search was conducted on setting-based interventions related to childhood obesity both in developed and developing countries. A study was considered eligible if it was a randomized controlled trial that focused on home-based, school-based, or community-based intervention for childhood obesity and published in English from 2010 to 2020. A wide range of electronic bibliographic databases, such as PubMed, Medline, Embase, and ERIC were searched. The various studies were carried out among children aged 4-18 years old. A total of 32 studies were identified; out of which 24 were school-based interventions, and the remaining were nonschool-based. Results. The studies in this review highlighted important school and nonschool-based interventions to avoid obesity among children and adolescents. School-based interventions that had considered both physical activity (PA) and diet along with home elements showed great effectiveness. These findings reveal that the specific intervention components such as nutrition education curriculum, prolonged time for PA, and upgrading self-efficacy of study participants should be considered to prevent obesity across developed and developing countries. However, the findings from nonschool-based interventions were restricted by the scarcity of the studies. Conclusion. Multisetting and multipronged strategies are required to avoid or reduce childhood obesity across the globe. However, additional studies are needed with a large sample size. Further study designs based on theory should be conducted in nonschool settings for the creation of meaningful and detailed guidelines that can support the prevention of obesity in children. 1. Introduction Child obesity is the main public health problem worldwide and has affected more than 155 million children; hence, the World Health Organization (WHO) has recognized childhood obesity to be a significant challenge of the twenty-first century [1]. The incidence of childhood obesity is quite high among low- and middle-income countries undergoing nutrition and economic transition, where 20-30% of children suffer from this issue [2]. Globally, around 10% of school-going children carry additional body fat, and 25% of them are categorized as obese children [3]. Further, according to recent reports, the burden of childhood obesity has risen ten times in the last 40 years owing to changing diets and lack of exercise, which can be considered as major contributors to childhood obesity. Childhood obesity is multifactorial [4], encompassing additive and multiplicative interactions between genes and environment that could be reflected in one’s learned behaviour, food consumption, sedentary lifestyle, and sociocultural provocations [4, 5]. Such interactions that result in childhood obesity can lead to numerous outcomes such as cancer, cardiovascular diseases, hypertension, and diabetes mellitus later in life [6]. Considering the financial implications of obesity and its associated comorbidities, prevention approaches are vital, especially in developing nations that ought to manage the double jeopardy of obesity and undernutrition [2]. Therefore, governments and policymakers need to prioritize this problem by designing cost-effective and sustainable interventions [2]. However, addressing childhood obesity can be difficult due to its complex nature and multicausality, but different interventions have been tested to address childhood obesity in various studies through randomized controlled trials [2]. Besides, the existing premise also suggests that there needs to be a focus on early life stages of a child’s development to break the cycle of obesity [7]. Generally, the evidence demonstrates that childhood obesity can be managed both by pharmacological (medical or surgical) and nonpharmacological interventions [8]. Nonpharmacological interventions might need to include individual, parent, family, and school-based interventions, thus making them more comprehensive and holistic [8]. In other words, the latter approach comprises alteration of behavioural factors such as improved physical activity (PA), intake of a healthy and nutritious diet, and altering environmental factors [8]. However, interventions have mostly focused on the individual level, thus ignoring the “obesogenic environment,” which is the sum of the effects that surrounding circumstances have on fostering obesity among children [9]. Altering the “obesogenic” environment could generate a more long-lasting impact on the behaviour of a child [10]. For instance, children intermingle with microenvironments including schools, homes, and neighbourhoods [9, 10]. These microlevel environments are affected by the wider macroenvironments including government policies, education and health systems, and the food industry, which are less modifiable. Furthermore, parents play a vital role as a mediator to shape the behaviour of their children, since children spend most of the time at homes [11]. Likewise, learning settings, such as schools offer a platform to adopt a healthy lifestyle via health education and health promotion strategies throughout critical stages of child growth and development [9]. Thus, this setting-based (home, school, and community-based) interventions seem to play a crucial role to prevent or eliminate childhood obesity [9]. Despite the previous interventions that have been evaluated by many randomized controlled trials, findings of such studies are not reviewed and synthesized collectively. Therefore, it is essential to collectively assess and evaluate the effectiveness and outcomes of these interventions to give robust evidence for preventing and managing childhood obesity. 2. Material and Methods The objective of this systematic review was to evaluate, synthesize, and combine the existing evidence on setting-based interventions related to childhood obesity. Guidelines specified by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were used to carry out this systematic review [12]. 2.1. Inclusion and Exclusion Criteria We carried out an electronic and systematic search in the literature review on setting-based interventions related to childhood obesity both in developed and developing countries across the world. To answer the study question, the eligibility of a study was contingent for inclusion if it was a randomized controlled trial (RCT) that was focused on nonpharmacological interventions for childhood obesity including home-based, school-based, or community-based intervention, an original research study published in English from 2010 to 2020. More specifically, we included those studies that were aimed at avoiding or controlling weight gain among children and adolescents (aged 2–19 years) in the settings such as school, preschool, community, and home by either focusing on a nutritional plan or PA or both. On the contrary, any study that had included pharmacological intervention and was published before 2007 was excluded from the review. In addition, we also excluded secondary data, letters to the editor, case reports, and grey literature from this systematic review. We grouped the eligibility criteria into four major categories using the PICOS (population, intervention, outcome, and settings) framework as given in Table 1. Study Year Country Setting Nemet et al. 2013 Israel 342 School-based Bonsergent et al. 2013 France 5354 School-based Cunha et al. 2013 Brazil 478 School-based Dewar et al. 2013 Australia 357 School-based Fairclough et al. 2013 England 318 School-based Meng et al. 2013 China 9750 School-based Safdie et al. 2013 Mexico 886 School-based Rappaport et al. 2013 USA 8504 School-based Rausch Herscovici et al. 2013 Argentina 405 School-based Annesi et al. 2013 USA 1154 Preschool based Annesi et al. 2013 USA 273 Preschool based Fitzgibbon et al. 2013 USA 146 Preschool based Kain et al. 2014 2014 Chile 1474 School-based Martínez-Vizcaíno et al. 2014 Spain 1070 School-based Santos et al. 2014 Canada 687 School-based Simon et al. 2014 France 954 School-based Tarro et al. 2014 Spain 2350 School-based Llaurado et al. 2014 Spain 916 School-based Lubnas et al. 2014 Australia 361 School-based Meyer et al. 2014 Switzerland 502 School-based Xu et al. 2014 China 1182 School-based Elder et al. 2014 USA 541 Community-based Cao et al. 2015 China 1854 School-based Greve et al. 2015 Denmark 18423 School-based Fulkerson et al. 2015 USA 160 Home/community Llargués et al. 2016 Spain 566 School-based Leme et al. 2016 Brazil 253 School-based Bogart et al. 2016 USA 2439 School-based Natale et al. 2016 USA 1211 Preschool-based Kong et al. 2016 USA 618 Preschool-based Hull et al. 2016 USA 272 Home/community Annesi et al. 2017 USA 141 School-based
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... Physical inactivity represent a major health burden, comparable to obesity and smoking, contributing to more than 5.3 million deaths worldwide [1,62]. In fact, physical inactivity is a key factor in the increase of fat storage and adiposity [63,64], so practicing physical activity and combating sedentariness are known as promising strategies for preventing childhood obesity [65,66]. Globally, children and young people are becoming less active [1,67] and increasing their time spent in sedentary activities, such as watching television and playing videogames. ...
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Exergames are defined as digital games that require bodily movements to play, stimulating an active gaming experience to function as a form of physical activity (PA). The players interact with the game through whole-body movements improving energy expenditure. Exergames may be effective in improving physical and psychological aspects of children and adolescents with obesity. In this narrative review, we synthesized the current evidence regarding the role of exergames in modifying body composition and weight and in promoting changes in sedentary behavior to define the benefits of active video games as useful tools for fighting sedentarism and to outline the future directions of exergaming as a supplementation exercise rather than a replacement in educational programs for pediatric obesity. Data from the literature indicate that exergames may offer an interesting impact on childhood obesity and may be considered a potential strategy for controlling weight gain and body composition, promote PA, and decrease time spent on sedentary behavior in children and adolescents with obesity. However, exergame use also has some limits, such as children’s poor self-regulation and poor structuring of exergame use. Therefore, a prudent approach should be maintained, and additional high-quality research is needed to determine if exergames can be effectively used in the treatment of childhood obesity and if new digital media, as a supplementation of exercise rather than a replacement, could be considered to combat sedentary behavior in educational programs for pediatric obesity prevention.
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RAMSIS is a highly realistic and time-efficient software tool that is designed to support manufacturers in improving customer satisfaction by finding design flaws and hence, improving the well-being of the customer. In this paper, the need for continuous redesigning of the passenger cabin in automobiles is discussed. A new design of a car is tested by seating a manikin inside and simulating its optimal posture for the given constraints of the car and manikin. The applied method is a digital simulation of the human interacting with the passenger cabin interior. The demonstration was performed on RAMSIS a CAD-based simulation tool. In this work, Furthermore, this study explores multiple discussion points such as the benefits and future applications of the software, results of the simulation, and how obstacles or limitations could be resolved. In this project, the following analyses are conducted: discomfort analysis, reach analysis, max-size backseat-passenger calculation, obstructive vision, and reflective vision. One main result is the incompleteness of the car design in terms of ergonomic design. Additionally, many of the conducted analyses showed significant ergonomic design faults for the current design. Lastly, future work extending the RAMSIS analysis is explored.
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Tracing coalition changes in knowledge in and engagement with childhood obesity prevention to improve intervention implementation
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Background While most coalition research focuses on studying the effects of peer relationship structure, this study examines the coevolution of coalition structure and behavior across three communities in the U.S. with the goal of identifying coalition dynamics that impact a childhood obesity prevention intervention. Methods Over two years (2018–2020), three communities within the U.S. participated in a childhood obesity prevention intervention at different times. This intervention was guided by the Stakeholder-Driven Community Diffusion theory, which describes an empirically testable mechanism for promoting community change. Measures are part of the Stakeholder-driven Community Diffusion (SDCD) survey with demonstrated reliability, which include knowledge of and engagement with childhood obesity prevention and social networks. Data from three coalition-committees and their respective networks were used to build three different stochastic actor-oriented models. These models were used to examine the coevolution of coalition structure with coalition behavior (defined a priori as knowledge of and engagement with obesity prevention) among coalition-committee members and their nominated alters (Network A) and coalition-committee members only (Network B). Results Overall, coalitions decrease in size and their structure becomes less dense over time. Both Network A and B show a consistent preference to form and sustain ties with those who have more ties. In Network B, there was a trend for those who have higher knowledge scores to increase their number of ties over time. The same trend appeared in Network A but varied based on their peers’ knowledge in and engagement with childhood obesity prevention. Across models, engagement with childhood obesity prevention research was not a significant driver of changes in either coalition network structure or knowledge. Conclusions The trends in coalition Network A and B’s coevolution models may point to context-specific features (e.g., ties among stakeholders) that can be leveraged for better intervention implementation. To that end, examining tie density, average path length, network diameter, and the dynamics of each behavior outcome (i.e., knowledge in and engagement with childhood obesity prevention) may help tailor whole-of-community interventions. Future research should attend to additional behavioral variables (e.g., group efficacy) that can capture other aspects of coalition development and that influence implementation, and to testing the efficacy of network interventions after trends have been identified.
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The Effect of Tailored, Daily Smartphone Feedback to Lifestyle Self-Monitoring on Weight Loss at 12 Months: The SMARTER Randomized Clinical Trial (Preprint)
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Background Self-monitoring (SM) is the centerpiece of behavioral weight loss treatment, but the efficacy of smartphone-delivered SM feedback (FB) has not been tested in large, long-term, randomized trials. Objective The aim of this study was to establish the efficacy of providing remote FB to diet, physical activity (PA), and weight SM on improving weight loss outcomes when comparing the SM plus FB (SM+FB) condition to the SM-only condition in a 12-month randomized controlled trial. The study was a single-site, population-based trial that took place in southwestern Pennsylvania, USA, conducted between 2018 and 2021. Participants were smartphone users age ≥18 years, able to engage in moderate PA, with a mean BMI between 27 and 43 kg/m2. Methods All participants received a 90-minute, one-to-one, in-person behavioral weight loss counseling session addressing behavioral strategies, establishing participants’ dietary and PA goals, and instructing on use of the PA tracker (Fitbit Charge 2), smart scale, and diet SM app. Only SM+FB participants had access to an investigator-developed smartphone app that read SM data, in which an algorithm selected tailored messages sent to the smartphone up to 3 times daily. The SM-only participants did not receive any tailored FB based on SM data. The primary outcome was percent weight change from baseline to 12 months. Secondary outcomes included engagement with digital tools (eg, monthly percentage of FB messages opened and monthly percentage of days adherent to the calorie goal). ResultsParticipants (N=502) were on average 45.0 (SD 14.4) years old with a mean BMI of 33.7 (SD 4.0) kg/m2. The sample was 79.5% female (n=399/502) and 82.5% White (n=414/502). At 12 months, retention was 78.5% (n=394/502) and similar by group (SM+FB: 202/251, 80.5%; SM: 192/251, 76.5%; P=.28). There was significant percent weight loss from baseline in both groups (SM+FB: –2.12%, 95% CI –3.04% to –1.21%, P
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Introduction Local governments can address access to healthy food and transportation through policy and planning. This study is the first to examine municipal-level transportation supports for food access. Methods We used a nationally representative sample of US municipalities with 1,000 or more persons from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living (N = 2,029) to assess 3 outcomes: public transit availability, consideration of food access in transportation planning, and presence of demand-responsive transportation (DRT). We used χ² tests to compare prevalences by municipal characteristics including population size, rurality, census region, median educational attainment, poverty prevalence, racial and ethnic population distribution, and low-income low-access to food (LILA) status. Results Among municipalities, 33.7% reported no public transit and 14.8% reported having DRT. Both public transit and DRT differed by population size (both P < .001) and census region (both P < .001) and were least commonly reported among municipalities with populations less than 2,500 (46.9% without public transit; 6.6% with DRT) and in the South (40.0% without public transit; 11.1% with DRT). Of those with public transit, 33.8% considered food access in transportation planning; this was more common with greater population size (55.9% among municipalities of ≥50,000 persons vs 16.8% among municipalities of <2,500 persons; P < .001), in the West (43.1% vs 26.8% in the Northeast, 33.7% in the Midwest, 32.2% in the South; P = .003), and municipalities with 20% or more of the population living below federal poverty guidelines (37.4% vs 32.2% among municipalities with less than 20% living in poverty; P = .07). Conclusion Results suggest that opportunities exist to improve food access through transportation, especially in smaller and Southern communities, which may improve diet quality and reduce chronic disease.
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Validation and refinement of the Stakeholder-driven Community Diffusion Survey for childhood obesity prevention
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Background Whole-of-community interventions hold promise in addressing childhood obesity. The COMPACT Stakeholder-driven Community Diffusion theory posits that stakeholders’ knowledge of childhood obesity prevention efforts and engagement with the issue contribute to successful intervention implementation. Building on completed formative research and pilot testing, we describe the validation and refinement of knowledge and engagement measures. Methods We assessed content validity using a modified Delphi process with science (n=18) and practice-based (n=16) experts. Next, we refined the survey based on input from science- and practice-based experts, cognitive response testing, and item analysis of extant survey data. Field testing of the refined survey involved community stakeholders in Greenville County, South Carolina (n=50), East Boston, Massachusetts (n=30), and Tucson, Arizona (n=84) between 2019 and 2020. Construct validity was assessed with confirmatory factor analysis (CFA). Two-week test-retest reliability was assessed among a subsample of 14 paired respondents in South Carolina. Results Experts rated existing knowledge domains (intervention factors, roles, sustainability, problem, resources) and engagement domains (dialogue/mutual learning, flexibility, influence/power, leadership/stewardship, trust) highly for their importance in addressing childhood obesity. Expert input resulted in 11 new knowledge items and 7 new engagement items that mapped onto existing domains. Correspondingly, two domain names were modified: implementation/sustainability and trust/trustworthiness. We also eliminated 8 extant items (4 knowledge and 4 engagement) and adapted item language for comprehension and consistency. Further modifications based on CFA results and item analyses resulted in 23 knowledge items across four domains (roles and resources merged) and 23 engagement items across five domains. Modified knowledge and engagement scales had adequate fit and strong item factor loadings (most >0.7 and all >0.5). Knowledge (α=0.86–0.87) and engagement (α=0.75–0.90) subscales had high internal scale consistency. Knowledge intraclass correlation coefficients (ICCs) for test-retest agreement of subscale scores ranged from 0.50 for intervention factors to 0.86 for roles/resources. For engagement subscale scores, ICCs ranged from 0.70 for trust/trustworthiness to 0.96 for leadership/stewardship. Conclusions Findings from this multi-method survey development process increase our confidence of the knowledge and engagement measures’ content validity, construct validity, and reliability.
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