Preventing childhood obesity _ health in the balance_clone

380 PREVENTING CHILDHOOD OBESITY THE PREVENTION OF CHILDHOOD OBESITY: UNDERSTANDING THE INFLUENCES OF MARKETING, MEDIA, AND FAMILY DYNAMICS WORKSHOP SPONSORED BY THE COMMITTEE ON PREVENTION OF OBESITY IN CHILDREN AND YOUTH INSTITUTE OF MEDICINE TUESDAY, DECEMBER 9, 2003 1:00 PM—5:30 PM KECK CENTER OF THE NATIONAL ACADEMIES CONFERENCE ROOM 100 500 FIFTH STREET, N.W. Washington, DC 20001 PROGRAM 1:00 pm Welcome and Introductions Jeffrey Koplan, M.D., M.P.H., Chair, Committee on Prevention of Obesity in Children and Youth 1:10 Marketing and Media Influences: Identifying Challenges and Effective Strategies for the Prevention of Childhood Obesity 1:10 – 1:30 pm Neal Baer, M.D., Executive Producer University City, CA 1:30 – 1:50 pm Eric Rosenthal, B.B.A., M.S., Marketing Specialist, Frankel, Chicago, IL 1:50 – 2:10 pm Mary Engle, Esq., Division of Advertising Practices, Federal Trade Commission, Washington, DC 2:10 Discussion Among Presenters and the Committee 3:10 Break

APPENDIX E 381 3:30 Family Dynamics: Challenges and Opportunities for Preventing Childhood Obesity and Promoting Healthful Lifestyles Susan McHale, Ph.D., The Pennsylvania State University, University Park, PA 4:00 Discussion 4:45 Open Forum Joan Almon, U.S. Alliance for Childhood Lilian Cheung, D.Sc., R.D., Harvard School of Public Health Jessica Donze, M.P.H., R.D., American Dietetic Association Tracy Fox, M.P.H., R.D., Produce for Better Health Foundation Lynn Fredericks, B.A., FamilyCook Productions Velma LaPoint, Ph.D., Howard University David Meyers, M.D., United States Breastfeeding Committee Jill Nicholls, Ph.D., National Dairy Council/Dairy Management Inc. Anne-Marie Nocton, M.S., M.P.H., R.D., Sports, Cardiovascular, and Wellness Nutritionists Robert Pallay, M.D., American Academy of Family Physicians Mercedes Rubio, Ph.D., American Sociological Association Margo Wootan, Sc.D., Center for Science in the Public Interest 5:30 Adjourn



F Biographical Sketches Jeffrey P. Koplan, M.D., M.P.H. (Chair), is the Vice President for Academic Health Affairs at the Woodruff Health Sciences Center at Emory University in Atlanta. He received a B.A. from Yale College, M.D. from Mt. Sinai School of Medicine, and M.P.H. from the Harvard School of Public Health. He is board certified in internal and preventive medicine. From 1998 to 2002, Dr. Koplan served as the Director of the Centers for Disease Control and Prevention (CDC) and Administrator of the Agency for Toxic Sub- stances and Disease Registry. He worked in the area of enhancing the interactions between clinical medicine and public health by leading the Prudential Center for Health Care Research, a nationally recognized health services research organization. Dr. Koplan has worked on a broad range of major public health issues, including infectious diseases such as smallpox and HIV/AIDS, environmental issues such as the Bhopal chemical disaster, and the health toll of tobacco and chronic diseases, both in the United States and globally. Dr. Koplan is a Master of the American College of Physicians, an Honorary Fellow of the Society of Public Health Educators, and a Public Health Hero of the American Public Health Association. He was elected to the Institute of Medicine (IOM) in 1999. He has served on many advisory groups and consultancies on public health issues in the United States and overseas and authored more than 170 scientific papers. Dennis M. Bier, M.D., is Professor of Pediatrics and the Director of the U.S. Department of Agriculture/Agricultural Research Service (USDA/ARS) Children’s Nutrition Research Center at the Baylor College of Medicine in 383

384 PREVENTING CHILDHOOD OBESITY Houston. Prior to this appointment, he was Co-director of the Pediatric Endocrinology and Metabolism Division and Director of the Pediatric Clini- cal Research Center at Washington University School of Medicine in St. Louis. Dr. Bier received his B.S. from LeMoyne College and his M.D. from New Jersey College of Medicine. Dr. Bier’s primary research interests are focused on the regulation of inter-organ transport of metabolic fuels with a special emphasis on the substrate and hormonal regulation of glucose, lipid, and protein/amino acid fuels. He has expertise in the areas of nutrition in human health and in the prevention and treatment of disease, particularly the role of maternal, fetal, and childhood nutrition on the growth, develop- ment, and health of children through adolescence; the long-term conse- quences of nutrient inadequacy during critical periods of embryonic and fetal life, infancy, and childhood on the pathogenesis of adult chronic dis- eases; macronutrients; intermediary metabolism; tracer kinetics; and diabe- tes, obesity, and endocrine disorders. Dr. Bier has served as President of the International Pediatric Research Foundation, Chair of the USDA/ARS Hu- man Studies Review Committee, Councilor for the American Pediatric Soci- ety, and as a member of the 1995 USDA/HHS Dietary Guidelines Advisory Committee, the IOM’s Food and Nutrition Board (FNB), and the IOM Committee on Implications of Dioxin in the Food Supply. He was elected to the IOM in 1997. He currently serves on the Board of the International Life Sciences Institute (ILSI) North America, and he is a member of the McDonald’s Global Advisory Council on Healthy Lifestyles. Leann L. Birch, Ph.D., is the Distinguished Professor of Human Develop- ment and Nutritional Sciences at The Pennsylvania State University in Uni- versity Park. She holds a Ph.D. in psychology from the University of Michi- gan. Dr. Birch’s research has focused on the development of eating behaviors in infants, children, and adolescents. Her research explores factors shaping food preferences in infants and children, regulation of food intake in chil- dren, dieting and problems of energy balance in school-age girls, predictors of maternal child feeding styles, and parental and environmental influences on children’s dietary practices. She currently receives research support from the National Institute of Child Health and Human Development (NICHD). Dr. Birch has received national and international recognition for her work including the Lederle Award from the American Society for Nutritional Sciences. She is the author of more than 150 publications. Ross C. Brownson, Ph.D., is Professor of Epidemiology and the Chair of the Department of Community Health at St. Louis University School of Public Health in Missouri. He was formerly Division Director with the Missouri Department of Health. He received his Ph.D. in environmental health and epidemiology at Colorado State University. Dr. Brownson is a

APPENDIX F 385 chronic disease epidemiologist whose research has focused on tobacco use prevention, promotion of physical activity, and the evaluation of commu- nity-level interventions. He is the principal investigator of a CDC-funded Prevention Research Center that is developing innovative approaches to chronic disease prevention among high-risk rural adults. Dr. Brownson is also developing and testing effective dissemination strategies for CDC de- signed to increase rates of physical activity among adults. Dr. Brownson receives research support from the National Institutes of Diabetes and Di- gestive and Kidney Diseases to conduct a diabetes prevention study aimed at promoting walking among high-risk rural adults. Dr. Brownson receives support from the Robert Wood Johnson Foundation (RWJF) to understand the environmental characteristics of activity-friendly communities and to measure the perceptual qualities of urban settings through RWJF’s Active Living Research program. He is a member of numerous editorial boards and is associate editor of the Annual Review of Public Health. Dr. Brownson is the author or editor of several books including Chronic Disease Epidemi- ology and Control, Applied Epidemiology, and Evidence-Based Public Health. John Cawley, Ph.D., is an Assistant Professor in the Department of Policy Analysis and Management at Cornell University. Dr. Cawley received his undergraduate degree in economics from Harvard University and his Ph.D. in economics from the University of Chicago. Dr. Cawley joined the Cornell faculty in 2001 after spending two years as a Robert Wood Johnson Scholar in Health Policy Research at the University of Michigan. His research fo- cuses on health economics, in particular the economics of obesity. He is currently studying the effect of body weight on labor market outcomes such as wage rates, unemployment, and employment disability; the role of body weight in the decision of adolescents to initiate smoking; the demand for anti-obesity pharmaceuticals; and the extent to which consumption of calo- ries can be considered addictive. His research is conducted with support from the Economic Research Initiative on the Uninsured, the University of Michigan Retirement Research Consortium, J.P. Morgan Private Bank Glo- bal Philanthropic Services, RWJF, Merck, and USDA. In addition to his affiliation with Cornell, Dr. Cawley is a Faculty Research Fellow of the National Bureau of Economic Research in the Health Economics and Health Care programs. He also serves on an advisory board to the CDC’s Project MOVE: Measurement of the Value of Exercise. George R. Flores, M.D., M.P.H., is a Senior Program Officer with The California Endowment, a major health foundation, where his focus is on disparities in health status, prevention of childhood obesity, community- based public health, and health policy. Dr. Flores served previously as

386 PREVENTING CHILDHOOD OBESITY Health Officer and Director of Public Health in San Diego and Sonoma Counties, Deputy Health Officer in Santa Barbara County, Assistant Clini- cal Professor at the University of California San Francisco School of Medi- cine, and Program Director for Project HOPE in Guatemala. He is a founder and member of the Board of Directors of the Latino Coalition for a Healthy California. Dr. Flores is an alumnus of the University of Utah College of Medicine, the Harvard School of Public Health, the Kennedy School of Government, and the Public Health Leadership Institute. He has served on the IOM Committee on Assuring the Health of the Public in the 21st Century. Simone A. French, Ph.D., is Professor in the Division of Epidemiology in the School of Public Health at the University of Minnesota in Minneapolis. She received a B.A. in psychology from Macalester College in St. Paul, Minnesota, and a Ph.D. in psychology from the University of Minnesota in Minneapolis. Dr. French’s expertise and research focuses broadly on the social and environmental influences on eating and physical activity behav- iors, community-based strategies for eating behavior change, and adoles- cent nutrition and physical activity. Her obesity prevention research has focused on pricing strategies to promote sales of lower fat foods in cafete- rias and vending machines, and changing the availability and promotion of healthful foods in school cafeterias to influence student food choices. She has also researched eating disorders, dieting, and other weight management strategies among adolescents and adults. Dr. French presently receives re- search support that focuses on obesity and nutrition from the National Heart, Lung, and Blood Institute and NICHD. She serves as co-editor of the International Journal of Behavioral Nutrition and Physical Activity. Dr. French has authored more than 100 scientific papers in peer-reviewed aca- demic journals. Susan L. Handy, Ph.D., is an Associate Professor in the Department of Environmental Science and Policy, University of California at Davis. She earned a B.S. in civil engineering from Princeton University, an M.S. in civil engineering from Stanford University, and a Ph.D. in city and regional planning from the University of California at Berkeley. Dr. Handy’s re- search focuses on the relationships between transportation and land use, including the impact of land use on travel behavior, and the impact of transportation investments on land development patterns. Her work is di- rected toward developing strategies to enhance accessibility and reduce automobile dependence, including land use policies and telecommunica- tions services. She is the Chair of the Committee on Telecommunications and Travel Behavior and a member of the Committee on Transportation and Land Development of the Transportation Research Board. She is also a

APPENDIX F 387 co-principal investigator on a project funded by The RWJF’s Active Living and Environmental Studies Program. Robert C. Hornik, Ph.D., is the Wilbur Schramm Professor of Communica- tion and Health Policy at the Annenberg School for Communication, Uni- versity of Pennsylvania in Philadelphia. He has a wide range of experience in mass-media communication evaluations, ranging from breastfeeding pro- motion, AIDS education, immunization and child survival projects, to anti- drug and domestic violence media campaigns at the community, national, and international levels. Dr. Hornik has served as a member of the IOM Committee on International Nutrition Programs, the National Research Council (NRC) Committee on Communication for Behavior Change in the 21st Century: Improving the Health of Diverse Populations, and the NRC Committee to Develop a Strategy to Prevent and Reduce Underage Drink- ing. He has received the Andreasen Scholar award in social marketing, and the Fisher Mentorship award from the International Communication Asso- ciation. He has also been a consultant to other agencies such as the U.S. Agency for International Development, UNICEF, CDC, and the World Bank. Dr. Hornik serves on the editorial boards of several journals, includ- ing Social Marketing Quarterly and the Journal of Health Communication. Dr. Hornik was the scientific director for the evaluation of the Office of National Drug Control Policy’s National Youth Anti-Drug Media Cam- paign and he is currently the director of the University of Pennsylvania’s National Cancer Institute-funded Center of Excellence in Cancer Commu- nication Research. He most recently edited Public Health Communication and was the author of Development Communication, and co-author of Educational Reform with Television: The El Salvador Experience, and To- ward Reform of Program Evaluation. Douglas B. Kamerow, M.D., M.P.H., is the Chief Scientist for Health, Social, and Economics Research at RTI International where he focuses on health-related behaviors, evidence-based care, and improving the quality of health care. Among his responsibilities is serving as principal investigator on an evaluation of the RWJF’s National Diabetes Program. He is also a Clinical Professor of Family Medicine at Georgetown University. A family physician who is also board certified in preventive medicine, Dr. Kamerow received his A.B. from Harvard College, M.D. from the University of Roch- ester, and M.P.H. from Johns Hopkins University. While a Commissioned Officer in the U.S. Public Health Service, he served as Director of the Center for Practice and Technology Assessment, Agency for Healthcare Research and Quality, Department of Health and Human Services and Director of the Clinical Preventive Services staff of the Public Health Service Office of Disease Prevention and Health Promotion. He conceived and supervised

388 PREVENTING CHILDHOOD OBESITY the creation of the Evidence-based Practice Centers Program and the Na- tional Guideline Clearinghouse, was managing editor of the first and sec- ond editions of the U.S. Preventive Services Task Force Guide to Clinical Preventive Services, and led the development of the Put Prevention into Practice campaign, which sought to incorporate clinical preventive services, including nutrition counseling, into routine medical practice. Shiriki K. Kumanyika, Ph.D., M.P.H., R.D., is Professor of Epidemiology in the Department of Biostatistics and Epidemiology, Associate Dean for Health Promotion and Disease Prevention, and the Director of the Gradu- ate Program in Public Health Studies at the University of Pennsylvania School of Medicine. She received her B.A. from Syracuse University, M.S.W. from Columbia University, Ph.D. in human nutrition from Cornell Univer- sity, and M.P.H. from Johns Hopkins University. The main themes in Dr. Kumanyika’s research concern the role of nutritional factors in the primary and secondary prevention of chronic diseases with a particular focus on obesity, sodium reduction, and related health problems such as hyperten- sion and diabetes. She directs a National Institutes of Health (NIH)-funded EXPORT (Excellence in Partnerships for Community Outreach, Research, and Training) Center that focuses on reduction of obesity-related health disparities. Dr. Kumanyika is the lead investigator or a collaborator on several federally-funded studies of obesity prevention and treatment in adults and children, of which some focus specifically on African Americans. She has served on a number of expert panels, including the 1995 and 2000 U.S. Dietary Guidelines Advisory Committees, and she served on the NIH Advisory Committee for the National Children’s Study in 2002-2003. She was vice-chair of the Joint WHO/FAO Expert Consultation on Diet, Nutri- tion and the Prevention of Chronic Diseases in 2002, and also chaired the 2002 WHO Expert Consultation on Appropriate BMI Standards for Asian Populations. Dr. Kumanyika’s current activities include serving on the IOM’s FNB, the NIH Clinical Obesity Research Panel, and the Prevention Group of the International Obesity Task Force. She was elected to the IOM in 2003. Barbara J. Moore, Ph.D., is the President and Chief Executive Officer of Shape Up America!, a national initiative to promote healthy weight and increased physical activity in America. She earned an undergraduate degree in philosophy from Skidmore College, received her M.S. and Ph.D. in nutri- tion from Columbia University, and served as a Postdoctoral Fellow in nutrition and physiology at the University of California at Davis. Previous positions include service as Deputy Director in the Division of Nutrition Research Coordination at the NIH, Acting Assistant Director of Social and

APPENDIX F 389 Behavioral Sciences at the White House Office of Science and Technology Policy, Chief Nutritionist of Weight Watchers International, and Assistant Professor of Nutrition at Rutgers University. Dr. Moore has conducted research on animal models of obesity and on addressing the public health and socioeconomic implications of obesity in the United States. She has served on the IOM Subcommittee on Military Weight Management. Arie L. Nettles, Ph.D., is an Assistant Professor and Assistant Research Scientist of Education, and previously served as Clinical Assistant Professor of Pediatrics and Communicable Diseases at the University of Michigan. Her research focuses on the study of academic achievement and the impact of sickle cell disease on children and equity issues in educational assess- ment. Prior to her appointment at the University of Michigan, she was an Assistant Professor of School Psychology at the University of Tennessee. Other faculty appointments include Tennessee State University, Fisk Uni- versity, and Trenton State College. Dr. Nettles has been a public school teacher in Iowa and Tennessee and a practicing school psychologist in Kentucky and New Jersey. She is a licensed psychologist in Tennessee and Michigan, and nationally certified in school psychology, endorsed by the National Association of School Psychology. She has a B.S. in social science education and M.S. in education administration from the University of Tennessee at Knoxville. She received a Ph.D. in psychology from Vanderbilt University specializing in clinical and school psychology. Dr. Nettles has served on the NRC Committee on Goals 2000 and the Inclusion of Students with Disabilities. Russell R. Pate, Ph.D., is the Associate Dean for Research and a Professor at the Norman J. Arnold School of Public Health, University of South Carolina in Columbia. He received a B.S. in physical education from Spring- field College, and M.S. and Ph.D. in exercise physiology from the Univer- sity of Oregon. Dr. Pate’s research interest and expertise focuses on physi- cal activity measurement, determinants, and promotion in children and youth. He also directs a national postgraduate course aimed at developing research competencies related to physical activity and public health. Dr. Pate is also involved in the CDC-funded Prevention Research Center at the University of South Carolina. His research includes studies on preschoolers’ physical activity levels and how schools can influence these levels and multi- center trials on the promotion of physical activity among middle and high school-age girls. Dr. Pate serves as an investigator for the RWJF Active for Life program that encourages physical activity among seniors. He is a Past- President of both the American College of Sports Medicine and the Na- tional Coalition on Promoting Physical Activity.

390 PREVENTING CHILDHOOD OBESITY John C. Peters, Ph.D., is the Associate Director of Food and Beverage Technology and Director of the Nutrition Science Institute at Procter & Gamble Company in Cincinnati. He received his B.S. in biochemistry from the University of California at Davis and his Ph.D. in biochemistry and nutrition from the University of Wisconsin at Madison. Dr. Peters’ research has focused on amino acid metabolism and dietary intake, triglycerides and lipid levels in humans, effects of weight cycling on susceptibility to obesity, and effects of fat replacements on energy, fat intake, and micronutrient metabolism. He has served on the scientific advisory board of the Arkansas Children’s Hospital Research Institute; on the planning committee of the Cincinnati Health Improvement Collaborative; as Vice Chair of the scien- tific advisory board of the ILSI Center for Health Promotion; and Treasurer of the public-private Partnership for Healthy Eating and Active Living. Dr. Peters is currently President of the ILSI Center for Health Promotion. Thomas N. Robinson, M.D., M.P.H., is an Associate Professor of Pediat- rics and of Medicine in the Division of General Pediatrics and Stanford Prevention Research Center, Stanford University School of Medicine. Dr. Robinson received both his B.S. and M.D. from Stanford University and M.P.H. in maternal and child health from the University of California at Berkeley. He completed his internship and residency in pediatrics at Children’s Hospital in Boston and at Harvard Medical School, and then returned to Stanford for postdoctoral training as a Robert Wood Johnson Clinical Scholar. Dr. Robinson’s community-, school-, and family-based health behavior change research has focused on nutrition, physical activity, and smoking behavior in children and adolescents; the effects of television viewing on health-related behaviors; childhood obesity prevention and treat- ment; and using interactive communication technologies to promote health behavior change. Dr. Robinson was an RWJF Generalist Physician Faculty Scholar awardee during his participation on this committee. Dr. Robinson is board certified in pediatrics, a Fellow of the American Academy of Pedi- atrics, and practices general pediatrics and directs the Center for Healthy Weight at the Lucile Packard Children’s Hospital at Stanford. Charles Royer, B.S., is a Senior Lecturer at the University of Washington with appointments in the School of Public Health and Community Medi- cine and in the Evans School of Public Affairs. He is also National Program Director of the Urban Health Initiative, an effort to improve the health and safety of children across five regions. He holds a B.S. from the University of Oregon. From 1990 to 1994, Mr. Royer was Director of the Institute of Politics at Harvard University and Lecturer at the Kennedy School of Gov- ernment. Prior to this, Mr. Royer served as Mayor of Seattle from 1978 to 1989, following a career in newspaper and television journalism. He has

APPENDIX F 391 served as President of the National League of Cities and as a member of the National Commission on State and Local Public Service, the Democratic National Committee, and the President’s Commission on White House Fellowships. He was named one of the top 20 American mayors in 1988 and received the 1989 Distinguished Urban Mayor Award from the Na- tional Urban Coalition. Shirley R. Watkins, M.Ed., is an Educational and Nutrition Services Con- sultant. From 1997 to 2001, she was Under Secretary for Food, Nutrition, and Consumer Services at USDA, the first African-American woman to hold that position. In that capacity she oversaw USDA’s food assistance programs and its dietary guidance promotion efforts. She also served USDA as Deputy Assistant Secretary for Marketing and Regulatory Programs and Deputy Under Secretary for Food, Nutrition, and Consumer Services. Be- fore joining USDA in 1993, Ms. Watkins was Director of Nutrition Services for Memphis, Tennessee city schools. Previous positions included food- service supervisor, home economics teacher, elementary school teacher, and a home demonstration agent with the University of Arkansas Extension Service. She is a past president of the American School Food Services Asso- ciation. She received a B.S. in home economics from the University of Arkansas at Pine Bluff and an M.Ed. from the University of Memphis. Robert C. Whitaker, M.D., M.P.H., is a Senior Fellow at Mathematica Policy Research, Inc., in Princeton, New Jersey. Before joining Mathematica he was a Visiting Senior Research Scholar at the Center for Health and Wellbeing at the Woodrow Wilson School of Public and International Af- fairs at Princeton University, and was an Associate Professor of Pediatrics at the University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center. His research has focused on the child- hood antecedents of adult chronic disease. This has included studies on school nutrition, obesity prevention strategies in preschool children, par- ent-child feeding interaction, the epidemiology of childhood obesity, and the determinants of social and emotional well-being in children. He served on the IOM Committee on Dietary Risk Assessment in the WIC Program. Dr. Whitaker received a B.A. in chemistry from Williams College, an M.D. from The Johns Hopkins University School of Medicine, and an M.P.H. from the University of Washington School of Public Health and Commu- nity Medicine. Dr. Whitaker completed his residency and fellowship in pediatrics at the University of Washington School of Medicine, and he received postdoctoral training as a Robert Wood Johnson Clinical Scholar.

392 PREVENTING CHILDHOOD OBESITY IOM Staff Tazima A. Davis is a Research Associate in the FNB at the IOM and has been with the FNB since September 2000. Prior to joining the National Academies, she worked as a Quality Control Supervisor with Kraft Foods and Bestfoods Foodservice. Ms. Davis earned a B.S. in food science from the University of Illinois at Urbana-Champaign (UIUC). During her under- graduate years at UIUC, she participated in research internships including ice cream ingredient development in Chicago; applied food microbiology research in Boslwart, Netherlands; and carotenoid research in Urbana, Illi- nois. Vivica I. Kraak, M.S., R.D., is a Senior Program Officer in the IOM’s FNB. In addition to working on the Prevention of Obesity in Children and Youth Study, she directs the international activities within FNB. She received her B.S. in nutritional sciences from Cornell University and completed a coordi- nated M.S. in nutrition and dietetic internship at Case Western Reserve University and the University Hospitals of Cleveland. Prior to joining the IOM in 2002, she worked as a Clinical Dietitian at Columbia-Presbyterian Medical Center and as a Public Health Nutritionist specializing in HIV disease in New York City. From 1994 to 2000, she was a Research Nutri- tionist in the Division of Nutritional Sciences at Cornell University, where she collaborated on several domestic and international food policy and community nutrition research initiatives. She has co-authored a variety of publications related to food security and community food systems, nutri- tion and HIV/AIDS, international food aid and food security, viewpoints about genetically engineered foods, use of dietary supplements, and the influence of commercialism on the food and nutrition-related decisions and behaviors of children and youth. Catharyn T. Liverman, M.L.S., is a Senior Program Officer in the FNB and the Board on Health Sciences Policy at the IOM. She served as study direc- tor for this study. In 12 years at IOM, she has worked on projects address- ing a number of topics, including veterans’ health, drug abuse, injury pre- vention, and clinical trials of testosterone therapy. IOM reports she has co-edited include Testosterone and Aging: Clinical Research Directions; Gulf War and Health, Vol. 1; Reducing the Burden of Injury; Toxicology and Environmental Health Information Resources; and The Development of Medications for the Treatment of Opiate and Cocaine Addiction. Her background is in medical library science, with previous jobs at the National Agricultural Library and the Naval War College Library. She received her B.A. from Wake Forest University and her M.L.S. from the University of Maryland.

APPENDIX F 393 Rose Marie Martinez, Sc.D., is the Director of the IOM’s Board on Health Promotion and Disease Prevention . Prior to joining the IOM, Dr. Martinez was a Senior Health Researcher at Mathematica Policy Research from 1995 to 1999 where she conducted research on the impact of health system change on the public health infrastructure, access to care for vulnerable populations, managed care, and the health-care workforce. Dr. Martinez is a former Assistant Director for Health Financing and Policy with the U.S. General Accounting Office where she directed evaluations and policy analy- sis in the area of national and public health issues. She also served as Chief of Health Studies at the Regional Institute for Health and Social Welfare, the research arm of the Regional Ministry of Health in Madrid, Spain. Dr. Martinez received her B.A. from the University of Southern California and her Doctor of Science from the Johns Hopkins School of Hygiene and Public Health. Linda D. Meyers, Ph.D., is the Director of the IOM’s FNB. She has also served as FNB Deputy Director and as a Senior Program Officer. Prior to joining the IOM in 2001, she worked for 15 years in the Office of Disease Prevention and Health Promotion in the U.S. Department of Health and Human Services where she was a Senior Nutrition Advisor, Deputy Direc- tor, and Acting Director. Dr. Meyers has received a number of awards for her contributions to public health, including the Secretary’s Distinguished Service Award for Healthy People 2010 and the Surgeon General’s Medal- lion. Dr. Meyers has a B.A. in health and physical education from Goshen College in Indiana, M.S. in food and nutrition from Colorado State Univer- sity, and Ph.D. in nutritional sciences from Cornell University. Janice Rice Okita, Ph.D., R.D., is a Senior Program Officer in the IOM’s FNB. Since joining the IOM in 2002, she has worked on projects involving evaluation of the safety of dietary supplements for the Food and Drug Administration, and reviewing the food packages used in the USDA Special Supplemental Food Program for Women, Infants, and Children. Dr. Okita participated in biomedical research in the Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University in Pullman from 1990-2001; the Department of Biochemistry, Medical College of Wis- consin in Milwaukee from 1988-1990; and the Platelet Biochemistry Labo- ratory, Blood Center of Southeastern Wisconsin in Milwaukee from 1982- 1988. Dr. Okita earned a B.S. in human food and nutrition from Florida State University in Tallahassee, and Ph.D. in biochemistry from the Univer- sity of Texas Health Science Center at Dallas. She is a Registered Dietitian and practiced clinical dietetics in Dallas from 1972 to 1974.

394 PREVENTING CHILDHOOD OBESITY Shannon L. Ruddy is a Senior Program Assistant in the FNB at the IOM. She has also worked with the NRC where she worked on several reports, including Partnerships for Reducing Landslide Risk, Fair Weather: Effec- tive Partnerships in Weather and Climate Services, Government Data Cen- ters: Meeting Increasing Demands, Resolving Conflicts Arising from the Privatization of Environmental Data, Review of EarthScope Integrated Science, and National Spatial Data Infrastructure Partnership Programs: Rethinking the Focus. She has been with the National Academies since 2001. She holds a B.A. in environmental science from LaSalle University in Philadelphia. Previously, she worked as a Researcher for Booz-Allen & Hamilton in the Environmental Protection Agency’s Region 3 CERCLA/ Superfund Records Center.

Index A prevention goals, 88 treatment for obesity, 108 Abdominal obesity, 69, 70 TV viewing time, 160-161 Academic performance, 105, 215, 252, 253 Advertising and marketing Action plan for prevention alcoholic beverages, 175 bans and restrictions on, 174-175, 178, clinical medicine approach, 107-108, 109 268, 353, 362, 363 codes and monitoring mechanisms, 176- contexts for, 25-44 definitions and terminology, 79-83 177 developing recommendations, 16, 111- and eating behavior, 169-170, 172-173 energy density of advertised foods, 172 115, 323 and energy imbalance, 172, 173, 174, energy balance, 3, 90-106 evidence-based strategies, 3, 16, 107- 355 ethnic groups targeted by, 106 115, 322-323 evidence of effects of, 353-354, 355 framework, 83-85 expenditures, 172 goals, 4-5, 86-90, 115 exposure time for children, 171, 174 public health approach, 108-110, 115, First Amendment rights, 174-175, 353, 127, 129 362 Active Living by Design, 206 health and nutrient claims, 169-170, 176 Added caloric sweeteners, 31, 145-146, 290 litigation, 354 Adolescents. See Children and adolescent packaging, 172, 356 prevention through, 128, 268, 353, 367; obesity; Older Children and Youth Adopted children, studies, 93 see also Public education Adults quantity and nature of commercials, 172 recommendations, 9, 177 diabetes, 68 research needs, 177, 268 energy balance, 90, 160 in schools, 176, 251, 265-269 obesity, 5, 22, 43-44, 63-65, 68 self-regulation by industry, 175, 354 overweight, 80 physical activity, 29, 35, 179 395

396 INDEX social and public health pressures, 366 American Psychological Association, 265, standards development, 175-176 371 targeting children, 106, 145, 172, 174, PsychINFO database, 341 355 Task Force on Advertising and Children, television commercials, 8, 44, 172-173, 173-174, 355, 356 174, 265, 301, 302, 355 American Public Health Association, 132, vulnerability of children to, 8, 172-173, 358, 359-360 267-268, 302, 353-354, 355 American Stop Smoking Intervention Study Advertising Council, 184 Advocacy (ASSIST), 199 Americans in Motion, 224 community mobilization, 210-211 Americans’ Use of Time Study, 29, 159 by health professionals, 223-225 Animal studies, 94 media, 181, 183, 351 Appetite. See also Hunger; Satiety by parents, 300 Age regulatory systems, 95, 157 and BMI, 56-57, 63-65 Arkansas BMI initiative, 271 and child obesity trends, 1, 63 Asian/Pacific Islanders. See also Ethnic AGRICOLA database, 339, 340 Agricultural policies, 6-7, 144-146, 148, 217 groups; Racial and ethnic disparities African Americans. See also Ethnic groups; body image dissatisfaction, 104 defined, 58 n.4 Racial and ethnic disparities diabetes, 68 body image dissatisfaction, 66, 104 obesity trends, 105 defined, 58 n.4 Association of State and Territorial Health diabetes, 68 interventions for, 200, 274 Officials, 132, 218 obesity trends, 60, 105 Atherosclerosis, 69 targeted marketing of foods to, 106 Australia, 44, 180, 256-257 Alabama, 61 Avon Longitudinal Study of Pregnancy and Alaska, 61 Alcohol prevention analogies, 175, 352, Childhood (ALSPAC), 140-141 Away-from-home foods. See also Fast food; 354, 366 America on the Move initiative, 141 Restaurant industry; School food and American Academy of Family Physicians, beverages consumption trends, 27-28, 30, 161, 224 357-358 American Academy of Pediatrics, 174, 224, costs and convenience, 26 defined, 331 253, 290, 358 energy density, 92, 162, 163 American Cancer Society, 201 energy intake, 30, 158, 161 American Council on Food and Nutrition, frequency of dining out, 161-162 leisure/social aspects, 28 367 n.6 nutrition labeling, 163-164, 165, 168, American Federation of School Teachers, 197, 356 portion sizes, 158 265 American Indians. See also Ethnic groups; B Racial and ethnic disparities Back to Sleep campaigns, 179 body image dissatisfaction, 66, 104 Balanced diet defined, 58 n.4 diabetes, 68 benefits associated with, 97 obesity trends, 60, 105 defined, 91, 331 school-based dietary interventions, 245, dietary guidelines, 96-97 ethnically appropriate foods, 144, 156 246, 247-248 responsibility to provide, 292-293 American Medical Association, 224 American Planning Association, 210, 218

INDEX 397 Basal metabolism, 331 monitoring, 306-308 Behavioral research, 17, 323-324 physiological regulation of, 159 Behavioral Risk Factor Surveillance System survey data, 89, 137, 140 Boy Scouts, 202 (BRFSS), 29, 35, 36, 61, 160 Boys and Girls Clubs of America, 44, 202 Behavioral settings. See Community Brain regulation of energy balance, 69-70, 94, environment; Home environment; School environment 95, 157 Better Business Bureau, 175 stress response, 70 Beverages. See also Food and beverage Breastfeeding, 222, 288-290 industry; Milk and other dairy Built environment. See also Local products; School food and beverages; Sodas and fruit drinks communities consumption trends, 33 city planning, 210 Blood pressure. See High blood pressure; community interventions, 203, 204-217 Hypertension correlation studies, 206-208 Blue Cross of California, 201 defined, 332 Body fat, 54, 80, 93, 137, 140, 334. See designing for physical activity, 11, 12, also Body mass index Body image, 66, 91-92, 100, 103-104, 199 125, 132, 196, 204-211, 273-274 Body mass index evaluation of interventions, 208-209 age-specific trends, 56-57, 63-65, 80, food access, 215-217 336 land development codes, 210 beverage consumption and, 293-294 race/ethnicity and, 205 calculation, 80 rating, 218 charts, 1 n.1, 55, 79-80, 88, 89-90 recommendations, 11, 209-211, 213- clinical screening and tracking, 221-222, 307-308 214, 220 and co-morbidities, 62, 80 recreational facilities, 206, 211 crossing percentiles, 89-90 research needs, 208-209 defined, 79, 331-332 safety considerations, 11, 205, 207-208, and diabetes, 24, 62, 68 distribution trends, 61-62, 80, 336 211 ethnicity and, 58-60 schools, 213-215, 273-274 gender tends, 56-58 smart growth principles, 209, 210 obesity definition, 1 n.1, 22, 54-55, 63 socioeconomic status and, 205, 207 optimum population goals, 86, 88-90 street-scale interventions, 208 overweight, 80, 336 transportation issues, 38, 205 revised growth reference, 55 walking and biking opportunities, 207, school screening, 270-271, 308 socioeconomic status and, 60-61 208, 209, 210, 211-215 TV viewing and, 302 Body weight C CDC guidelines for children, 89 and energy intake, 159 California, 71, 103-104, 180, 200, 201, goals, 89-90 213, 214, 242, 248, 358, 359 growth spurts and, 91, 307 as health issue, 306-308 Caloric sweeteners. See Added caloric healthy, 335 sweeteners heritability, 91, 93, 94 inappropriate gain, 90 Calories, defined, 332. See also Energy measurement, 137, 140 expenditure; Energy intake Canada, 44, 68, 356 Cancer, 69, 107, 169 Carbohydrates, 34 Cardiovascular disease food label health claims, 169

398 INDEX prevention interventions, 107, 109, 196, BMI distributions, 61-62, 80, 336 200, 223, 262 diabetes, 23, 73 energy balance, 90, 97 risk factors, 23, 69 energy expenditure, 90 Center for Consumer Freedom, 367 n.6 energy requirements, 97, 158, 167-168 Centers for Disease Control and Prevention, free time, 36, 38, 160 physical activity trends, 35-36, 160 346 purchasing influence, 172, 292, 302 BMI charts, 1 n.1, 55, 79-80, 88, 89-90 Children’s Advertising Review Unit, 175- grants program, 132, 133 guidelines for healthy weight, 89 176 health curriculum recommendations, Cholelithiasis, 67, 72 Cholesterol, dietary, 180 261 Church-based interventions, 199-200 Healthy Days Measures, 218 CINAHL (Cumulative Index to Nursing and physical activity promotion, 141, 255 Project MOVE, 136-137 Allied Heath Literature), 339, 340 REACH 2010 initiative, 200 Class of 1989 Study, 197 recommended role, 130-131 Clinical medicine. See also Treatment of research funding, 135, 204 revised growth reference, 55 obesity School Health Index, 274-275 effectiveness of interventions, 365 surveillance and monitoring, 29, 37, 61, evidence-based approach, 107-108, 109 preventive services, 221-224, 226 137 Clinical practice guidelines, 107 tobacco prevention policies, 358 Coalition building, 7, 128, 198-199, 200, VERB campaign, 141, 182-183, 184 Check-off programs, 145 202-203, 225-226 Child and Adolescent Trial for Cochrane Database, 339, 340 Common Sense for Consumption Act, 363 Cardiovascular Health (CATCH), Community-based interventions. See also 245, 246, 256, 262-263, 270 Child and Adult Care Food Program Built environment; Local (CACFP), 142, 143 communities Childhood and adolescent obesity. See also advocacy, 210-211 Epidemic of childhood/adolescent categories of, 346-349 obesity; Prevalence of childhood/ child/youth programs, 197-198, 201-204 adolescent obesity church-based, 199-200 abuse and neglect and, 287 coalition building, 7, 10, 11, 128, 198- adult obesity trends and, 63-65 199, 200, 202-203, 225-226 age-related trends, 1, 63 culturally appropriate and targeted and co-morbid health risks, 62, 67-69, strategies, 198, 199-201, 203 319 demonstration projects, 132, 200, 204, definitions, 1 n.1, 22, 56, 63, 79-81, 208-209, 213 115, 336 dietary changes, 196, 197 food insecurity and, 215 ecological framework, 196-199, 203 genetics and, 65, 91, 94, 106 by employers, 195, 202 health care costs, 72 evaluation of, 11, 17, 203-204, 217-219, intergenerational transmission, 65 325 international dimensions, 2, 22 evidence of effectiveness, 46, 196-198, medical conditions and, 91 222-223, 348 public interest, 40-43 food-access-related, 11, 144, 216-217, Children and youth. See also Infants; Older 218, 357-358 children and youth; Toddlers and funding, 132-133, 209 young children guide to preventive services, 209, 348- balanced diet, 91 349

INDEX 399 large-scale, 196-197, 217-219, 345, 347 Costs of childhood obesity. See also neighborhood associations, 210-211 Economic costs of obesity nutrition education, 198, 201 physical activity, 12, 179-180, 196, 197, health-care-related, 70-72 integrated view of, 69-70 201, 202, 211-215 physical health, 65, 67-69, 71, 73 public health preventive services, 125, social and emotional health, 22-24, 65, 200, 346, 347, 348-349 66-67, 69-70, 71, 73 recommendations, 10-12, 201-204, 219- Counseling 221, 225 by health-care professionals, 221-223 recreational programs, 202 at school, 269-270 “report cards,” 218 Current Population Survey, 45 by youth organizations, 201 Community centers, schools as, 272-274 D Community environment. See also Built Dairy products. See Milk and other dairy environment; Local communities products access to food products, 144, 215-217, Deaths, 67, 68, 73 357-358 Demographic trends, 25-40 health impact assessment, 217-219 Demonstration projects, 132, 200, 204, Community health care advocacy by professional organizations, 208-209, 213 Denmark, 287 224-225 Depression and depressive symptoms, 66, counseling by health-care professionals, 67, 69-70, 105 221-223 Diabetes, type 1, 67 n.5 insurance coverage, 225-226 Diabetes, type 2 preventive services, 12, 221-225, 226, in adults, 68 348-349 BMI and, 24, 62, 68 quality-improvement programs, 226 in children, 23, 73 recommendations, 12, 225, 226-227 complications of, 68, 69 Community Health Status Indicators in ethnic minority groups, 23, 68 gestational, 65, 288 Project, 218 health care costs, 71-72 Community Preventive Services Taskforce, high-fructose corn syrup and, 146 lifetime risk, 2, 23, 67-68 361 prevalence, 67-68, 225 Co-morbidities of obesity. See also Diabetes risk factors, 68 Diet. See also Balanced diet BMI and, 62, 80 deaths related to, 67, 73 defined, 332 nutrient density, 96 disorders, 67 Dietary Guidelines Advisory Committee, economic costs, 23, 70-71 health risks of children, 62, 67-69 131 trends, 22, 62 Dietary Guidelines for Americans, 13, 96- Congress for the New Urbanism, 210 Consumer attitudes. See also Public interest 97, 131, 164, 165, 239, 240, 292, 332 in obesity Dietary intake trends, 40-43 economic environment and, 100, 101, Consumer information, 128, 141-142, 215-216, 358 and energy balance, 95-98, 101 163 health claims advertising and, 169-170 Continuing Survey of Food Intakes by by macronutrient, 34 physiological regulation of, 159 Individuals, 97, 137, 138, 159, 163, 293 Corn subsidies, 146 Coronary artery disease, 69 Cost-reduction interventions, 46, 347, 349

400 INDEX psychosocial and behavioral Economic environment considerations, 95-98, 105 and food intake, 100, 101, 215-216, 358-360 research challenges, 97-98 funding of school meals, 250, 252 trends, 28, 30-33, 97 and physical activity, 100, 102 Dietary interventions in schools, 238, 250-252, 358, 359 community-based, 196, 197 taxation and pricing interventions, 44, education campaigns, 180, 345 128, 146-147, 178, 358-360 effectiveness of, 241, 244-247, 364 school based, 240-241, 244-247, 252- Edible Schoolyard, 248 Education. See Public education 253, 364 Electronic media. See also Television self-help, 365 tobacco control interventions compared, viewing home environment, 39-40, 303 350-351 time spent by children on, 171, 172 Dietary Reference Intakes, 168, 333 EMBASE (Excerpta Medica), 339, 340, 342 Disability, defined, 333 Employers and worksite interventions, 195, Disease 202 defined, 333 Energy balance emergency response to, 133 Discrimination, 66, 67, 100, 178 action plan for prevention, 90-106 Dyslipidemia, 62, 67 adults, 90, 160 body image, 103-104 E in children and youth, 90, 97 central nervous system regulation of, 69- Eating behavior in absence of hunger, 294-296, 305 70, 94, 95, 157, 159 advertising and, 172-173 defined, 83 n.2, 90, 115, 333 brain’s regulation of, 69, 95, 157 dietary intake and, 95-98, 101 breastfeeding and, 222, 288-290 ecological systems theory model, 83-85, “clean the plate” pressures and, 295 energy density of foods and, 156-157, 115 159, 291, 293 environmental influences, 100-106 flavor preferences, 289, 291 food marketing and advertising practices food as reward and, 295 health-claims advertising and, 169-170 and, 172, 173, 174, 355 home environment and, 14-15, 287-296 genetic variation and biological introducing new foods, 291 package size and, 159 considerations, 91, 93-95, 159 parental influence, 287-289, 305-306 physical activity and, 92, 98-99, 102 portion size and, 158, 291-292, 294- promotion, 115 296, 305 psychosocial and behavioral selection and availability of foods, 292- 294 considerations, 69-70, 95-99 self-regulation, 289, 294 racial and ethnic disparities, 105-106 TV viewing during meals and, 222, 293 sociocultural environment and, 84-85, Eating disorders, 43, 287 91-92, 100-106 Eating patterns, trends, 27-28, 30-35 socioeconomic status, 104-105, 146-147 Ecological systems theory model, 83-85, stigmatization considerations, 100, 103 surveys, 137 115 transportation patterns and, 37 EconLit database, 339, 340 TV viewing and, 301-302 Economic costs of obesity, 23, 70-71, 72, Energy density of foods, 28 access and affordability issues, 216 225 of advertised foods, 172 of away-from-home foods, 92, 162, 163 defined, 333 and eating behavior, 156-157, 159, 291, 293

INDEX 401 and energy storage, 156-157 high-risk population subgroups, 58-61, infant response to, 290 134 labeling foods for, 170, 171 and satiety, 157, 159 lifestyle trends, 25-26, 27-39 of school foods, 240, 243 media and, 39-40 taxes on energy-dense foods, 44, 146- overall burden, 55-58 physical activity and, 29, 35-39 147 physical health implications, 22-23, 67- Energy expenditure 69 adult patterns, 160 prevalence and time trends, 22, 54-65 defined, 90, 333 programs and policies, 43-44 measurement of, 99, 332 public awareness, 40-43 physical activity and, 92, 99 public health implications, 22-24 resting metabolism and, 92 n.6 public health precedents, 21, 44-47, Energy imbalance, 83-85, 93 Energy intake 343-371 away-from-home foods, 30, 158, 161 regional differences, 61 body weight and, 159 social and emotional consequences, 23, defined, 91, 333 by gender, 35 66-67 measurement, 332 socioeconomic difference, 60-61, 104- physiological regulation of, 289, 294 predictors of, 158-159 105 trends for children, 97 ERIC (Educational Resources Information Energy requirements for children and Center) database, 339, 340-341 adolescents, 97, 158, 167-168 Ethnic groups. See also Racial and ethnic Entertainment industry. See Leisure, disparities; Sociocultural environment entertainment, and recreation body image perceptions, 199 industries; Television viewing definitions, 58 n.4 Environmental influences. See also diabetes, 23, 68 Community environment; Home diversity trends, 26-27 environment; School environment food preferences, 27, 106 defined, 334 genetic susceptibility to obesity, 106 ecological layers, 15, 100, 101-102, 286, high-risk groups, 58-61, 68, 199-201 320 interventions targeted to, 199-201, 203, on energy balance, 100-106 genetic interactions, 93-94 257 monitoring needs, 140 media education campaigns, 182-183 obesogenic, 2, 306, 320, 336 obesity prevalence, 1, 10, 26-27, 58-61, Epidemic of childhood/adolescent obesity adult obesity epidemic and, 63-65 94, 105-106 BMI distribution, 61-62 physical activity, 29-30, 205, 257 consumer attitudes and, 40-43 and protective effects of breastfeeding in, contexts for action, 25-44 costs for children and society, 22-24, 65- 289 72 regional differences, 61 defined, 21 n.1, 55, 334 socioeconomic difference, 60-61, 106, demographic trends, 1, 25-40 eating patterns and, 27-28, 30-35 201 in ethnic groups, 1, 26-27, 58-61 targeted marketing of foods to, 106 family life and, 25-26 trust issues, 106, 200 health-care costs, 70-72 TV viewing time, 301 Evaluation of prevention interventions BMI distribution as measure of change, 88 community-based participatory studies, 17, 203-204, 217-219, 325 demonstration projects, 132, 200, 204, 208-209, 213

402 INDEX design of studies, 304 Food and beverage industry. See also funding for, 204, 215 Advertising and marketing; health impact assessment, 217-219 Restaurant industry; School food and intermediate goals and, 6, 17, 86-87, beverages 323 check-off programs, 145 natural experiments, 209 federal regulation, 361-362 pilot programs, 242, 247-248, 251, 252, liability protection, 360, 362 litigation, 362-364 274, 277 motivation for change, 154, 157, 170, pretest/posttest design, 208 prospective approach, 217-219 366 Exercise. See also Physical activity packaging, 154, 158-159, 167, 172, 356 defined, 334 portion sizes, 154, 158-159 Expanded Food and Nutrition Education positive changes, 7, 155, 156, 266-267 product development, 154, 155-157, Program, 141, 142 170 F recommendations, 8, 156, 166 sales to young consumers, 153-154, 172 Family Interaction, Social Capital and self-regulation, 175-176, 366 Trends in Time Use Data, 29, 160 targeted marketing of foods, 106, 145, Family life, trends, 25-26, 285-286 172 Farmers’ markets, 144, 216, 248 Food and Drug Administration Fast food. See also Restaurant industry nutrition labeling regulation, 9, 167- advertising and marketing, 302, 355 171, 362 consumption trends, 162, 163, 358 defined, 334 Obesity Working Group, 163 energy density, 92, 163 tobacco regulation, 353 litigation, 363-364 Food, Drug and Cosmetic Act, 361 nutrient density, 162 Food environment nutrition labeling, 356 access and opportunity, 27, 100, 101, sales, 162 Fat, dietary. See also Body fat 105, 128, 144, 215-217, 292-294, consumption trends, 30-31, 34, 245 356-358 food supply trends, 34, 366 away-from-home foods, 26, 27-28, 331 saturated, 169 built environment, 215-217 Fat-brain axis, 95 community-based interventions, 144, Federal Trade Commission, 9, 153, 174, 216-217, 218, 357-358 and eating behavior, 292-294 175, 177, 355-356 economic factors and, 100, 101, 215- Federal Transportation Enhancements 216, 358-360 healthy foods, 105, 144, 215-217 Program, 209 at home, 292-294 Feeding Infants and Toddlers Study (FITS), policy and political considerations, 100, 101, 144-146, 369 290, 291 portion sizes, 27, 358, 369 Feet First, 206 rating, 218 Finland, 196 recommendations, 217 Fish and shellfish, 32 restricting availability, 357 Fit ‘n Active Kids program, 141 sociocultural considerations, 100, 101, Fitness. See also Physical fitness 106 Food Guide Pyramid, 28, 164-165, 292, cardiorespiratory, 179-180 334 counseling, 269-270 Food insecurity, 88 n.3, 104-105, 143-144, defined, 334 147, 215 Five-a-Day media campaign, 141, 180, 244 Fluoridation campaigns, 199, 350

INDEX 403 Food insufficiency, 104-105 Georgia, 211, 250 Food Marketing Institute, 167 Germany, 44 Food security, 215, 334 Girl Scouts, 44, 198, 202 Food service workers, 134 Girls Health Enrichment Multi-site Study Food Stamp Program, 141, 142-143, 144, (GEMS), 200, 203 216 Girls on the Run, 197 Food supply, 34, 35, 145, 146 Global Strategy for Diet, Physical Activity Food system, 145, 334 Foods. See also specific food groups and Health, 367 Glucose intolerance/insulin resistance, 67, ethnic, 156 of minimal nutritional value, 241, 335 68, 69, 70 product groups with health claims, 169 Go for Health, 256 reduced-calorie products, 156 Growth charts, 89 n.4. See also Body mass as reward and, 295 4H Clubs, 202 index, charts Framework Convention on Tobacco Growth spurts, 91, 307 Guidelines for School and Community Control (FCTC), 350-351, 356, 360 France, 44 Programs to Promote Lifelong Fruits and vegetables Physical Activity Among Young People, 255 access to fresh foods, 144, 216, 242, Gun control analogies, 350, 361, 362 251 H children’s acceptance of, 291 consumption trends, 28, 32 Health costs, 216, 360 body weight and, 306-308 health benefits, 107, 169, 223 costs of obesity, 22-23, 65, 67-69, 71, promotion, 107, 141, 180, 198, 200, 73 defined, 335 223 food security and, 215 school offerings, 240, 242, 247-248, impact assessments, 217-219 population, 215, 336 251, 291 promotion, 100, 106, 128, 335, 359-360 subsidies, 360 report cards, 270-271 Funding community-based interventions, 132- Health-care professionals advocacy role, 223-225 133, 209 obesity screening and counseling by, 10, for evaluation studies, 204, 215 221-223, 272 of school meals, 250, 252 school referrals to, 272 training, 224-225 G Health-care system, 128 Gender Health education, 106 and BMI, 56-58 and body image dissatisfaction, 104 classroom requirements and practices, and energy intake, 35 261-262 and physical activity, 257-258 recommendations, 264-265 Genetics teacher training, 264, 265 and energy balance, 91, 93-95, 159 Health insurance coverage, 60-61, 225-226, environmental interactions, 93-94 and body fatness, 93 307 and body weight, 91, 93, 94 Health services. See also Community health and prevalence of obesity, 94 single-gene disorders, 94 care susceptibility to obesity, 65, 106 costs, 70-72 school-based, 269-272 Healthful diet. See Balanced diet

404 INDEX HealthStyles Survey, 38, 211 prevalence, 29-30 Healthy Days Measures, 218 safety reasons, 207 Healthy Eating Index (HEI), 96-97 technology and, 160 Healthy People 2000, 156 TV viewing and, 301-305 Healthy People 2010, 129, 194, 321 Indiana, 247 Hepatic steatosis, 67 Industry. See also Advertising and High blood pressure, 62, 69. See also marketing; Food and beverage Hypertension industry; Leisure, entertainment, and High-density lipoprotein (HDL) cholesterol, recreation industries; Restaurant industry 69 health promotion by, 128, 161, 182 High fructose corn syrup, 145-146 recommendations, 8, 165-166, 177 High-risk population subgroups, 6, 58-61, self-regulation, 175, 354 Infants 68, 134, 199-201, 322 breastfeeding, 222, 288-290 Highway safety analogies, 44-45, 126, 128, food insecurity, 105 low birthweight, 288 132, 350, 361, 366 mortality rates, 21 Hispanics. See also Ethnic groups; Racial overweight, 55, 58 n.3, 80-81 Information environment. See Advertising and ethnic disparities and marketing; Public education body image dissatisfaction, 66, 104 Injury prevention campaigns, 345, 361 energy gaps, 93 Institute of Medicine, 144, 168, 344, 360 defined, 58 n.4 Institute of Traffic Engineers, 210 diabetes, 68 Insulin levels, 62. See also Diabetes; Glucose obesity trends, 60, 105 intolerance/insulin resistance HIV prevention, 107 International dimensions of obesity, 2, 22, Home environment. See also Parents; 367, 371 International Food Information Council, Television viewing 40-41 and eating behavior, 14-15, 287-296 Intervention programs. See also electronic media, 39-40, 303 Community-based interventions family characteristics and, 25-26, 285- behavioral theory and, 345 comprehensive approaches, 46-47, 128, 287 131, 196-199, 203, 262-263, 345, food and beverage selection and 349-352 ethnic groups targeted, 199-201, 203, availability, 292-294 257 meal preparation, 26, 28 evaluation of, 133, 134, 136-137, 142, obesogenic families, 306 214-215 and physical activity, 14-15, 296-301 evidence of effectiveness, 45-46, 196- recommendations, 14-15, 290, 308-309 198, 222-223, 262-263, 348, 349- Home visits, 46, 349 352, 370-371 Hunger. See also Appetite; Satiety funding, 6, 44, 128, 131, 132-133, 142, eating in absence of, 294-296, 305 148, 359-360 in U.S., 88 industry-sponsored, 161 Hypertension, 62, 67, 225 international efforts, 44 Hypertriglyceridemia, 69 large-scale, 196-197, 217-219, 345, 347 Hypothalamic-pituitary-adrenal axis, 70 parental involvement, 287 registry of, 44 I school-based, 239, 244, 246-247 Illinois, 213 Inactivity deaths related to, 67 decreasing, 114, 301-305 defined, 336 health care costs of, 71, 73

INDEX 405 successful elements of, 46-47, 350-351 Louisiana, 61, 250 taxes on soft drinks and snack foods, Low-income populations 44, 128, 146-147 built environment, 205, 207 translation and diffusion of, 134-135 community-based interventions, 199, Intrauterine environment, 65, 95, 288 Iowa, 247 206, 217, 274 food access issues, 215-216, 217 J nutrition programs, 142-144 overweight in, 206 Joint Committee of National Health Lung cancer prevention, 107 Education Standards, 261 M Jump Up and Go Program, 225 Macronutrients. See Carbohydrates; Fat, K dietary; Protein, dietary Kaiser Family Foundation, 184, 355, 371 Marketing. See Advertising and marketing Kidney failure, 69 Maryland, 207 Kids Off the Couch, 201 Mass media Know Your Body study, 244 advertising and marketing, 8, 171-177, L 178 Labeling. See Nutrition labeling advocacy, 181, 183, 351 Laws and regulations, 357 anti-drug campaigns, 181-182 anti-tobacco campaigns, 178, 181-182, evidence of effectiveness, 46, 347, 349 Lead paint control analogies, 350, 362 347 Leisure, entertainment, and recreation dietary interventions, 180 effectiveness of campaigns, 46, 179, 347, industries, 7-8, 159-161, 166, 172, 175-176 349, 364-365 Leisure time obesity coverage, 40-41, 154, 181, 202 availability, 36, 38, 159-160 obesity epidemic, 39-40 physical activity trends, 29, 35, 36, physical fitness promotion, 179-180 37 public education campaigns, 8, 9-10, Leptin, 95 Lexis/Nexis, 339, 341 177-185, 349, 364, 371 Life expectancy, 23 public service announcements, 184 Lifestyle Education for Activity Program, Massachusetts, 225, 271 257 Meals. See also Balanced diet; Eating Lifestyle trends, 25-26, 27-39 Litigation, 128, 154, 354, 362-364 behavior Local communities. See also Community breakfast, 28 health care; Community “clean the plate” pressures, 295 interventions eating out, 26 built environment, 132, 204-217 home preparation, 26 defined, 193-194, 332 snacks, 28 food environment, 215-217 TV viewing during, 222, 293 mobilization, 43-44, 128, 194-221 Meat and poultry recommendations, 213, 217, 219-221 consumption trends, 32 stakeholders and coalitions, 128, 133, Media. See also Electronic media; Mass 194, 195, 196-204 media; Television viewing Medicaid, 61, 71 Early and Periodic Screening, Diagnostic, and Treatment program, 226 Medical Expenditure Panel Survey Household Component, 61 Medicare, 61, 71

406 INDEX Medline, 339, 341 National Institutes of Health, 358 Menstrual abnormalities, 67 Task Force on Obesity Prevention, 131, Metabolic syndrome, 69, 70 135 Metabolism. See Basal metabolism; Energy National Library of Medicine, 341 balance National Longitudinal Study of Adolescent resting, 92 n.6, 93 Metropolitan Planning Organizations, 210 Health, 60, 138 Michigan, 61, 247 National Longitudinal Survey of Youth Micronutrient deficiencies, 88 n.3 Middle-School Physical Activity and (NLSY), 60, 61, 62, 139 National Personal Transportation Surveys, Nutrition study, 257 Midwestern Prevention Project, 197 39 Military recruits, weight-for-height National School Lunch Program, 142, 143, standards, 24 145, 237 n.1, 239-241, 250 Milk and other dairy products, 31-32, 240, National Walk Our Children to School Day, 293 213 Minnesota, 104, 242-243 National Youth Anti-Drug Media Heart Health Program, 179, 180, 196, Campaign, 182 197 Native Americans. See American Indians Neighborhood associations, 210-211 Mississippi, 61, 250 Neonatal critical period, 95 Monitoring the Future Survey, 40 New Mexico, 247 Montana, 207 North Carolina, 266 North Carolina Black Churches United for N Better Health project, 199-200 National Association for Sport and Physical North Karelia Project, 179, 196-197 Education, 98, 253 Nutrient density of foods, 96, 115, 162, National Association of County and City 171, 172, 243, 335 Health Officials, 132, 218 Nutrition Academic Award Program, 225 Nutrition and Physical Activity Program to National Cancer Institute, 180, 199 National Center for Health Statistics, 54 Prevent Obesity and Other Chronic National Committee for Quality Assurance, Diseases, 204 Nutrition assistance programs, 6-7, 142- 226 144, 148 National Governors Association, 132 Nutrition education National Health and Nutrition Examination availability, 100 behavioral curricula, 262-263 Survey (NHANES), 6, 29, 36, 54, community-based interventions, 198, 55-56, 60, 61, 63, 68, 89, 137, 138, 201, 273 139, 140, 148, 157, 160 food service personnel, 134 National Health Education Standards, 261 health education curriculum, 261-262 National Health Examination Survey media campaigns, 141 (NHES), 36, 60 programs, 141-142, 148, 225 National Health Interview Survey, 29, 159- recommendations, 6, 142, 148 160, 221 by restaurant industry, 164-166 National Heart, Lung, and Blood Institute, at school, 261-263, 273 179, 225 Nutrition labeling National Highway Traffic Safety calorie content, 168 Administration, 361 comparative claims, 170-171 National Household Travel Survey (NHTS), consumer understanding and use, 167, 38, 39, 138 169-170 National Human Activity Pattern Survey, and eating behavior, 169-170 160 energy density and nutrient density, 170, 171

INDEX 407 health claims, 9, 167, 169-170, 171, 362 physical activity patterns of, 297-298, ingredient disclosure, 356 302 nutrient claims, 9, 167, 168-169, 171 Nutrition Facts Panel, 9, 158, 166-168, physician counseling for, 222 promoting healthy food choices, 14-15, 169, 171, 335 percent Daily Value, 166-167, 171 287-296 recommendation, 8-9, 171 promoting physical activity, 14-15, 299, research needs, 9, 171 restaurant foods, 163-164, 165, 168, 300-301 as role models, 183, 195, 197, 273, 286, 197, 356 serving size, 167, 168, 356 292, 298, 305-306 warnings, 353, 356 Partnership for a Walkable America, 141, Nutrition Labeling and Education Act, 166, 213 n.2 170 n.8 Partnership for the Public’s Health, 200 Nutrition standards, 44, 125, 129-130, 131, Partnership to Promote Healthy Eating and 134 Active Living, 84, 141 Pathways, 245, 246, 262-263 O Pawtucket Heart Health Program, 179, 196 Pediatric Nutrition Surveillance System Obesity. See also Childhood and adolescent obesity; Epidemic of childhood/ (PedNSS), 139 adolescent obesity; Prevalence of Pennsylvania, 207 childhood/adolescent obesity Physical activity. See also Inactivity; BMI, 22, 54-55, 63 Sedentary behavior Ohio, 67, 206, 207, 247 and academic performance, 253 Older children and youth active living, 155 n.1, 331 adults, 29, 35, 179 family decision-making responsibilities, after-school programs, 260, 272-274 304-305 age and, 98, 296-297, 302-303 benefits of, 98-99, 253, 300 fast food consumption, 163 biological correlates, 69, 296-297 healthful eating behaviors, 290-292 built environment and, 38, 125, 132, 1% or Less campaign, 180 Orthopedic problems, 67 196, 204-211 Overweight changes needed, 128, 252-263 age-specific trends, 63, 80 classroom curricula, 255, 262-263 BMI, 80, 336 community mobilization, 44, 179-180, defined, 55, 80, 336 196, 197, 201, 202, 211-215 P competitive sports, 202, 258-259, 299 counseling, 223 Parents dance classes, 257 as advocates, 300 defined, 97, 336 defined, 14 developmental correlates, 296-297 eating behavior, 305-306 economic environment and, 100, 102 involvement in interventions, 287 education programs, 141-142, 299 labor force participation, 25, 26 effectiveness of interventions, 256-258, media campaigns targeting, 179, 183 nutrition education, 142, 287, 299 262-263 obese or overweight, 64-65, 93, 104, endurance training, 256-257 199, 289 and energy balance, 92, 98-99, 102 perception of weight as health issue, 42- environmental influences, 102, 105, 257 43, 65-66, 269, 306-308 evaluation of programs and policies, 213, 260, 274-275, 364 extracurricular programs, 258-259 family-based interventions, 299-300 food intakes and, 91, 245 funding for programs, 44

408 INDEX gender differences, 257-258, 296-297 and implementation of interventions, home environment and, 14-15, 296-301 348 industry-sponsored efforts, 182 interactive effects of diet and, 92-93 and physical activity, 100, 102, 214 interventions, 136-137, 141-142, 179- public opinion and, 178-179 Portion sizes, 358, 369 180, 182, 211-215, 223, 245 age and, 165 leisure time, 36, 105, 159-160 of away-from-home foods 158 measurement of, 98-99, 205, 209 control, 165, 294-296 media campaigns, 179-180 defined, 158 n.3 outdoor play, 205, 222, 299, 300 and eating behavior, 158, 291-292, 294- parental role, 299 PE classes and recess, 35, 37, 125, 253- 296 marketing strategy, 158-159, 366 258, 259, 336 quantifying dietary intakes, 98 physical environment and, 125, 132, regulation of, 362 trends, 27, 30 196, 204-211, 299 Potatoes, 28 promoting, 44, 141-142, 148, 161, 179- Pregnancy gestational diabetes, 65, 288 180, 200-201, 222, 299 intrauterine environment, 65, 95, 288, psychosocial and behavioral correlates, 289 98-99, 297 obesity during, 65, 288, 289 public programs, 141-142 President’s Council on Physical Fitness and race/ethnicity and, 29-30, 205, 257 recommendations, 6, 259-261, 273 Sports, 141 recommended levels, 29 n.3, 98, 253 Prevalence of childhood/adolescent obesity reducing sedentary behaviors, 263-264, adult obesity and, 22, 63-65 301-305 away-from-home foods and, 26, 331 research needs, 261, 300 BMI distribution, 61-62, 73 safety issues, 205, 211, 299, 300 in ethnic groups, 1, 26-27, 58-61, 94, school-based interventions, 43, 245, 105-106 256-258, 299 food environment and, 356-357 social environment and, 297-299 high-risk population subgroups, 58-61, socioeconomic status and, 105, 201, 72-73 205, 206, 298-299 overall burden, 1-2, 55-58 surveillance, 29, 137, 140 population genetics and, 94 transportation patterns and, 37-39, 71 regional differences, 61 trends, 29, 35-39, 160 socioeconomic status and, 60-61, 104- TV viewing and, 301-305 types, 29 105 walking and biking, 37, 38-39, 92, 125, Prevention of childhood/adolescent obesity. 141, 160, 211-215, 259, 300 See also Action plan for prevention; Physical environment. See also Built Intervention programs annual report on, 130-131 environment; Food environment; behaviors targeted, 222 School food and beverages clinical screening and tracking, 221-224, and food intake, 100, 101 226 and physical activity, 100, 102 community health services, 221-225, Physical fitness, 129, 137, 140, 141, 269- 226, 348-349 270, 334, 336 congressional support, 131, 177 Planet Health, 137, 245, 246-247, 263, 264 coordinating task force, 5-6, 130-131, Policy/political environment 147 agricultural policies, 144-146 cost considerations, 100 food environment and, 100, 101, 144- current efforts, 125-126 146, 369

INDEX 409 definitions, 81-83, 337 components of, 112-113 economic benefits of, 72 cost-effectiveness analyses, 136-137 energy balance, 90-106 developing recommendations, 111-115 federal commitment to, 5, 129-131 experimental behavioral, 134, 135-136 food industry as target of, 370 falsifiability, 108 global dimension, 371 federal investment in, 135, 177 government support and funding, 5-6, framework, 136 generalizability, 107-108, 111, 260, 345, 128 guide to preventive services, 209, 348-349 346, 350, 364 individual-level approach, 86, 87, 107- incorporation into program planning 108, 109, 110, 221-223 and implementation, 136 individual responsibility vs. collective interdisciplinary and interdepartmental action, 369 collaborations, 130, 134, 135 insurance coverage, 100, 224, 225-226 literature on, 114, 339-342 intermediate goals, 86-87 phases, 108 legislation and regulations, 360-361 population-based, 110, 134 lessons learned from other initiatives, predictability, 107 public health approach, 108-110 103, 109, 125, 128, 179-183, 344- randomized controlled trials, 110, 111, 352, 369-370 longitudinal studies, 140-141, 209 114 multifactorial approaches, 16, 46-47, recommendations, 148 81-82, 83, 109, 125, 126, 128, 178, replicability, 107-108 179, 245-246, 249, 299, 322, 344, review of evidence, 107-115 349-352, 370 scientific uncertainty and, 109 national priorities, 5-7, 127, 129-131, social values and, 109-110 147-148 standard of evidence, 111, 114 population-level approach, 82, 86, 87, Project MOVE (Measurement of the Value 88-90, 107-109, 125, 199-201 primary prevention approach, 82, 107, of Exercise), 136-137 115, 337 Protein, dietary psychosocial considerations, 222 public health precedents for, 24, 44-47, consumption trends, 34 83, 107, 179-183, 321, 350-351 food supply trends, 34 public-private partnerships, 141 Provider reminder systems, 46, 347, 348, social environment and, 320, 365-367 sociocultural considerations, 100, 103, 349 106, 109-110, 369 PsychINFO database, 339, 341 stakeholders, 16, 19, 127, 320, 321, 324 Psychosocial and behavioral considerations state and local priorities, 6, 131-134, 148 depression and depressive symptoms, 66, targeted to high-risk populations, 81, 67, 69-70, 105 142 treatment distinguished from, 81-82 and dietary intake, 95-98, 105 Prevention research. See also Evaluation of in energy balance, 69-70, 95-99 prevention interventions health costs of obesity, 23, 65, 66-67, best practices and effectiveness evaluations, 97-115, 344-345, 346, 69-70, 71, 73 370-371 and physical activity, 98-99 causality and, 108-109 stigmatization of obesity, 2, 23, 103 clinical practice approach, 107-108, 109, Puberty, 297 110 Public education community-based, 134, 344-345 areas of focus, 183-184 audience exposure, 180-181 barriers to success, 180-181 complementary components, 178 dietary interventions, 180, 345 evaluation and monitoring component, 178

410 INDEX funding for, 184 school-based interventions, 347, 348, media campaigns, 9-10, 43, 128, 177- 349, 364 185, 353 social environment and, 126-127, 365- nutrition and physical activity programs, 367 141-142 state and local agencies, 133-134, 148 of parents, 179, 183 surveillance and monitoring, 137-141, recommendations, 9-10, 183-185 sensitivity in design of, 178 148 Public health. See also Prevention of taxes on food and beverages, 146-147 Public Health Foundation, 218 childhood/adolescent obesity Public interest in obesity access and opportunity issues, 356-358 and policy changes, 178-179, 365-367 achievements of 20th century, 21, 44-46, raising, 306-308 trends, 40-43, 154 346-348 triggers for, 126-127 action plan for preventions, 108-110, R 115, 127, 129 agricultural policies and, 144-146, 148 Racial and ethnic disparities. See also Ethnic community preventive services, 7, 125, groups; Sociocultural environment 200, 346, 347, 348-349 in BMI, 58-60 criteria for comparison of prior in body size dissatisfaction, 103-104 in built environment, 205 approaches, 368 community health interventions, 203 economic factors, 347, 358-360 in energy balance, 105-106 evidence-based approach, 108-110, 126 in food access, 215-216 framework for interventions, 352-367 in physical activity opportunities, 205 implications of obesity epidemic, 22-24 in prevalence of obesity, 105-106 individual and clinical efforts, 348, 365 REACH 2010 initiative, 200 information environment, 353-356 Recommendations leadership, coordination, and priority evidence-based approach to developing, setting, 7, 129-134 16, 111-115, 323 legal environment, 349, 360-361 Recreation industry. See Leisure, lessons learned, 125, 128, 179-183, 344- entertainment, and recreation 352, 369-370 industries litigation, 362-364 Recreational facilities and programs, 202, media campaigns, 179-183, 346, 347, 206, 211 Regional differences in prevalence of 349, 364-365 obesity, 61 multi-problem approaches, 126, 349- Research priorities, 16-17, 88, 177, 322- 325. See also Prevention research 352 Restaurant industry. See also Away-from- nutrition assistance programs, 142-144, home foods; Fast food advertising, 172, 175-176 148 healthier food options, 162, 163-164 nutrition education programs, 141-142 nutrition education, 164-166 oversight and enforcement role, 133-134 nutrition labeling, 163-164, 165, 168, physical activity programs, 141-142 197, 356 precedents for prevention, 21, 24, 44-47, recommendations, 8, 165-166 sales, 162 83, 125-126, 128, 179-183, 343-371 self-regulation, 175-176 prevention and treatment programs, Reyes Syndrome campaigns, 179 107-109, 364-365 product labeling, 356 recommendations, 131, 134, 135, 137, 140, 141, 142, 144, 147-148 regulatory environment, 361-362 research and evaluation, 107-109, 134- 137, 148

INDEX 411 Risk, defined, 337 recommendations, 12-14, 114-115, 259- Risk analysis, defined, 337 261, 264-265, 273, 276-278 Robert Wood Johnson Foundation, 206, reducing sedentary behaviors, 263-264 218 research needs, 261 Role models tobacco prevention policies, 358 School food and beverages health professionals as, 223 access to, 44, 252, 358 parents as, 183, 195, 197, 273, 292, advertising, 14, 176, 251, 265-269 bonus commodities, 145, 248, 250 298, 305-306 cafeteria offerings, 238-239, 240 Roper Youth Report, 173 changes needed in, 248-250, 252-263 competitive foods, 13, 241-244, 250, S 251-252, 332 Safe Routes to School programs, 213, 214 dietary intervention studies, 240-241, Safety 244-247, 252-253, 364 in built environment, 205, 207-208, 211 energy density of, 240, 243 defined, 337 energy intakes, 237 Satiety, 157, 159, 289, 294, 295 environmental interventions, 245-246 School Breakfast Program, 142, 143, 237 federal meal programs, 142, 143, 145, n.1, 239-241, 258-259 237, 239-241, 250, 337, 358, 364 School environment fresh fruits and vegetables, 217, 242, after-school and extracurricular 243, 247-248, 251, 291 programs, 200, 258-259, 260, 272- funding of meals, 250, 252, 277 274 garden programs, 217, 248 menu planning, 239-240 behavioral nutrition curricula, 262-263 nutrition guidelines, 239 changes needed in, 248-250, 252-263, nutritional quality and standards, 13, 264-265 240, 241, 243, 245, 249, 251, 277 Channel One News, 265, 266 pilot programs, 242, 247-248, 251, 252, classroom curricula, 253, 261-265 as community center, 272-274 274, 277 competitive sports, 258-259 pricing strategies, 251-252 evaluation of programs and policies, recommendations, 13-14, 114-115, 248- 260, 274-275, 277-278 250, 252-253, 276-277 fitness screening and counseling, 269- research needs, 252-253 restricting sales of, 241-242, 249, 250, 272 health education, 14, 261-262 358, 359 health services, 14, 269-272, 308, 349 revenue issues, 250-252, 358, 359 interventions, 46, 114-115, 128, 137, standards setting, 44, 125, 129-130, 141, 197, 211-215, 244-247, 256- 131, 134 258, 349 training of food service personnel, 249- location in community, 213-215 nutrition education programs, 141, 249- 250 250, 273 vending machines, 44, 114-115, 239, PE classes, 125, 336, 253-258, 259, 260, 358 241, 242, 243, 250, 251-252, 266, physical activity, 13, 14, 43, 211-215, 358, 359, 364 253-261, 262-263, 276-277, 358 School Health Index, 274-275 prevention opportunities, 12-13, 237- School Health Policies and Programs Study 238 (SHPPS), 137, 139, 242, 253, 254, rating, 218 266, 269 recess, 255, 258 School Meals Initiative for Healthy Children, 240

412 INDEX School Nutrition Dietary Assessment Study, and energy balance, 104-105, 146-147 240, 250 and healthy food access, 105, 106, 201 and intergenerational obesity, 65 Section 402 State and Community Highway and obesity prevalence, 10, 60-61, 104- Safety Grant program, 132 105 Sedentary behavior and physical activity opportunities, 105, defined, 337 electronic media and, 40 201, 205, 207 energy expenditure patterns, 160 racial/ethnic disparities, 60-61, 106, 201 health care costs, 70 Sociological Abstracts, 339, 341 reducing, 263-264 Sodas and fruit drinks bans on school sales, 242 Self-efficacy, 262 and BMI, 293-294 Self-esteem issues, 43 consumption trends, 293, 358 diet beverages, 156 race/ethnicity and, 66 energy density and nutrient density, 170 Self-help interventions, 126, 365 Serving size. See also Portion size n.7, 293 limiting consumption, 222, 242 defined, 158 n.3 marketing contracts with schools, 251, infant feeding and, 290 package size and, 167, 168, 356 266 recommended, 165 taxes on, 44, 128, 146-147, 359 Shaping America’s Youth, 44, 161 South Australian Daily Physical Activity Sleep apnea, 67, 72 Small Steps campaign, 181 Program, 256-257 Smart Growth America, 210 South Carolina, 61 Smart Growth Network, 210 Special Supplemental Nutrition Program for Smart growth principles, 209, 210 Snacks and snacking Women, Infants and Children (WIC), activities needed to burn calories in, 92 55, 65, 141, 142, 143-144, 216 energy-dense foods, 28, 92 Sports, Play and Active Recreation for Kids Social change models, 351-352 (SPARK), 247, 256 Social cognitive theory, 262, 264 Stanford Adolescent Heart Health Program, Social marketing campaign, 182-183, 184 245, 247, 263 Social movement theory, 350-351, 360 Stanford Dance for Health, 257 Social norms and values, 8, 15-16, 84-85, Stanford Five-City Project, 179-180, 196 Stanford SMART (Student Media 91-92, 100, 103, 106, 126, 286, 320, Awareness to Reduce Television), 321, 369 247, 263-264 Sociocultural environment Stanford Three Community Study, 179, 196 body image, 66, 91-92, 100, 103-104 Steps to a Healthier U.S. Initiative, 132-133, and energy balance, 84-85, 91-92, 100- 181, 204 106 Stereotyping, negative, 66 and food intake, 100, 101, 106 Stigmatization, 2, 23, 43, 66, 100, 103, and obesity, 64, 100 178, 222, 270 and physical activity, 100, 102 Stress response, 70 and prevention, 100, 103, 369, 371 Stroke, 69 prior reform movements, 45 Sudden Infant Death Syndrome, 179 stigmatization, 23, 43, 66, 100, 103 Summer Food Service Program, 142 targeting interventions to, 198, 199-201, Surveillance and monitoring. See also 203, 275 individual surveys Socioeconomic status. See also Low-income adolescent health and behavior, 60, 61, populations 62, 138, 139, 209 and BMI, 60-61 body weight, 89, 137, 140 and community interventions, 10, 203, collaborations, 137-138 205 dietary intake, 97, 137, 138

INDEX 413 energy balance, 137 Transportation funding, 140 and access to healthy foods, 216 longitudinal studies, 140-141 patterns, 37-39, 205, 211-212 needs, 140 nutrition and health, 29, 36, 54, 55-56, Transportation Alternatives, 214 Transportation Research Board, 205, 341 60, 61, 63, 68, 89, 137, 138, 139 Treatment of obesity physical activity, 29, 137, 140 public health, 137-141 prevention distinguished from, 81-82 recommendations, 6, 140-141 research approach, 108 school health policies and programs, TRIS (Transportation Research Information 137, 139 Services) database, 339, 341 time use, 60, 61, 62, 139, 159-160 21st Century Community Learning Centers transportation patterns, 38, 39, 138 Sweden, 44 program, 273 Sweeteners. See Added caloric sweeteners Twin studies, 93, 94 2 Fruit ‘n’ 5 Veg Every Day, 180 T U Task Force on Community Preventive United Kingdom, 44, 213, 214, 248 Services, 299 University of California Cooperative Taxation and pricing interventions, 44, 128, Extension, 201 146-147, 178, 358-360 U.S. Census Bureau, 105 U.S. Conference of Mayors, 132 Team Nutrition, 141 U.S. Department of Agriculture, 268, 332 Teasing, 100, 178 Television viewing Agricultural Marketing Service, 145 Cooperative Extension Service, 141 advertising, 8, 44, 172, 174, 265, 301, dietary guidelines, 96-97, 131, 164-165, 302, 355 332 bedroom sets, 39, 302, 304 dietary intake surveys, 137-138 household sets, 39 Farm Service Agency, 145 interventions to reduce, 200, 222, 247, Healthy Eating Index, 96-97 and industry, 153 263-264, 303-304 nutrition programs, 129, 141-142, 144, mealtime viewing, 222, 293, 302 and obesity prevalence, 177-178, 301- 145, 238, 239, 240, 250, 252 obesity prevention role, 13, 129, 130, 302, 303 position statements of medical 131 research on nutrition, 135 professionals, 224, 304 U.S. Department of Defense, 130, 131 recommended limits, 15, 304, 308 Fresh Produce Program, 145, 248 time management monitor, 264 U.S. Department of Education, 130, 131, time spent, 39-40, 41, 114, 160-161, 268, 273, 341 301-302 U.S. Department of Health and Human Texas, 61 Tobacco control analogies, 45, 103, 107, Services, 253, 332 collaboration with CDC, 200 126, 128, 133, 146, 154, 178, 197, dietary guidelines, 96-97, 131, 164, 332 199, 223, 350-351, 352-356, 357, funding of community-based health 360, 361, 362, 363, 364, 366, 368, 369-371 efforts, 132-133, 208 Toddlers and young children guideline development for advertising food insecurity, 105 healthful eating behaviors, 290-292 and marketing, 9, 175-176, 177 predictors of energy intake, 158-159 health and nutrition survey, 29, 36, 54, Tort reform, 363-364 55-56, 60, 61, 63, 68, 89, 137-138, 139, 140, 148

414 INDEX and industry, 153, 175-176 Walking School Bus program, 213 obesity prevention role, 129, 130, 131, Washington, 206 Weight. See Body weight 147, 204, 220-221 Well-being, defined, 65, 337 registry of research and intervention West Virginia, 61, 250 White House Office of National Drug programs, 44 Small Steps campaign, 181, 184 Control Policy, 182 U.S. Department of Housing and Urban Whites. See also Racial and ethnic Development, 130, 131 disparities U.S. Department of Justice, 354 body image dissatisfaction, 66, 104 U.S. Department of the Interior, 130, 131 defined, 58 n.4 U.S. Department of Transportation, 130, obesity prevalence, 143 World Health Organization, 290, 350, 367 131, 208, 220-221 U.S. Preventive Services Task Force Y (USPSTF), 221 YMCA, 202 Youth Media Campaign Longitudinal V Survey, 37 Vegetables. See Fruits and vegetables Youth Risk Behavior Surveillance System VERB campaign, 141, 182-183, 184 Virginia, 207 (YRBSS), 35, 137, 139, 209, 256, 258, 301 W Z Walking and biking opportunities built environment and, 207, 208, 209, Zuni Indian Tribal Organization, 247 210, 211-215