Childhood ObesityChildhood Obesity

One needs but to walk down a beach or through a mall to confirm what numerous media reports tell us: Americans are getting fatter. For those of us caring for children and adolescents, this epidemic is both obvious and alarming, as we increasingly see the direct health consequences of obesity among the youth in our care.

According to age- and sex-specific body mass index (BMI) standards, developed from national data collected from 1963 to 1994, the rates for childhood obesity have approximately tripled during the past 3 decades. In 2002, Congress directed the Centers for Disease Control and Prevention to request that the Institute of Medicine develop an action plan to prevent childhood obesity. The Institute of Medicine assembled an impressive 19-member panel of experts (including a valued colleague of mine here at Stanford), chaired by Jeffery Koplan. After six meetings, an extensive literature review, a commissioned article discussing “lessons learned” from earlier public health and social change campaigns, and, no doubt, extensive communications among the members, this impressively complete and quite readable report was published. (The article is included in the appendix.)

The book starts with a 21-page executive summary, which includes the group's 10 specific recommendations, each associated with several steps for implementation (available at http://www.nap.edu/execsumm_pdf/11015.pdf). The next three chapters provide a richly referenced introduction, summarizing the extent and consequences of childhood obesity and approaches to preventing it. Here, the pivotal aspects of energy balance (or, all too commonly, imbalance)—ingested calories (input) and physical activity (output)—are detailed. Essentially, we are taking in more calories while expending fewer through physical activity. Well-designed tables and graphs highlight and summarize important aspects of the problem and recommended actions.

The next five chapters flesh out the recommended actions in specific arenas: government, industry and the media, local communities (including the health system and the built environment), schools, and the home. Each chapter summarizes that domain's possible past contributions to the obesity epidemic, providing a well-balanced review of the data. Potential corrective actions and the data supporting them are also reviewed. Frequently, the data, although incomplete, support action (with appropriate follow-up studies). The final chapter provides a summary and, importantly, a list of immediate steps to advance the prevention of childhood obesity.

Several themes suffuse the book. First, many factors have likely contributed to the spectacularly rapid rise in childhood obesity, and, thus, the solution to the obesity epidemic will require multiple components at all levels of society. Second, society should act now, despite imperfect knowledge of how well a specific intervention will succeed. Although many of the proposed actions have substantial face validity and collateral benefits, the report appropriately advocates additional research to optimize the interventions and to monitor their effectiveness and sustainability. The authors highlight the synergies between obesity-prevention efforts directed at adults and at children. Finally, the authors recognize the potential numbing impact of a problem as great and apparently intractable as the obesity epidemic. They remind the reader at intervals that a number of public health campaigns, including reducing tobacco's impact on health and improvements in motor vehicle safety, have been reasonably successful. While the authors note the clear differences between those campaigns and the report's recommendations for obesity prevention in children, the other campaigns show that societies can change firmly entrenched customs.

Readers will probably tend to focus on those recommendations most relevant to their own concerns and will find proposals to cheer on and others, perhaps, to criticize. Overall, the panel has provided a concise and lucid review of causes and correlates of pediatric obesity and a cogent, well-thought-out set of recommendations. This book is essential reading for anyone interested in preventing childhood obesity, a considerable audience indeed.