Preventing Overweight and Obesity - Prevention Efforts Target Families, Communities, And Schools, Is Nutrition Education Working To Improve Americans' Diets?

As a society, we can no longer afford to make poor health choices such as being physically inactive and eating an unhealthy diet; these choices have led to a tremendous obesity epidemic. As policy makers and health professionals, we must embrace small steps toward coordinated policy and environmental changes that will help Americans live longer, better, healthier lives.

—Richard H. Carmona, U.S. Surgeon General, Physical Activity and Good Nutrition: Essential Elements to Prevent Chronic Diseases and Obesity at a Glance 2005 (Atlanta, GA: Centers for Disease Control and Prevention, 2005)

Many obesity researchers and health professionals believe that the most effective way to win the war on obesity is to intensify efforts to prevent overweight and obesity among children, adolescents, and adults. They assert that over time, prevention is far more cost effective than the expenditures associated with weight-loss efforts and medical treatment of obesity-related diseases. They also observe that prevention is a preferable strategy since to date no universally effective long-term treatment consistently produces and maintains weight loss.

The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity (Rockville, MD: U.S. Department of Health and Human Services, 2001) called for design and implementation of interventions to prevent and decrease overweight and obesity, both individually and collectively. It asserted that effective actions must occur at many levels and acknowledged that while individual behavioral change is at the core of all strategies to reduce overweight and obesity, to be optimally effective, efforts must not be limited to individual behavioral change.

The report recommended actions to modify group influences by initiating prevention programs targeting families, communities, employers and workers, the health-care delivery system, and the media, as well as changes in public policy. Further, the report called for concerted efforts and predicted that actions to prevent and reduce overweight and obesity would fail unless changes were made at every level of American society. Characterizing these problems as societal rather than individual, the Call to Action observed that individual behavioral change is possible only in "a supportive environment with accessible and affordable healthy food choices and opportunities for regular physical activity." The report also warned that actions aimed exclusively at individual behavioral change, that did not consider social, cultural, economic, and environmental influences, would be counterproductive, serving only to reinforce negative stereotypes, bias, and stigmatization of people who are overweight or obese.

The Call to Action promised to abide by five overarching principles to guide its recommendations about how to prevent and decrease overweight and obesity. These included:

• Promoting recognition of overweight and obesity as major public health problems
• Assisting Americans to balance healthful eating with regular physical activity to achieve and maintain a healthy body weight
• Identifying effective and culturally appropriate interventions to prevent and treat overweight and obesity
• Encouraging environmental changes to help prevent overweight and obesity
• Developing and enhancing public-private partnerships to realize important public health goals

Many public health professionals believe that environmental change and policy interventions are the most promising strategies for generating and maintaining healthy nutrition and physical activity behaviors at a population level. Environmental interventions are those actions that modify availability of, access to, pricing of, or education about, foods at the places where they are purchased. Policy interventions legislate, regulate, or, through formal or informal rules, serve to guide individual and collective behavior. Examples of environmental and policy initiatives that have met with success include:

• Increasing availability of fruits and vegetables at school and workplace cafeterias, and the addition of fresh fruit to refrigerated vending machines
• Replacing soft drinks in school vending machines with fruit juices and water
• Instituting daily physical education requirements for students
• Providing point-of-purchase nutrition information at restaurants and grocery stores to encourage healthy food choices
• Allowing workers adequate break time and a location where nursing mothers can express milk so their babies can continue to accrue the health benefits of breastfeeding even after their mothers return to work