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Am Fam Physician. 2004;70(12):2377-2378

Reversing the rapid increase in obesity among children and adolescents in the United States will require a multi-pronged approach by schools, families, communities, industry, and government that would be as comprehensive and ambitious as national antismoking efforts, according to a new report from the Institute of Medicine of the National Academies. “Preventing Childhood Obesity: Health in the Balance” is available online at

The report was written by a committee of 19 experts in child health, nutrition, fitness, and public health. The report is in response to a request from the U.S. Congress for an obesity prevention plan based on sound science and the most promising approaches. While no single intervention or group acting alone can stop the epidemic of childhood obesity, the steps recommended in the report aim to increase and improve opportunities for children to engage in physical activity and eat a healthy diet.

Among specific steps recommended by the report are the following:

Schools should implement nutritional standards for all foods and beverages served on school grounds, including those from vending machines. There has been a rapid increase in the availability and marketing of foods such as vending-machine sodas and snacks, and other high-calorie, low-nutrient foods and beverages that compete with those offered through federal school-meal programs. A 2000 report from the General Accounting Office found that competitive foods were sold in 98 percent of secondary schools, 74 percent of middle schools, and 43 percent of elementary schools. While the U.S. Department of Agriculture (USDA) requires school meals to follow its Dietary Guidelines for Americans, federal restrictions on competitive foods and beverages are limited to prohibiting the sale of soft drinks and certain types of candy in cafeterias while meals are being served; 21 states, however, have imposed further restrictions.

Schools should expand opportunities for all students to engage in at least 30 minutes of moderate to vigorous physical activity each day. Schools should provide physical education classes that last 30 to 60 minutes each day. Because children have a variety of abilities and interests, schools also should expand opportunities beyond traditional physical education classes to create or enhance intramural sports, activity clubs, walking and biking to school, and other venues and programs.

School health services should measure each student’s weight, height, and body mass index (BMI) annually and provide the results to the students and families. Given that many adolescents do not get annual check-ups, this information would help families become aware of any weight concerns and track their children’s progress.

Food, beverage, and entertainment industries should voluntarily develop and implement guidelines for advertising and marketing directed at children and youth. Congress should give the Federal Trade Commission the authority to monitor compliance with the guidelines and establish external review boards to prohibit advertisements that fail to comply.

Parents must play their part as well, by providing healthy foods in the home and encouraging physical activity by limiting their children’s recreational television, video game, and computer time to less than two hours a day. Although many societal factors affect children’s eating and activity habits, parents can exert a profound influence on their children by promoting healthy foods and an active lifestyle from an early age and by serving as role models, the report says. Parents can encourage their children to develop a healthy, varied diet by introducing new foods in a persistent but noncoercive way. Repeated exposure is most critical during the early years of life, and it can take five to 10 exposures to a new food before a child will accept it. In addition, parents should consider smaller portion sizes, encourage children to stop eating when they feel full, and avoid using food as a reward.

Health insurance companies should designate childhood obesity prevention as a priority health issue and should include screening and obesity prevention services in routine clinical practice. While insurers primarily have focused on the treatment of obesity, the high cost of this treatment provides insurers with an incentive to prevent the condition.

Physicians, nurses, and other health care professionals should actively discuss their patients’ weight and BMI with parents and with the children themselves in a sensitive and age-appropriate manner. Conversations about weight at the physician’s office can be difficult because of concerns about stigmatization and reluctance to recognize a challenging problem. Health professionals’ training programs and professional organizations should require that knowledge and skills related to obesity prevention be incorporated into their curricula and examinations so that health professionals have the awareness and skills to tackle these issues.

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Copyright © 2004 by the American Academy of Family Physicians.

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