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Fat City News

August 8, 2013

The CDC has a tidbit of good news on the obesity front. Their advance release of MMWR indicates that between 2008 and 2011, there were small but statistically significant declines in obesity among low-income preschoolers in 18 states and one territory (of the 43 states and territories examined). Obesity prevalence increased significantly in only three states and was unchanged in the rest.

The study however has limitations and there is no agreement on what has caused the decline, features that illustrate the unfortunately typical gaps in the certainty of effectiveness of actions or mixture of actions being implemented across the country.

Not a moment too soon comes the IOM report, Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress. Perfect for summer reading at the beach (only 490 pages), this document outlines the challenges and suggested solutions to the vexing problem of assessing what works and why.

With a focus on policy and environmental strategies rather than on clinical interventions for individuals, the report contends that the current collection, packaging and dissemination of evaluation data and information is often not useful in answering two high-priority questions: “What works to prevent obesity?” and “How are we doing in preventing obesity?”

The IOM report spells out the problem. Despite tracking key impact indicators, the current collective monitoring and surveillance system: (1) lacks focus on policy, environmental, and systems-level efforts important for obesity prevention for a variety of settings, and for certain populations; (2) lacks dedicated leadership for coordinating efforts; and (3) lacks resources for assessment, monitoring, surveillance, and summative evaluation and timely reporting of results. The dreaded trifecta of not enough focus, leadership, and resources (FLR).

These are important observations, not least because unpredicted and unexplained “significant declines in obesity” could, at some other time, just as easily be “significant increases in obesity.” It is right to be pleased with this recent positive news, but enthusiasm must be tempered by the uncertainties about cause or duration.

My recent eagerness to celebrate the pace of increase in life expectancy in New York City was only matched by my curiosity about what could explain it, particularly in terms of policy and city leadership. Rigorous monitoring and evaluation of what Mayor Bloomberg and Health Commissioner Thomas Farley have done for life expectancy will likely find parallels in their obesity prevention policies and programs. And from that should come lessons for mayors and health department officials elsewhere, as recommended by the IOM report.

It is clear that Bloomberg and Farley are focused on the key environments within which obesity policy strategies must be deployed:

(1) the physical activity environment, which includes the built environment as well as norms and processes that increase opportunities for, access to, and social reinforcement of physical activity;

(2) the food and beverage environment, including support for increased availability and affordability of healthful foods;

(3) the message environment that encompasses media and marketing;

(4) the healthcare and worksite environments in which promotion of healthful foods and physical activity can be supported and arranged; and

(5) the school environment as an important hub of health promotion.

It only remains for the details of their collective policies and programs to be carefully documented and evaluated before I open the champagne bottle and festoon them with honors. At least I presume that is how it’s all going to turn out.

—   Michael Lytton, AJPM Blog Editor

Further Reading in AJPM:

Elbel B, Taksler GB, Mijanovich T, Abrams CB, Dixon LB. Promotion of Healthy Eating Through Public Policy: A Controlled Experiment. Am J Prev Med 2013;45(1):49-55.

Puhl R, Luedicke J, Peterson JL. Public Reactions to Obesity-Related Health Campaigns: A Randomized Controlled Trial. Am J Prev Med 2013;45(1):36-48.

Finkelstein EA, Khavjou OA, Thompson H, et al. Obesity and Severe Obesity Forecasts Through 2030. Am J Prev Med 2012;42(6):563-70.

Matthews SA. Thinking About Place, Spatial Behavior, and Spatial Processes in Childhood Obesity. Am J Prev Med 2012;42(5):516-20.

Wall MM, Larson NI, Forsyth A, et al. Patterns of Obesogenic Neighborhood Features and Adolescent Weight: A Comparison of Statistical Approaches. Am J Prev Med 2012;42(5):e65-e75.

Barker LE, Kirtland KA, Gregg EW, Geiss LS, Thompson TJ. Geographic Distribution of Diagnosed Diabetes in the U.S. A Diabetes Belt. Am J Prev Med 2011;40(4):434-9.

Michimi A, Wimberly MC. Spatial Patterns of Obesity and Associated Risk Factors in the Conterminous U.S. Am J Prev Med 2010;39(2):e1-e12.

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