Zoning restrictions on fast-food restaurants near schools and playgrounds, community policing to improve safety around public recreational sites, requirements that publicly run after-school programs limit video game and TV time, and taxes on high-calorie, low-nutrient foods and drinks are some of the strategies local government officials can use to tackle the childhood obesity epidemic in their communities, says a new report from the Institute of Medicine and National Research Council.
The report highlights several examples of ways that officials have promoted healthier lifestyles in communities ranging from big cities to small towns. It also recommends starting points that could help officials initiate childhood obesity prevention plans tailored to their jurisdictions' resources and needs.
Local governments play a crucial role in the fight against childhood obesity by creating environments that make it either easy or hard for children to eat healthier diets and move more, said the committee of health experts that wrote the report. The staggering increase in childhood obesity and the costs associated with obesity underscore the urgency for prevention efforts at the community level. Over the past 35 years -- less than half a lifetime -- the percentage of American adolescents who are obese has tripled, rising from 5 percent to almost 18 percent. A report published in HEALTH AFFAIRS in July estimated that obesity tallied $147 billion in medical costs in 2008.
"The healthy choice must be the easy choice," said committee chair Eduardo J. Sanchez, vice president and chief medical officer, Blue Cross and Blue Shield of Texas. "Although leisure activities and food consumption are personal matters, local environments influence the choices people make. It's hard to eat fruit instead of chips or cookies when neighborhood stores carry little fresh produce, or to bike to school on busy roads with no bike lanes. Local officials can make a dent in the obesity epidemic, as demonstrated by the examples we highlighted in this report."
The report offers a list of actions that hold the greatest potential to curb obesity rates among children. Many of these steps focus on increasing access to healthy foods and opportunities for active play and exercise. They include providing incentives to lure grocery stores to underserved neighborhoods; eliminating outdoor ads for high-calorie, low-nutrient foods and drinks near schools; requiring calorie and other nutritional information on restaurant menus; implementing local "Safe Routes to School" programs; regulating minimum play space and time in child care programs; rerouting buses or developing other transportation strategies that ensure people can get to grocery stores; and using building codes to ensure facilities have working water fountains. The full list of action steps can be found in Boxes S-1 and S-2 in the report's summary chapter.
The report cites 10 examples of local efforts to promote healthy eating and physical activity. They range from a comprehensive obesity prevention initiative -- involving walking trails, a new fitness center, and breastfeeding promotion -- to a city law requiring calorie information on restaurant menus, to a fitness index that helps organizations monitor their progress in meeting dietary and fitness goals. The report highlighted efforts in Austin, Texas; Baltimore; New Orleans; New York City; Henderson, Texas; Shelby, Mont.; Somerville, Mass.; San Diego County; King County, Wash.; and the state of Michigan.
The committee recognized that every community is distinct and local leaders are in the best position to identify which strategies fit each area's resources and needs. As an initial step, local officials should consider conducting a community assessment to determine such factors as the number and location of grocery stores, fast-food restaurants, vending machines, walking and biking paths, and sidewalks as well as the location and content of food and beverage ads in public places, residents' perceptions of public safety, the quality and accessibility of sports and other activities for youth, and participation rates in federal nutrition assistance programs.
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