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Making Headway or Headed Nowhere?

Monday, May 19, 2008

The Institute of Medicine raised an urgent alert against childhood obesity in 2004, much like the surgeon general did against smoking in 1964. The institute demanded "immediate steps for confronting the epidemic." How are we doing? The Washington Post's Susan Levine and Lori Aratani asked experts to grade some of the results.

Federal Government

The recommendations:

* Establish an interdepartmental task force to coordinate federal actions.

* Develop nutrition standards for foods and beverages sold in schools.

* Fund state-based nutrition and physical-activity grants with strong evaluation components.

* Develop guidelines on advertising and marketing to children.

* Expand funding for prevention research, surveillance and evaluation.

Jeffrey Koplan, vice president for global health at Emory University's Woodruff Health Sciences Center, former director of the federal Centers for Disease Control and Prevention, chairman of the 2004 IOM report and, in 2006, of the IOM's Committee on Progress in Preventing Childhood Obesity:

Grade: D

"The [Bush] administration has avoided a leadership role in national prevention of childhood obesity, has not provided a consistent coordinated cross-departmental effort, has not provided substantive programmatic or research support beyond occasional rhetoric and has been surpassed in energy, creativity and leadership by state and local efforts."

Industry and Media

The recommendations:

* Develop healthier food and beverage products.

* Expand consumer nutrition information.

* Provide clear and consistent media messages.

Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest:

On products and packaging

Grade: C+

"Companies have been working to reformulate products to reduce the amount of saturated fat, trans fat, salt and added sugars. They also have produced more products in portion-controlled packaging; 92% of respondents in a survey by the Grocery Manufacturers Association have introduced or reformulated over 10,000 products and sizes offering with nutritional improvements. [But] many processed foods are still high in saturated fat, sodium and added sugars and do not contain adequate whole grains, fruits and vegetables."

On consumer nutrition information

Grade: B+ for manufacturers

"Virtually all packaged foods are required by law to provide nutrition facts labels on packages. However, this detailed nutrition information should be supplemented by simple, easy to use, front-of-package labeling, which makes it easier for people to identify healthier foods. "

Grade: D- for restaurants

"Many restaurant meals are high in calories, saturated fat and sodium. Half of chain restaurants don't provide any nutrition information to their customers. . . . The restaurant industry has been vigorously opposing state and local efforts to require calorie labeling on menus."

On media messages

Grade: C+ for food companies

"Ads and marketing aimed at children are still overwhelmingly for foods of poor nutritional quality. However, 13 major food manufacturers and restaurants have pledged to limit such marketing . . . and [to] apply those standards to television, print and radio ads, marketing in elementary schools and on the Internet, and [not] use product placement. [But such pledges] most often do not cover on-package marketing or marketing in middle and high schools. "

Grade: D- for entertainment companies

"Most entertainment companies have agreed to limit the use of their licensed characters on foods of poor nutritional quality. However, those policies do not apply to other marketing by the companies."

State and Local Governments

The recommendations:

* Expand opportunities for physical activity in the community through changes to ordinances, capital improvement programs.

* Work with communities to expand access to healthful foods.

Christine Ferguson, director of the Strategies to Overcome and Prevent Obesity Alliance, based at George Washington University:

Grade: C-

"There are four specific areas where state and local action has been insufficient to date: Establishing a definition of successful weight loss based on health outcomes; encouraging innovations in treatment; addressing and reducing the impact of stigma; and broadening obesity research."

Health Care Professionals

The recommendations:

* Routinely track body mass index in children and offer counseling and guidance.

Sandra Hassink, member of the Board of Directors of the American Academy of Pediatrics and director of the Childhood and Adolescent Weight Management Clinic at A.I. Dupont Hospital for Children in Wilmington, Del.:

Grade: A-

"A new survey of pediatricians found that 76 percent calculated their patients' BMI at least some of the time; more than half surveyed used the measurement at all or most well visits of children age 2 and older. Pediatricians routinely discuss nutrition, physical activity and screen time with patients and their families."

School Districts

The recommendations:

* Improve the nutrition in schools and school-related activities.

* Increase and improve physical activity during and after school.

* Reduce children's "screen time."

* Develop, implement and evaluate innovative pilot programs for teaching about healthful eating and physical activity.

Margo Wootan, director of nutrition policy at Center for Science in the Public Interest:

Grade: D+

"The center . . . evaluated the school nutrition policies of all 50 states and the District of Columbia. . . . Two-thirds of states have weak or no policies. No states received an A grade, though two states (Kentucky and Oregon) received an A-minus. Sixteen states received a B. Thirteen states received C's or D's. Twenty states received F's."

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