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Inertia at the Top

Federal officials defend their record, saying they have worked "resolutely and steadily" in the past eight years to combat obesity. They calculate that the Department of Health and Human Services has spent $4.5 billion on prevention, treatment and research since fiscal 2003, although programs that broadly address chronic disease are part of the total. Obesity-specific initiatives include Web-based public education campaigns, public service announcements, new dietary guidelines and, coming by late fall, first-time guidelines on physical activity.

Acting Surgeon General Steven K. Galson declared childhood obesity his main priority upon taking office last year and began traveling this spring to highlight jurisdictions that have been especially engaged. As head of an HHS council on the subject, he has received "incredible support" in focusing the department's attention, he said.

A White House spokeswoman said President Bush is equally concerned. Emily Lawrimore noted his speeches about fitness and the need for parents to be role models. He met with corporate executives last year to encourage advertising changes that would help youths make better food choices and stay active. "He thinks childhood obesity is a serious problem in our country that places a tremendous burden on American families, our economy and future generations," she said.

Yet the president has proceeded on often contradictory tracks. Although he launched an expansive HealthierUS project in 2002, he has tried to kill or cut some prominent federal efforts aimed at overweight children and teens. His 2009 budget, for example, would end a $75 million program to help schools and communities expand physical-education offerings and purchase equipment. It would maintain at current levels obesity grants to states, which have enough money to benefit just half the country.

Critics say the White House has not pushed the issue much beyond personal responsibility. They say the administration and lawmakers are not aggressively pressing for industry or food policy changes.

Only in December did the U.S. Department of Agriculture modify the Women, Infants and Children nutrition program to assist low-income families in buying fresh fruits and produce. The addition was blocked for a decade by politics and by industry sectors worried that WIC's food packages would contain less milk, eggs and cheese. Yet those traditional subsidies have helped to tip the scales. Nearly half of toddler and preschool WIC recipients are overweight or obese in some communities.

And the USDA's school breakfast and lunch program continues to sell whole milk and sweetened flavored milk. Mexico has eliminated both from its poverty programs and intends to do the same in schools.

Into the breach have stepped foundations committing hundreds of millions of dollars. State and local governments have also stepped up, passing myriad measures since 2005 to strengthen school nutrition standards and add recess and physical-education requirements. From churches and community centers to Scout troops, organizations large and small are trying to again get children moving or to teach them about better eating.

Influential groups have worked with food companies to limit marketing and availability of certain products to younger children. In the first major pact, the beverage industry acceded to removing many soft drinks from campus vending machines by the 2009-10 school year. "They understand they're under siege," said Kenneth R. Stanton, an assistant professor of finance at the University of Baltimore.

Stanton has become known for the UB Obesity Report Card, which he and colleagues first released in 2003. Few legislatures were debating anti-obesity bills then, much less enacting them. Three years later, Stanton found that more than half the states had approved panels on obesity, and a dozen had agreed to test students' height and weight to track body mass index.

But advocates say the limited power of persuasion and lesser state and local resources make forceful federal measures imperative. Jeffrey Levi urges an all-hands mobilization similar to what the government has demanded in advance of a possible flu pandemic.

"Obesity has potentially as great, if not greater, an impact on public health," said Levi, executive director of Trust for America's Health.

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