Reversing the rapid rise in obesity among American children and youth requires multiple interventions by schools, families, communities, industry and government. These actions will need to be as comprehensive and ambitious as national antismoking efforts, according to a report released Sept. 30 by the Institute of Medicine (IOM), an independent advisory group that develops national health policy.

The recommended steps aim to increase and improve opportunities for children to engage in physical activity and eat a healthy diet.

The IOM’s committee of 19 experts in child health, nutrition, fitness and public health developed the report in response to a request from Congress for an obesity prevention plan based on sound science and the most promising remedies.

This summary of some of the important recommendations is provided by the Medical Society of the State of New York (MSSNY), which has targeted the prevention of obesity as one of its primary health care goals.

Sharing the Responsibility

Among the specific steps recommended is a call for schools to implement nutritional standards for all food and beverages served on school grounds, including those from vending machines. The committee also recommended that schools ensure there are opportunities for all students to engage in at least 30 minutes of moderate to vigorous physical activity each day.

Even though the food and beverage industries spend $10 to $12 billion annually marketing to children and youth, and even though research suggests that the impact of long-term exposure to such advertisements may adversely affect children’s eating habits and activity levels, the committee found insufficient evidence to directly link advertising to childhood obesity and support a ban on all food and beverage advertising to children.

The report does, however, call on the food, beverage and entertainment industries to voluntarily develop and implement guidelines for advertising and marketing directly to children and youth. The IOM recommended that Congress give the Federal Trade Commission the authority to monitor compliance with such guidelines and establish external review boards to prohibit ads that fail to comply. Restaurants are encouraged to expand their offerings of nutritious food and beverages and provide calorie contents and other nutrition information.

The report states that community organizations and state and local governments can make a difference by implementing programs that promote nutrition and regular physical activity. They can support zoning ordinances and comprehensive plans to include or enhance sidewalks, bike paths, parks and playgrounds and other recreational facilities. The committee also recommended that federal programs, such as the Food Stamp Program and the Special Supplemental Nutrition Program for Women, Infants and Children, support pilot programs to increase access to nutritious foods, including fruits and vegetables.

Parents Can Have Profound Influence

Although many societal factors affect children’s eating and activity habits, parents can have a profound influence on their children from an early age by promoting healthy food and an active lifestyle and by serving as role models. Parents can encourage their children to develop a healthy, varied diet by introducing new foods into their diets. They can also encourage their children to choose healthy snacks by stocking their homes with healthy products, particularly fruits and vegetables.

Although the links between sweetened beverage consumption and obesity are not definitive, the committee recommended that children be encouraged to avoid sodas and other high-calorie, low-nutrient beverages. In addition, parents should serve small portions, encourage children to stop eating when they feel full,and avoid using food as a reward.

Caregivers can encourage children to make physical activity a regular part of their lives by engaging in active play or sports with them, providing equipment and opportunities and cheering on children’s active pursuits.

Parents should decrease their children’s inactivity by limiting recreational TV viewing and video and computer game playing to two hours a day or less. Studies have shown that the prevalence of obesity is highest among children who watch several hours of television each day or who have TV sets in their bedrooms. The committee noted that the limit applies only to recreational screen time and does not preclude the use of computers and other media for educational purposes.

Involvement of Health Professionals

The report stresses that health insurers and health plans should designate childhood obesity prevention as a priority and include screening and obesity prevention services in routine clinical practice. The high cost of obesity treatment should provide insurers with a financial incentive to prevent the condition. The IOM also recommended a policy for physicians that has already been adopted by MSSNY-to counsel parents and guardians about their children’s weight and to keep up to date on treatments for obesity.

The IOM study was sponsored by the U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion; the Centers for Disease Control and Prevention; the National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute of Child Health and Human Development; the National Heart, Lung and Blood Institute; the National Institutes of Health’s Division of Nutrition Research Coordination; and the Robert Wood Johnson Foundation.

The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. For more information about the IOM and the complete report, go to www.iom.edu.

This information is provided by the Medical Society of the State of New York. For more health-related information and referrals to physicians in your community, contact your local county medical society.