You don't make progress by standing on the sidelines, whimpering and complaining. You make progress by implementing ideas.
A recent study published in the journal Pediatrics suggests a startling lack of progress against childhood obesity in the United States.1 As someone who has conducted research and policy work in this area for more than 15 years, this news is distressing if not surprising. Considering the progress we have made in a number of practice, policy, and environmental domains (see the Active Living Research and Healthy Eating Research Web sites for numerous examples at https://activelivingresearch.org/ and http://healthyeatingresearch.org/), our inability to move the needle is disheartening. However, if one considers the collective portfolio of childhood obesity prevention and treatment, a few suggestions can be made as we continue to search for solutions to this (still) growing epidemic.
- We have made substantial progress in preventing obesity in school and out-of-school settings, but the home and community environments continue to thwart our best efforts. For example, the summer months continue to account for the majority of the annual increase in obesity rates in school-aged children,2 where a lack of structured days that discourage obesogenic behaviors may play a role.3 We need more research to inform programmatic efforts to prevent these increases and more opportunities for at-risk youth to spend their summers in environments that promote healthy behaviors.
- While the contributions of physical activity and healthy eating to the prevention and treatment of obesity are established, the public health community needs to broaden its approaches to include other behavioral and psychological risks for obesity. Sleep, stress, self-regulatory behaviors, and social determinants of health can be targeted for intervention just as we have targeted physical activity and healthy eating.
- A number of promising interventions and policies have been developed, but widespread adoption, implementation, and sustainment are lacking. Where we have evidence for the effectiveness of interventions, we often lack widespread adoption, implementation, and maintenance.4 Part of this can be attributed to a lack of funding or discontinuation of funding for technical assistance and provision of tangible resources, but a large component is a lack of research in the implementation and sustainability of public health initiatives. Similarly, there is a lack of adoption of evidence-based policies at the state level, which can be partially attributed to a lack of research on the effectiveness of state-level polices to change behaviors or impact obesity. Clearly, we have a great deal of work ahead of us.
Ultimately, childhood obesity is a multifaceted disease that is going to take a multifaceted approach to prevent and treat. I do not believe that I am going out on a limb when I say that there is not one single policy or program that will reverse the trends we are still observing. However, a more comprehensive and coordinated effort that includes family, community, and clinical approaches has the greatest potential to succeed in reversing the current trends in childhood obesity. As highlighted in this issue, more insight is needed into the development of obesity policies5 and infrastructure to combat obesity.6 Ultimately, the challenge moving forward is one of adoption, implementation, and sustainability in complex systems in need of synergy and cooperation.7
1. Skinner AC, Ravanbakht SN, Skelton JA, Perrin EM, Armstrong SC. Prevalence of obesity and severe obesity in US children, 1999-2016 [published online ahead of print February 26, 2018]. Pediatrics. doi: 10.1542/peds.2017-3459.
2. Baranowski T, O'Connor T, Johnston C, et al School year versus summer differences in child weight gain: a narrative review. Child Obes. 2014;10(1):18–24.
3. Brazendale K, Beets MW, Weaver RG, et al Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis. Int J Behav Nutr Phys Act. 2017;14(1):100.
4. Moore JB, Carson RL, Webster CA, et al The application of an implementation science framework to comprehensive school physical activity programs: be a champion! Front Public Health. 2018;5:354.
5. Jou J, Nanney MS, Walker E, Callanan R, Weisman S, Gollust SE. Using obesity research to shape obesity policy in Minnesota: stakeholder insights and feasibility of recommendations [published online ahead of print August 21, 2017]. J Public Health Manag Pract. 2018;24(3):195–203.
6. Xiao T, Stamatakis KA, McVay AB. Development of a survey to assess local health department organizational processes and infrastructure for supporting obesity prevention [published online ahead of print December 7, 2017]. J Public Health Manag Pract. 2018;24(3):211–214.
7. Brennan LK, Sabounchi NS, Kemner AL, Hovmand P. Systems thinking in 49 communities related to healthy eating, active living, and childhood obesity. J Public Health Manag Pract. 2015;21(suppl 3):S55–S69.