Most of the health issue that people face on a day-to-day basis do not become pandemics. But this is not the case with obesity. Over a billion people are affected by obesity worldwide (Miller, et al., 2004). The statistics are particularly discouraging for children who are obese. Children who have a body mass index (BMI) that is greater than the figures in the 85th percentile for their age and gender are considered to be obese (Miller, et al., 2004). During the past three decades, the number of children identified as obese under that standard has tripled (Miller, et al., 2004). In the United States, more than 30% of the children are overweight or obese, with BMI measurements greater than the 95th percentile (Miller, et al., 2004). The International Obesity Task Force has estimated that, across the globe, 22 million children under five years of age are obese (Miller, et al., 2004). Incredibly, in some parts of Africa, obesity has replaced malnutrition, such that, the incidence of being overweight or obese is four times that of malnutrition (Miller, et al., 2004).
White House Task Force on Childhood Obesity
Solving the problem of childhood obesity is not going to be a simple process. Obesity in our nation's children is a policy problem -- that is why I selected the national program to address childhood obesity. The White House Task Force on Childhood Obesity is a comprehensive plan that calls for action at the federal level, at the state or local level, and in the private sector. Recommendations from the work of the Task Force are categorized as follows: (1) Early Childhood; (2) Empowering Parents and Caregivers; (3) Healthier Food in Schools; (4) Access to Healthy, Affordable Food; and (5) Increasing Physical Activity ("White House," 2010).
Accomplishments in schools. Since February 2010, a number of recommendations made by the White House Task Force on Childhood Obesity have been implemented. The Healthy, Hunger-Free Kids Act was signed into law to ensure that students have access to healthier food at school and access to healthy school lunches. The current effort in this area is to increase the number of schools that meet the Healthier U.S. School Challenge, and schools across the country have signed up in an effort to increase the activity levels of students. Of the food service providers for the nation's schools, three of the largest have committed to improving the healthfulness of the food that they provide to school. Specifically, these food service providers have agree to meet the recommended levels of fat, sugar, and whole grains over a 5-year period, and to double the amount of vegetable and fruits served over a 10-year period. As a result of the efforts of a coalition of the Fruit and Vegetable Alliance, the Food, Family, and Farming Foundation, and the United Fresh Produce Association, 6,000 salad bars will be established nationwide in schools over the next three years. A unique program called Chefs Move to Schools, will pair 2,000 volunteer professional chefs with schools in order to engage entire educational communities to create school menus that are healthier and to help educate students about making healthy food choices. Assistance is coming from the private sector, as well, with companies like All-Clad that has responded to the challenge of helping schools by donating 1,000 demonstration cooking kits for chef who volunteer in the Chefs Move to Schools program.
Accomplishments with accessibility and affordability of healthy foods. The Let's Move program is working with businesses to help parents bring better food choices home to their children. Wal-Mart has established a Nutrition Charter that is designed to increase the amount of healthful and affordable foods available to the 140 million people who shop at Wal-Mart each week. Within the next five years, the Healthy Weight Commitment Foundation -- a CEO-led coalition with a mission to bring healthy foods to families -- has pledged to reduce annual calories in the national food supply by 1.5 trillion, and end childhood obesity by 2015. Over a thousand pounds of food had been produced under the White House Has a Kitchen Garden -- renewing a practice that has been dormant for decades. The program has enabled kids to gain first-hand experience in seeing how food is produced.
Accomplishments in physical activity. Let's Move has set annual goals for the number of Americans who earn the Presidential Active Lifestyle Award (PALA). Organizations like the National Football League (NFL) are working to help meet these goals by signing up thousands of kids. Disney, the National Hockey League (NHL), and Major League Baseball (MLB) are teaming up with Let's Move to spread the word about the program. Pubic service announcements (PSAs) are on national channels because of these outreach efforts, and kids are being inspired by their favorite athletes and stars to get active and play sports. Families and communities are participating in the Let's Move Outside program that encourages people to take advantage of outdoor opportunities available in every town, city, and community. In addition, mayors and community groups are working with Let's Move to ensure that kids have safe places to be active and to play by building or adopting playgrounds. Moreover, Safe Routes to School are being established in communities so that children can walk or bike to school.
Accomplishments in spreading the message. Over 500 American communities have signed up for Let's Move Cities and Towns, which brings local leaders and Let's Move together to support significant changes that will support healthful communities. New public service announcements are being released to engage parents and caregiver in the effort to increase the physical activity and to make healthier food choices. The American Beverage Association, the Grocery Manufacturers Association, and the Food Marketing Institute are working to ensure that the food and beverage packaging on shelves in stores include clear information about the calories of those items. Through the efforts of the American Academy of Pediatric and the American Academy of Family Physicians, more children are being screened for BMI during their Well Child visits. The goal of these professional organizations is for 100% of the doctors to screen for BMI and, in fact, the new Affordable Care Act will require all new health insurance plans to cover childhood obesity screening and counseling from doctors regarding obesity health issues. Faith-based community and community-based organizations are participating in Let's Move Faith and the Communities to complete 500,000 Presidential Active Lifestyle Awards, walk three million miles, and host 10,000 farmers markets or community gardens.
Rev It Up! Coalition
In contrast to the national childhood obesity task force activities, the Rev It Up! coalition program is localized to the region in and around Yakima, Washington. As a community coalition, the program is geared to provide successful strategies for the creation of partnerships among community members, agencies, and the state department of health. This broader base is intended to generate interventions that are active at all relevant levels -- policy, community, organizational, interpersonal, and individual. Astonishingly, the eastern Washington agricultural community of Yakima County was ranked as the eighth "fattest city" in the United States.
The Yakima Health District (YHD) determined to address the obesity problem and established two major goals: (1) To decrease the incidence of childhood obesity in Yakima County, and (2) to establish a community coalition of experts and key stakeholder who were equipped to focus on solutions. Federal and state grants were applied for and awarded to the community coalition. Rev It Up! was officially kicked off with an initial recruitment event in September of 2008. The Washington State Department of Health was invited to advise the coalition building and the action-planning processes of Rev It Up! A Basic Food and Nutrition Education Program (BFNEP) provided support through the Healthy Choices program for schools. Through this program, school districts were helped to review their vague strategies and to implement in compliance with Washington State Substitute Senate Bill 5436. The BFNEP grant also helped fund the Coordinated Approach to Child Health (CATCH), an after-school program that focuses on nutrition and physical activity for school aged children. In fact, CATCH addresses 4 out of the 8 school health components established by the Centers for Disease Control and Prevention: Family and community involvement, health education, nutritional services, and physical education.
Recommended Policy or Policy Change
The experiences of the Yakima community coalition provide a case study for policy change suggestions. The coalition experienced several setbacks in their overall initiative. A primary setback occurred when the resources of the public health members of the coalition were substantively taxed by an outbreak of H1N1 influenza in the community -- in effect, the action plan was put on ice. The delay caused by the influenza outbreak resulted in a loss of momentum and many community members fell away or withdrew completely from the effort. Upon reflection, the community coalition members determined that they lost potential partners during the 6-month period when they were setting up the coalition because -- they…