1. Obesity is a problem of epidemic proportions, and we must put adequate resources into its prevention. Over 60% of adults and approximately 30% of children in the United States are overweight or obese. Adult obesity prevalence has doubled in the last 10 years. Child obesity prevalence has tripled since 1970. Though the latest child obesity prevalence rates show signs of leveling off, and even lowering among some subgroups, they are still alarmingly high. In Chicago, the rate of childhood obesity is more than twice the national rate. The prevalence of obesity-related conditions and diseases once seen almost exclusively in adults is growing rapidly among children. Diseases such as diabetes mellitus II, hypertension, and many cancers are correlated with overweight and obesity. Obesity is also linked to mental health conditions such as depression and anxiety. With such rapid and large increases in the prevalence of childhood overweight and obesity and their correlated diseases, it is clear that prevention must remain a public health priority.
2. Childhood obesity prevention must be evidence-based. The science of obesity prevention is improving rapidly, but there is still much that is unknown. While there are evidence-based models for individual behavior change (involving counseling and education), models for effective policy and environmental change are emerging, but information about how they impact individual behavior and longer-term health outcomes is still needed. To answer these and many other questions, obesity prevention programs and policies will require rigorous evaluation. New ways of thinking about “evidence” in these arenas are also needed – the standard scientific method has thus far been ineffective at evaluating change strategies at these broader levels. Potential impact, feasibility, sustainability, effects on equity, potential negative consequences, and acceptability to stakeholders are factors that we use when considering policy approaches.
3. Childhood obesity must be addressed at multiple levels—the individual, the family, peers, the community, and society. Prevention efforts focused on any one of these levels will fail to produce sustainable outcomes without simultaneous, complementary, and supporting work at other levels. This means, for example, that it is not possible to prevent or treat obesity in one child without addressing family norms and resources, community-level access to healthy food, and safe places for physical activity (indoor and outdoor), or the policies and practices of institutions where children live, learn, and play. Broader social factors that are shaped by decisions at the federal level (e.g., agriculture and transportation policy, reimbursement and nutrition standards for school lunch, the scope and content of public food assistance programs) or reimbursement rates for doctor visits to address healthy lifestyle and nutrition all contribute to population-level obesity rates and often combine to influence the health and well-being of one child. Because very few, if any, organizations have expertise at all of these levels, the consortium approach is ideally suited to address such a complex public health problem.
4. Childhood obesity prevention approaches must be community-driven. Minority and low income adults and children have disproportionately high obesity prevalence rates. Among children, Hispanic males and African American females have the highest obesity rates. The disparity indicates a need for childhood obesity prevention programs that are culturally appropriate for these most severely impacted populations. Community-driven approaches have been demonstrated to be effective in reducing health disparities, in part because of their focus on specific local contexts that can influence health behaviors. Such local context factors matter when developing intervention approaches. For example, minority populations in Chicago are less likely to have access to full-service grocery stores within easy traveling distance from residents’ homes. Consequently, an intervention focused solely on nutrition education is unlikely to address the full range of barriers to fruit and vegetable consumption in this area. In other community areas, safety from crime and traffic may be issues that need to be taken into account when planning or advocating for outdoor physical activity programs or promotion. We recognize that the causes of obesity are complex and involve a complicated interplay of factors at multiple levels including individual, social (family and community), environmental, and policy. Each of these factors differs from community to community. As such, we are committed to an approach that works with communities to identify and address locally specific factors at multiple levels to successfully confront the obesity epidemic in Chicago.
5. Any organizational approach to childhood obesity prevention must prioritize policy, systems, and environmental change initiatives to ensure long-term sustainability of these efforts. There is evidence that environmental factors contribute to rising obesity rates, and thus, policy, systems, and other strategies to modify environmental settings of children must be implemented to maximize our obesity prevention efforts and sustain this work beyond our organization’s and our partners’ current efforts. We are committed to evidence-based approaches to childhood obesity prevention. However, we recognize that operationalizing evidence-based policy interventions requires a broader interpretation of this term than used in the traditional clinical sense for maximum effectiveness.
6. Research findings indicate that multiple risk factors operate early in life—from pre-conception through 5 years of age—that place children at increased risk for obesity. Prevention is needed to reduce maternal weight gain before and during pregnancy; reduce maternal smoking in pregnancy; promote breastfeeding, healthy eating, and growth patterns, and plenty of sleep in infancy; and foster healthy eating, ample activity, and well-placed growth through the preschool years. Hospitals, primary care practices, and child care settings are places where policies and systems can and should support breastfeeding, healthy eating, adequate sleep, ample physical activity, and healthy growth for infants and young children, and tobacco avoidance for parents and caregivers.
7. Chicago is an ideal community in which to promote and study childhood obesity prevention. Available data indicate that Chicago children exceed the national average for obesity prevalence. While we have seen a slight but significant reduction in obesity rates among the youngest children in Chicago, tens of thousands are affected by this condition. The city’s size and infrastructure, its dynamic and diverse communities, and an active obesity prevention coalition make the work going on in Chicago nationally significant. Models developed here can be and have been replicated in communities across the country and around the world. Local work is very important but needs to align with a national movement because the problem of obesity goes beyond any one community, city, or state. Only a coordinated nationwide effort will succeed in decisively combating the childhood obesity epidemic.