Detailed ACTION Plan: Recommendations for Action by Families Schools, Communities and Policy Makers

Five projected intervention outcomes

  • Goal #1: Increase daily physical activity among children and adolescents.
  • Goal #2: Reduce the amount of time kids spend watching television, video games, and the Internet.
  • Goal #3: Decrease the consumption of energy-dense, high-sugar/high-fat foods like soda, ice cream, junk food, and fast food.
  • Goal #4: Increase the consumption of nutritious foods like fruits, vegetables, whole grains, and skim milk.
  • Goal #5: Create social, monetary, and policy-driven incentives that reinforce long-term environmental and behavioral change.

Goal #1: Increase daily physical activity among children and adolescents. Actively promote and protect regular activity at home, at school, and in the community.

• Increase the frequency and effectiveness of school physical education (PE) classes. Introduce kids to the joy of physical activity; teach them about the importance of exercise to health: and equip them with the skills necessary to maintain health and fitness for life. (Enhance : environment, knowledge, attitudes, behavior)

School activity programs

  • Increase active participation in PE classes by targeting students' unique interests, skills and needs. Design lesson plans sensitive to specific ages, genders, ethnicities, and cultures, and have every student set personal, attainable goals, which can be used to chart progress, build commitment, and boost confidence. Help adolescents develop personal fitness programs they can stick to during after-school hours.
  • Avoid intimidating or marginalizing students who are unskilled in a sport, afraid of competition, or self-conscious about their athletic abilities. Expose kids to a diverse mix of physical activity approaches, including team-oriented challenges, individual fitness activities, un/structured games, sports competitions, performance, and play.
  • Limit class size to facilitate teacher-student interactions.
  • Improve access to, and quality of, school PE facilities , including fields, courts, tracks, pools, gymnasiums, and exercise/weight rooms. If applicable, extend hours of operation, renovate old facilities, and purchase new technology/equipment for students.
  • Supplement PE with a strong health education program that teaches kids about their bodies and the connection between exercise, body, mind, and health. Integrate lessons about physical activity into traditional school subjects, such as math, science, biology, history, and language arts. Most importantly, help teachers help kids understand the mind-body connection: Move your body, move your mind.

School activity policy

  • Adopt a comprehensive K-12 PE curriculum that fulfills National Association for Sports and Physical Education (NASPE) standards and builds upon cumulative student learning from early childhood into early adulthood.
  • Work with students, parents, caregivers, and PE teachers to evaluate and improve the PE curriculum and keep lessons exciting and in tune with the rapidly changing culture of children, “tweens” (aged 9-13), and teenagers.
  • Allot adequate time in the school day for lunchtime and recess .

National/state/local education policy

  • Mandate daily PE classes for all students in grades K-12.
  • Strengthen PE programs by improving teacher training and hence teacher qualifications. In particular, equip instructors with the knowledge and awareness they need to help kids build self-confidence and self-esteem, in addition to lifelong physical activity skills.
  • Foster communication and sharing of methods and results among different school communities, districts, and states – organize conferences, forums, and online discussions.

• Integrate physical activity into family and community recreation – help community members to be more active by improving access to, and quality of, recreational facilities and programs. (Enhance : environment, behavior)

Family activity practices

  • Provide children with plenty of fun and safe opportunities for physical activity –particularly after school, on the weekends, and during vacation periods. Spend quality family time away from the TV , walking, jogging, bicycling, dancing, playing catch, doing yard work, or taking a trip to the local playground.
  • Steer kids toward structured fitness activities geared toward either individuals (e.g. dance, swimming, skating, martial arts, gymnastics, aerobics, tennis) or groups and teams (e.g., basketball, soccer, football, field hockey, lacrosse, water polo, baseball, volleyball). Whenever possible, support your children's efforts and encourage whole-family participation in community and school programs.

School activity programs

  • Keep school gymnasiums and other facilities open and accessible to the community, particularly during the late-afternoon/early-evening hours, when kids who are home alone are most likely to take part in juvenile crime, violence, and drug abuse.
  • Provide “active” weekend and after-school programs such as: dance classes, aerobics, kickboxing, nature/hiking clubs, biking clubs, and traditional team and intramural sports.
  • Enlist both professional expertise and volunteer support – particularly from high school and college students and other interested community members – to run programs, market “coolness”, and maximize youth participation.

School activity policy

  • Work with kids, parents, and schoolteachers to design popular after-school programs.
  • Provide the staff necessary to extend school facility hours and open up gyms, courts, and fields to the outside community. Allocate adequate funding for extracurricular activities by soliciting financial support from local health departments, community centers, and school fundraisers.

Local public safety practices/policy

  • Provide the funding and manpower needed to keep local parks, fields, courts, nature trails, and pools clean, safe, and well staffed.

Local health/childcare practices

  • In the daycare environment, introduce young children to a variety of fitness activities, including tag, hide-and-seek, and relay races. Also, provide opportunities for unstructured play and nurture children's creativity.

Local recreation programs/policy

  • Improve ease of use and access to physical activity facilities, such as parks, fields, community gyms, and swimming pools. Reduce entrance fees, add new equipment (balls, rackets, bats) and exercise/weight machines, target outreach/publicity efforts to families, and keep areas safe for all children and families.
  • Provide “active” weekend and after-school programs such as family fitness classes, town sports leagues, neighborhood or community-wide tournaments, parades, county fairs, and town-wide dance nights. Work with local officials to procure space in town halls, gyms, and community centers. Enroll community volunteers to help teach or run classes and programs.

• Change local transportation patterns by improving roads, sidewalks, and bike lanes, and simultaneously encouraging more people to make more trips via foot, bicycle, or skates. (Enhance : environment, behavior)

Family activity practices

  • Set a good example for your children and families: set aside several days a week to walk to work or the grocery store – and consciously set aside time to walk with your kids to school, or the bus stop, or the local community center.

Local public transport programs/policy

  • Remove local barriers to bicycling, such as a lack of bike trails, a lack of connections across roads and highway bridges, and a lack of places to store bikes safely. Repave sidewalks and roads, and (space-permitting) include new, well-marked lanes for bicyclists and skaters.
  • Particularly in urban areas, clean up and renovate mass transit systems to increase daily walking and decrease the number of people relying on cars/trucks for transportation.
  • Design and implement “walking school bus” programs. Help families and neighborhoods coordinate the daily trip to school on foot, and encourage parents and children to walk together to school in the morning. Possible incentives include class recognition, extra break time, free materials (e.g. t-shirts), student/parent awards, and monetary incentives.

Local public safety programs

  • Remove barriers to active transportation by addressing the safety concerns of potential walkers and bicyclists, i.e., crime, traffic, and poor lighting at night. Improve the marking of crosswalks and bike lanes, design longer walk signals at intersections, and enhance street lighting for nighttime travel.

Local health/childcare practices

  • Teach patients (kids) about the joys and health benefits of active transportation. Provide specific examples of where and when this is possible – e.g., walking to school, riding your bike to a friend's house, or jogging to a nearby store – and help kids map out their own active transport plans.

National/state transport programs/policy

  • Advocate for and allocate more funds for road, sidewalk, and bicycle lane maintenance.
  • Advocate for and allocate more funding of mass transit systems. Make public transportation more convenient and reliable, and ultimately get more commuters walking to/from work, instead of driving.

National/state urbanization practices/policy

  • Change zoning laws and land use requirements to include: safe pedestrian access to schools and shopping centers, adequate construction of sidewalks and bicycle lanes, and the reservation of certain downtown spots as automobile-free pedestrian areas.

• Use a mass media/public education campaign to teach children, families, and communities about the importance of physical activity to obesity prevention and overall protection against disease and early death. Utilize social marketing techniques to “sell” physical activity and ultimately get kids and their families moving . Most importantly, help kids understand the mind-body connection: Move your body, move your mind . (Enhance: knowledge, attitudes, behavior)

Family activity practices

  • Educate your children about the benefits of physical activity by becoming positive role models and incorporating regular exercise into your own daily routine.

Local health/childcare practices

  • Educate patients and childcare recipients about the benefits of physical activity by becoming positive role models and incorporating regular exercise into your own daily routine.
  • Tell kids to start off small so that they won't get discouraged. Have children choose an activity that they enjoy and then gradually increase the frequency and duration of that activity, until it becomes a routine form of exercise. Help kids view physical activity as a fun way to spend time, instead of a tedious chore.

Local public transport programs

  • Work with community groups and health officials to distribute free pedometers to local families, in an effort to spark interest and increase daily walking.
  • Place point-of-decision signs near elevators, escalators, and stairs, informing people about the health benefits of physical activity and stair usage. Simultaneously, work with local architecture and construction firms to design buildings with more accessible, inviting, and better-lit stairwells.

Local recreation programs

  • Raise community consciousness about health promotion, physical activity, and obesity prevention. Broadcast messages via local media – e.g., fliers, brochures, posters, signs, and outdoor tables – distributed in prominent community locations like town centers, grocery stores, shopping malls, food courts, and schools. Combine general campaigns with targeted outreach to kids, healthcare providers, teachers, families, and populations at high risk for obesity.

National/state health programs

  • Collaborate with the media and advertising industry and utilize best practices to promote physical activity among the nation's youth. Expose kids and families to simple but catchy messages and images, distributed through a variety of media, including television, radio, websites, billboards, movie trailers, professional sporting events, and magazines.

Goal #2: Reduce the amount of time kids spend watching television, video games, and the Internet.

• Educate youths about the risks associated with excess TV consumption and sedentary lifestyle. Integrate lessons about mass media, pop culture, and physical inactivity into the traditional school curriculum, and actively involve parents in school-based TV reduction initiatives. (Enhance: knowledge, attitudes, behavior)

School activity programs

  • Assign projects centered around limiting television use – have students brainstorm why and how they should cut down on viewing hours, and require students to keep a daily journal monitoring how much TV they watched and what they saw (e.g., shows, movies, cartoons, commercials).
  • Integrate lessons about TV into the health education curricula. Inform kids about the dangers of a sedentary lifestyle, and teach interactive classes about creativity, mixed media messages (particularly concerning food choice and body image), and other dangers of excessive TV consumption. Invite and actively involve parents in the planning and implementation processes.

Local health/childcare practices

  • During yearly check-ups, occasional visits to the nurse's office, or regular afternoons in the daycare center, routinely encourage children to limit TV-watching, and explain to them the connection between TV, sedentary lifestyle, poor health, and a tired body and mind.

• Offer kids exciting or entertaining alternatives to television and video games – improve opportunities for, and participation in, active pastimes like sports, dance, shopping, jump roping, bicycling, performance arts, nature-walks, and unstructured play. Increase the safety, accessibility, and attractiveness of playgrounds and parks – and look into novel uses of technology (e.g. interactive video games and fitness machines) that would interest older adolescents and teens. (Enhance: attitudes, behavior)

Family activity practices

  • Provide alternatives to television and video games, but do not force your children to participate in activities. Instead, offer incentives and let kids choose the activity that they are most passionate about.

School activity programs

  • Through innovative PE and after-school programs, introduce kids to new ways of having fun .

Local recreation programs

  • Through innovative community programs, introduce kids to new ways of having fun .

National/state education policy

  • Mandate that all schools allow sufficient time for a daily break or recess , during which time students can and should move around, play, stretch, or otherwise exercise their bodies and minds.

• Recommend that children and adolescents limit TV-viewing time to <2 hours per day, and promote a periodic “TV-Free Week” to shake community members out of sedentary habits and unhealthy routines. (Enhance: attitudes, behavior)

Family leisure activity practices

  • Educate your children about the hazards of sedentary lives by becoming a positive role model and limiting your own hours in front of the television screen. Also, explain why it is important to kids' health and well-being that they spend less time sitting and more time moving, reading, talking, and playing.
  • Limit kids' TV viewing hours and encourage regular television-free days. If possible, restrict TV/video game usage by keeping televisions outside the bedroom.

Local healthcare practices

  • During yearly check-ups, occasional visits to the nurse's office, or regular afternoons in the daycare center, routinely encourage all children to limit TV-watching to a couple hours a day, regardless of their weight status. Also ask young patients about their leisure time activities, and suggest “cool” alternatives to television, Internet, and video games.

National/state health/media programs

  • Launch a public education campaign to warn people about sedentary lifestyles and motivate them to turn off their television sets and get active. Coordinate efforts with local health departments, community centers, and schools to sponsor a periodic National TV-Free Day (or week). Ultimately, raise community consciousness and give people a “break” from their almost uninterrupted exposure to television.

Goal #3: Decrease the consumption of energy-dense, high-sugar/high-fat foods like soda, ice cream, junk food, and fast food.

• Restrict children's access to energy-dense, nutrient-lacking foods at home, at school, and in the community. (Enhance: environment)

Family food practices

  • Limit purchasing of unhealthy snacks, cereals, soft drinks, and ready-to-eat meals.
  • During food preparation, reduce the amount of fat, butter, oil, sugar, or salt added to meals.
  • Refrain from using food to reward or punish children.

School food practices

  • Provide rigorous training for school chefs and food services staff, particularly in the areas of nutrition, taste, and presentation. Help cooks change the image of school cafeteria food into a more positive, tasty, healthy, and attractive meal choice.
  • During food preparation, r educe the amount of fat, butter, oil, sugar, or salt added to school meals.

School food policy

  • Either raise prices or ban the sale of non-nutritious foods and beverages, such as chips, candy, ice cream, and soft drinks.
  • Replace junk food snacks with healthy alternatives in school vending machines.
  • Mandate that all school food options – both a la carte foods and National School Breakfast/Lunch Program meals – follow national nutrition guidelines . Work with government and health officials to design methods of enforcement and evaluation.

Local restaurant/manufactured food practices/policy

  • Arrange grocery and convenience stores differently so that candy and soda stands are not located in doorways, point-of-decision places, or high-traffic checkout areas.

National/state food/nutrition policy

  • Legislate tighter regulations on food production , and enforce healthier methods of food preparation in chain restaurants, manufacturing plants, and food vendors.

• Reduce portion sizes for both home-cooked meals and away-from-home food sources, such as fast food meals, vending machine snacks, and prepackaged lunches and frozen dinners. (Enhance: environment, behavior)

Family food practices

  • Educate your children about the differences between portion size and serving size, and set a good example for kids and teens – be careful not to overeat at home or in a restaurant.

School food practices/policy

  • Slim down the portion sizes of school meals and high-fat/high-sugar vending machine and a la carte foods.
  • Utilize health and nutrition classes to teach students about portion size, serving size, and the calorie balance.

Local health/childcare

  • Explain to parents and children the connection between portion size, food consumption, and weight gain . Emphasize that most people will finish eating the food they see in front of them, regardless of how hungry or full they are.

Local restaurant/manufactured food practices/policy

  • Slim down the portion sizes in restaurant meals and prepackaged foods.
  • Modify food/menu labels , so that consumers (especially young consumers) can see and understand the differences between portion size and serving size.

National/state food/nutrition policy

  • Legislate tighter regulations on manufactured food labeling : make serving/portion size disparities more visible on prepackaged meals, snack packs, and beverage bottles and cans.

• Place stricter regulations on direct-to-child advertising , particularly with respect to fast food/junk food commercials that air on television during peak child-viewing hours (e.g. weekday afternoons and Saturday mornings). (Enhance: environment, knowledge, attitudes)

Family education practices

  • Monitor the shows and commercials your kids are viewing, and discuss with children and adolescents the difference between reality and what they see on TV. Explain the motives that drive advertising , and help kids understand that “TV truths” are not always the entire truth.

School food programs/policy

  • Design interactive lessons that increase students' awareness of food advertising gimmicks. Have students create and “market” their own products, and then discuss the methods they used or saw on television, e.g., exaggeration, bending of the truth, exclusion of details, and implied association with other products, qualities, ideas, people, or things.
  • Ban all unhealthy advertising in schools . In particular, prohibit Channel One advertising and any exclusive pouring/serving contracts made with soda, candy, or fast food companies.

Local manufactured food/restaurant policy

  • Require chain restaurants and food vendors to post nutritional information on their menus , and reduce the deceptive nature of visual food advertisements.

National/state media policy

  • Collaborate with the Federal Communications Commission (FCC) and Children's Advertising Review Unit (CARU) to strengthen regulation of direct-to-child advertising .

• Strengthen school health education and nutrition programs so that students truly understand the health hazards of over-eating and excess consumption of fats, oils and sweets. Teach kids about the USDA dietary recommendations, and equip youths with the skills necessary to maintain healthy eating habits for life. Most importantly, help kids understand the mind-body connection: Eat right, Feel great. (Enhance: knowledge, attitudes, behavior)

School food practices/policy

Work with health and science teachers, health professionals, students, parents, counselors, and school board members to design a comprehensive curriculum that exposes students to the basics of eating right – i.e., important nutrients, portion sizes, human biology, the Food Guide Pyramid, national guidelines, and particularly the dangers of eating poorly.

  • Implement a cumulative curriculum so that students can build on the knowledge they learned previously and integrate lessons into other school subjects.
  • Develop exciting and interactive lessons that include demonstrations, videos, guest speakers, and 3-dimensional models of food science concepts.

National/state education policy

  • Require that all students take at least 1 year of health and nutrition classes at each level of schooling (elementary, middle, and high school).
  • Strengthen health education programs by improving teacher training and hence teacher qualifications. In particular, equip instructors with the knowledge and awareness they need to help kids build self-confidence and self-esteem, in addition to lifelong healthy eating skills.
  • Foster communication and sharing of methods and results among different school communities, districts, and states – organize conferences, forums, and online discussions.

• Use a mass media/public education campaign to teach children, families, and communities about the dangers of eating too many fats, oils, and sweets – e.g., rising healthcare costs, increased risk of obesity, heart disease, stroke, cancer, and diabetes, and the possibility of premature death. Utilize social marketing techniques to “sell” healthy eating habits and ultimately get kids and their families to cut down on fatty foods and sugary snacks. (Enhance: knowledge, attitudes)

Family food practices

  • Talk to your children about how too many burgers and fries can clog your arteries and harm your heart, and become a good role model by limiting your own consumption of soda, fast food, and candy.

School food programs/policy

  • Place point-of-decision signs near food stands, cafeteria lines, and vending machines, informing people about the health dangers of fatty and sugary foods (or, conversely, the health benefits of fruits and vegetables). Involve students in the design and production of these signs, and work with local businesses and buildings to post signs around the community.

Local health/childcare programs

  • Distribute to patients an easy-to-read, visually attractive pamphlet describing the negative health effects of excess fat/sugar/oil consumption.
  • Work with schools, restaurants, and community centers to raise community consciousness about health promotion, healthy eating, and obesity prevention. Broadcast messages via local media – e.g., fliers, brochures, posters, signs, and outdoor tables – distributed in prominent community locations like town centers, grocery stores, shopping malls, food courts, and schools. Combine general campaigns with targeted outreach to kids, healthcare providers, teachers, families, and populations at high risk for obesity.

Local restaurant/manufactured food practices

  • Place point-of-decision prompts and informational posters and billboards around grocery stores, food courts, cafeterias, community centers, and movie theaters. Emphasize moderate consumption of junk/fast food, and inform people about the health dangers of eating/drinking too much fat and sugar.
  • Require chain restaurants and food vendors to post nutritional information on their menus , including calories, fat/sugar/nutrient content, and health indicators like “heart-healthy."

National/state health programs

  • Cooperate with health organizations and the food and advertising industries to launch a public education campaign that will improve eating habits among the nation's youth. Expose kids and families to simple but catchy messages and images distributed through a variety of media, including television, radio, websites, billboards, movie trailers, professional sporting events, and magazines. In general, encourage moderate over excessive consumption, and emphasize healthy choices over restrictive dieting.

Goal #4: Increase the consumption of nutritious foods like fruits, vegetables, whole grains, and skim milk.

• Improve children's access to nutritious foods at home, at school, and in the community. (Enhance: environment)

Family food practices

  • Offer children a healthy variety of food options – choose what foods are purchased and available in the home, but let children make the final decision on which fruits, vegetables, and grains they want to eat.
  • If you are a new mother, breastfeed your child in order to increase his/her acceptance of fruits and vegetables, and later protect against overweight and obesity. Consult healthcare providers with questions.

School food practices/policy

  • Stock school vending machines with healthy foods like fruits, vegetables, whole-wheat crackers, granola bars, and dried fruits and nuts, as well as healthy beverages like water, skim milk, and 100% fruit juice.
  • Improve the attractiveness and accessibility of healthy food options in school cafeterias and a la carte programs: lower prices, offer fresher produce, and prepare and advertise healthier meals that cover all the five major food groups.
  • Work with grant programs like the USDA Fruit and Vegetable Pilot Program (FVPP) to offer students free fruit and veggie snacks during class, in vending machines, and as part of school meals.

Local restaurant/manufactured food practices

  • Offer cheaper and more attractive versions of healthy food options in restaurants and convenience stores.
  • Arrange grocery and convenience stores differently so that stands with whole grain snacks/fruits/vegetables, or coolers with water, skim milk, and 100% fruit juice, are located in prominent places, such as doorways, point-of-decision places, and high-traffic checkout areas.

Local agriculture/market programs/policy

  • Coordinate efforts between local farmers and school officials to plan and implement “ farm-to-school ” food supply programs, in which farmers supply fresh produce directly to local schools – model preliminary planning meetings on recommendations from the USDA Small Farms/School Meals Initiative.

National/state food/nutrition programs/policy

  • Authorize and allocate more funds for healthy school meal programs , such as the USDA National School Lunch Program, School Breakfast Program, Special Milk Program, Summer Food Service Program, Child and Adult Care Food Program, Fruit and Vegetable Pilot Program, and Small Farms/School Meals Initiatives.
  • Strengthen nutrition guidelines for food stamp and other federal/state/local food assistance programs – increase access to healthy foods like whole grains, fruits and vegetables, and skim milk.
  • Advocate for and allocate increased funding for programs, such as the U.S. Department of Agriculture WIC Farmer's Market Nutrition Program, which increase low-income families' access to fresh produce via local farmer's markets . Likewise, provide additional funds to support local produce stands and markets.

• Strengthen school health education and nutrition programs so that students truly understand the science behind the healthy and tasty value of fruits, vegetables, grains, and milk. Teach kids about the USDA dietary recommendations, and equip youths with the skills necessary to maintain healthy eating habits for life. Most importantly, help kids understand the mind-body connection: Eat right, Feel great. (Enhance: knowledge, attitudes, behavior)

School food practices/policy

  • Work with health and science teachers, health professionals, students, parents, counselors, and school board members to design a comprehensive curriculum that exposes students to the basics of eating right – i.e., nutrients, portion sizes, human biology, the Food Guide Pyramid, national guidelines, and particularly the importance of eating essential vitamins, minerals, and nutrients from fruits, vegetables, whole grains, and milk.
  • Design effective lessons to help children, adolescents, and teens understand – from firsthand experience – how a healthy diet can get them energized in the morning, help them concentrate, and make their minds and bodies feel great .
  • Implement a cumulative curriculum so that students can build on the knowledge they learned previously and integrate lessons into other school subjects.
  • Develop exciting and interactive lessons that include demonstrations, videos, guest speakers, and 3-dimensional models of food science concepts.

National/state education policy

  • Require that all students take at least one year of health and nutrition classes at each level of schooling (elementary, middle, and high school).
  • Strengthen health education programs by improving teacher training and hence teacher qualifications. In particular, equip instructors with the knowledge and awareness they need to help kids build self-confidence and self-esteem, in addition to lifelong healthy eating skills.
  • Foster communication and sharing of methods and results among different school communities, districts, and states – organize conferences, forums, and online discussions.

• Use a mass media/public education campaign to teach children, families, and communities about the taste potential and health benefits of nutritious foods like fresh produce, whole grains, and skim milk, which can all protect against obesity, heart disease, stroke, cancer, and diabetes. Utilize social marketing techniques to “sell” good nutrition and ultimately get kids and their families eating healthier. (Enhance: knowledge, attitudes)

Family food practices

  • Talk to your children about how healthy foods help you live longer and make your body stronger and your brain sharper. Become a good role model by supplementing your own diet with fruits, vegetables, whole-wheat products, and milk.
  • Show kids that “health foods” can also be tasty foods – experiment with new and easy recipes that combine nutrition with flavor.

School food programs/policy

  • Place point-of-decision signs near food stands, cafeteria lines, and vending machines, informing people about the health benefits of fresh produce, grains, and low-fat milk (or, conversely, the health dangers of fatty and sugary foods). Involve students in the design and production of these signs, and work with local businesses and buildings to post signs around the community.

Local health/childcare programs

  • Distribute to patients an easy-to-read, visually attractive pamphlet describing the positive health effects of a balanced diet that includes fruits, vegetables, whole grains, and skim milk – and provide simple information about vitamins, minerals, phytochemicals, and fiber.
  • Encourage parents to start off making small changes to family eating habits and food purchasing patterns – e.g., switch from ground meat to lean meats, or buy lower-fat versions of milk and cheese.
  • Encourage new mothers to breastfeed , in order to increase an infant's acceptance of fruits and vegetables, and hence protect against later obesity. Provide support, educational materials, advice, and recommendations on proper breastfeeding practices.
  • Work with schools, restaurants, and community centers to raise community consciousness about health promotion, healthy eating, and obesity prevention. Broadcast messages via local media – e.g., fliers, brochures, posters, signs, and outdoor tables – distributed in prominent community locations like town centers, grocery stores, shopping malls, food courts, and schools. Combine general campaigns with targeted outreach to kids, healthcare providers, teachers, families, and populations at high risk for obesity.

Local restaurant/manufactured food practices

  • Place point-of-decision prompts and informational posters and billboards around grocery stores, food courts, cafeterias, community centers, and movie theaters. Emphasize moderate consumption of food, and inform people about the health benefits of eating healthy.
  • Encourage chain restaurants and food vendors to post nutritional information on their menus , including calories, fat/sugar/nutrient content, and health indicators that highlight “heart-healthy” meals.
  • Introduce and publicize new food items like whole wheat pasta/bread, salads, fruit salads, and veggie side dishes – use strategic marketing techniques to increase the “taste factor” of these meals among consumers (i.e., juicy, crunchy, soft, ripe, sweet, sour, tangy, fresh, refreshing, chewy, melt-in-your-mouth).

Local agriculture/gardens/markets programs

  • Work with government officials to set up local farmer's markets or produce stands in visible locations throughout the community – and collaborate with health officials to advertise the health value of fruits and vegetables.

National/state health/nutrition programs

  • Cooperate with health organizations and the food and advertising industries to launch a public education campaign that will improve eating habits among the nation's youth. Expose kids and families to simple but catchy messages and images distributed through a variety of media, including television, radio, websites, billboards, movie trailers, professional sporting events, and magazines. In general, encourage moderate over excessive consumption, and emphasize healthy choices over restrictive dieting.

Goal #5: Create social, monetary, and policy-driven incentives that reinforce long-term environmental and behavioral change.

• Use market forces to drive healthy food consumption: lower the prices of fruits and vegetables, or tax burgers, sodas, and vending machine snacks, in order to make healthy food a more attractive consumer option. At the same time, earmark soda or candy taxes specifically for the funding of health promotion and obesity intervention programs. (Enhance: environment)

School food policy

  • Lower prices for nutritious fruits, vegetables, grains, and milk – and increase prices of high-fat or high-sugar foods, which contain more than 30% of their calories from fat, and insufficient amounts of protein, vitamin A, vitamin C, iron, and calcium.

National/state food/nutrition policy

  • Implement small taxes on candy or soda to discourage unhealthy behaviors, but more importantly, to fund health promotion and obesity intervention programs.

• Introduce and implement laws and policies that specifically aim to improve youth diet and physical activity via concrete enhancement of education, healthcare, childcare, media/advertising regulation, food and nutrition services, transportation, and/or community recreation. (Enhance: environment)

National/state health policy

  • Promote early recognition of overweight and obesity among child patients: mandate that pediatricians and school nurses routinely monitor a child's weight gain relative to his/her linear growth, and calculate his/her BMI using CDC BMI growth charts, at least once a year. Train healthcare providers to be especially sensitive to patients who are at increased risk of obesity, because of family background, birth weight, or socioeconomic, ethnic, or environmental factors. In the case of youth at risk of becoming overweight, encourage doctors to monitor changes in obesity-related predictors of later disease, including high blood pressure, high blood lipids/cholesterol, insulin resistance, and sleep apnea.
  • Work with both private HMOs and federal/state Medicaid providers to expand health insurance coverage of obesity prevention and treatment services. Also, work with big e mployers to design employee benefit packages that include coverage for fitness club membership fees or community-based exercise classes.
  • Support and help implement the President's HealthierUS Initiative and the HHS Steps to a HealthierUS Initiative , with particular focus on programs targeting children, adolescents, and teenagers.
  • Enlist local, state, and federal policymakers to support children's health and current obesity prevention legislation in Congress, including the IMPACT Act, Right Start Act, SMARTS Act, Act to Leave No Child Behind, Better Nutrition for School Children Act of 2003, Healthy Nutrition for America's Children Act, Healthy America Act, Obesity Prevention Act, and Breastfeeding Promotion Act.

National/state food/nutrition policy

  • Enlist local, state, and federal policymakers to support children's health and current obesity prevention legislation in Congress , including the Better Nutrition for School Children Act of 2003, Healthy Nutrition for America's Children Act, and Healthy America Act.

National/state education policy

  • Authorize and allocate more funds and logistical support for healthy school meal programs , such as the USDA National School Lunch Program, School Breakfast Program, Special Milk Program, Summer Food Service Program, Child and Adult Care Food Program, Fruit and Vegetable Pilot Program, and Small Farms/School Meals Initiatives.
  • Enlist local, state, and federal policymakers to support children's health and current obesity prevention legislation in Congress , including the Right Start Act, SMARTS Act, Act to Leave No Child Behind , and Obesity Prevention Act.

• Pay attention to and care for kids who are lonely, depressed, anxious, angry, or suffering from insecurity and low self-esteem. Build healthy relationships and support networks with these children through mentoring programs centered in the home, school, doctor's office, and daycare center. (Enhance: environment, knowledge, attitudes)

Family home practices

  • Spend time with your children, eat more meals together, and increase sensitivity to underlying issues related to loneliness, depression, anxiety, and fear.

School programs

  • Hire or support professionally trained school counseling staff to work with children dealing with loneliness, low self-esteem, depression, anxiety, and fear.
  • Design, implement, and support after-school programs that keep kids engaged in communities instead of sitting home alone.
  • Work with upper-grade students to organize “ buddy programs ” in which older teens mentor younger children, building trust and continuity throughout the youth community.

Local health/childcare practices/policy

  • Strengthen professional training programs that better enable doctors, daycare providers, and school nurses and counselors to recognize and address sensitive issues like loneliness, depression, low self-esteem, and anxiety.
  • Set higher standards of professional performance, offer incentives, and implement better modes of evaluating programs and providers.

National/state health/education programs/policy

  • Support national outreach and mentoring programs , such as Boys and Girls Clubs of America (BGCA) and Big Brothers Big Sisters of America (BBBSA).
  • Provide funding and logistical support for joint outreach programs that bring together faith-based organizations, community youth groups, schools, community centers, public health departments, hospitals, and daycare centers.

• Use mass media campaigns and targeted informational/educational outreach to convey to the public the very real urgency of the childhood obesity epidemic. Help kids, families, teachers, neighbors, and policymakers to see the obesity problem, not as an individual lack of self-control, but as a complex web of causes and effects that impacts the entire community, state, and nation. (Enhance: knowledge, attitudes)

References