Childhood Obesity: Public Health Impact and Policy Responses

Evidence is emerging, especially from European countries, that the most effective policies to stem the tide of child obesity involve numerous concentrated interventions, implemented simultaneously. In the United States, policy change has been scattershot and episodic, and therefore minimally effective. The American polity, dominated by interest groups and featuring a system of elaborately separated powers, may not permit the type of focused, multiple-approaches policy change that seems necessary. Possibly exacerbating this problem is the nature of evaluation research-testing a single intervention, often during the formative stage of implementation-which may communicate to policy makers and the public alike the wrong signals about the efficacy of achieving sustainable reform. Since the rise in childhood obesity became a source of widespread public concern early in the present century, a fierce debate has centered around causes: What are the principal elements contributing to this "epidemic"? The increasingly inactive lifestyle of American children is the primary culprit, according to one well-publicized view-a position encouraged, as it happens, by the food and beverage industries. Efforts to enhance exercise among youth have thus been the predominant public response to rising childhood obesity rates. But a host of recent research suggests that altering American children's relatively sedentary lives-through school-based physical activity interventions, for example-has at most limited benefits, without simultaneous and dedicated attention to the effects of caloric overconsumption.