Childhood Obesity:

Most Experts Identified Physical Activity and the Use of Best Practices as Key to Successful Programs

GAO-06-127R: Published: Oct 7, 2005. Publicly Released: Nov 7, 2005.

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In the past 30 years, the number of obese children has increased throughout the United States, leading some policy makers to rank childhood obesity as a critical public health threat. The rate of childhood obesity has more than tripled for children between the ages of 6 and 11 and also increased for children of other ages over the same period. According to a 2005 Institute of Medicine (IOM) report, there are approximately 9 million children nationwide over the age of 6 who are considered obese. An important consequence of childhood obesity is the increasing number of children experiencing illnesses and other health problems associated with obesity, such as hypertension and type II diabetes. The rise in obesity-related health conditions also introduces added economic costs. Between 1979 and 1999, obesity-associated hospital costs for children between the ages of 6 and 17 more than tripled, from $35 million to $127 million. Moreover, because studies suggest that obese children are likely to become overweight or obese adults--particularly if the children are obese during adolescence--the increase in the number of obese children may also contribute to health care expenditures when they become adults. Obesity-related health expenditures are estimated to have accounted for more than 25 percent of the growth in health care spending between 1987 and 2001. In 2000, an estimated $117 billion was spent for health-related expenditures due to obesity, with direct costs accounting for an estimated $61 billion. These direct costs accounted for approximately 5 percent of U.S. health expenditures. Nearly half of all medical spending related to adult obesity is financed by the public sector, through Medicaid and Medicare. Some federal agencies support efforts to target the issue of childhood obesity, and legislation introduced in the current Congress also focuses on the issue, including the Improved Nutrition and Physical Activity (IMPACT) Act and the Childhood Obesity Reduction Act. Congress asked us to provide information on program strategies and elements experts have identified as likely to contribute to success in addressing childhood obesity. Congress also asked us to provide information on how those strategies and elements have been implemented. In this report we (1) describe the key strategies identified by experts as most important to include in programs to prevent or reduce childhood obesity; (2) provide examples of how selected programs implemented the key strategies identified and challenges these programs faced; (3) describe the program elements identified by experts as most important to include in programs to prevent or reduce childhood obesity, as well as outcome measures identified as important; and (4) provide examples of how selected programs implemented key elements identified and the challenges these programs faced, as well as examples of possible roles for the federal government.

Experts we surveyed identified several key strategies to include in the design or implementation of a program to prevent or reduce childhood obesity. The program strategy identified by experts as most important was "increasing physical activity." The second-highest-ranked strategy was the "other" category, in which experts wrote in a variety of responses. The number and variety of these write-in responses suggests that, beyond physical activity, there is less consensus on which strategies should be used to target childhood obesity. The strategy of improving children's nutritional intake was identified as third in importance for programs designed to prevent or reduce childhood obesity by surveyed experts. Our interviews with officials at four programs provided different examples of implementing the key strategies, including the top-ranked strategy, increasing physical activity. For example, one school-based program provided children with a card that was hole-punched when they walked at recess and which the children could redeem when completed for small prizes and incentives. Another program provided pedometers to encourage walking. Program officials we interviewed also identified multiple challenges to implementing key strategies that included policy concerns, such as a lack of or inconsistent physical education requirements by school districts, and infrastructure concerns, such as no sidewalks. Experts we surveyed identified several key elements to include in the design or implementation of a program to prevent or reduce childhood obesity. The program element identified as the most important was the use of best practice or evidence-based models. Experts also identified other key elements including the suitability and acceptability of the program to the target community, and sufficient financial and human resources. Responses from surveyed experts indicate that there is no consensus on what outcome measures should be used to determine program success. Officials we interviewed at four programs provided a variety of examples demonstrating how they implemented the top-ranked program element--use of best practices or evidence-based program models. For example, one program drew best practices from multiple sources, including clinical treatment programs and programs aimed at children of other ages, to guide the development of their prevention program. Program officials we interviewed also identified challenges to implementing key elements that included difficulties in working within school systems and communities to obtain program acceptance, and resource constraints. Program officials also identified several possible roles for the federal government related to obesity, including supporting and staffing clearinghouses to provide information on best practices.

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