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Reversing the rapid rise in obesity among American children and youth will require a multi-pronged approach by schools, families, communities, industry, and government that would be as comprehensive and ambitious as national anti-smoking efforts, according to a new report from the Institute of Medicine of the National Academies. While no single intervention or group acting alone can stop the epidemic of childhood obesity, the steps recommended by the committee that wrote the report all aim to increase and improve opportunities for children to engage in physical activity and eat a healthy diet.

"We must act now and we must do this as a nation," said Jeffrey Koplan, vice president for academic health affairs, Emory University, Atlanta, and former director of the Centers for Disease Control and Prevention. Koplan chaired the committee of 19 experts in child health, nutrition, fitness, and public health who developed the report in response to a request from Congress for an obesity prevention plan based on sound science and the most promising approaches. "Obesity may be a personal issue, but at the same time, families, communities, and corporations all are adversely affected by obesity and all bear responsibility for changing social norms to better promote healthier lifestyles," Koplan added. "We recognize that several of our recommendations challenge entrenched aspects of American life and business, but if we are not willing to make some fundamental shifts in our attitudes and actions, obesity's toll on our nation's health and well-being will only worsen."

Among specific steps recommended by the report is a call for schools to implement nutritional standards for all foods and beverages served on school grounds, including those from vending machines. The committee also recommended that schools expand opportunities for all students to engage in at least 30 minutes of moderate to vigorous physical activity each day.

The report also calls on the food, beverage, and entertainment industries to voluntarily develop and implement guidelines for advertising and marketing directed at children and youth. Congress should give the Federal Trade Commission the authority to monitor compliance with the guidelines and establish external review boards to prohibit ads that fail to comply. Restaurants should continue to expand their offerings of nutritious foods and beverages, and should provide calorie content and other nutrition information.

Parents must play their part as well, by providing healthy foods in the home and encouraging physical activity by limiting their children's recreational TV, videogame, and computer time to less than two hours a day, among other means.

Community organizations and state and local governments can make a difference by implementing programs that promote nutrition and regular physical activity and by supporting the establishment or revision of zoning ordinances and comprehensive plans to include or enhance sidewalks, bike paths, parks and playgrounds, and other recreational facilities. The committee called on school health services to play a more prominent role in addressing obesity by measuring each student's weight, height, and body mass index (BMI) annually and providing the results to the students and families. Given that many adolescents do not get annual checkups, this information would help families become aware of any weight concerns and track their children's progress.

The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences.

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