Background
The potentially catastrophic upswing in the prevalence of overweight and obesity in the United States has spurred numerous scientific and community-wide efforts to find effective means to both reverse this trend and to thwart obesity’s negative personal and public health outcomes. One significant effort—supported collaboratively by the Robert Wood Johnson Foundation, the Michael and Susan Dell Foundation, the Institute of Medicine (IOM), Home Box Office, the CDC, the NIH, the Michael and Susan Dell Foundation, and Kaiser Permanente—is “The Weight of the Nation” campaign. This multiplatform initiative has resulted in the publication of several reports, production of a 4-part made-for-television miniseries, a CDC-sponsored conference, and a book targeted at the general public (The Weight of the Nation: Surprising Lessons about Diets, Food, and Fat; St. Martin’s Press, 2012). As part of this campaign, a group of experts (the Committee on Accelerating Progress in Obesity Prevention) was charged by the IOM with developing a set of recommendations for accelerating progress in obesity prevention over the next decade and proposing potential measures of progress toward this goal. The committee then used a systems approach to develop 5 goals encompassing 5 “environments” needing immediate public action. These goals are as follows:
Make physical activity an integral and routine part of life.
Create food and beverage environments that ensure that healthy food and beverage options are the routine, easy choice.
Transform messages about physical activity and nutrition.
Expand the role of health care providers, insurers, and employers in obesity prevention.
Make schools a national focal point for obesity prevention.
As a follow-up and with funding from the Michael and Susan Dell Foundation, the IOM formed a subsequent expert panel (the Committee on Evaluating Progress of Obesity Prevention Efforts), chaired by Dr. Lawrence Green (Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco). This group was asked to develop a “concise and actionable plan for measuring progress in obesity prevention efforts for the nation” as proposed in the preceding IOM document. In addition, they were charged with developing a community-level measurement plan that adds detail and support for the national-level plan.
Establishing a Vision and Evaluation of Existing Evaluation Efforts
The committee began its deliberations by developing its vision: “to assure collection and analysis of timely and meaningful data or information to inform and improve obesity prevention efforts at national, state, and community levels.” The committee then constructed an evaluation framework that integrated aspects of inputs, activities, outputs, outcomes, and intended impacts/improvements needed to meet its vision.
After critically evaluating existing methods by which obesity prevention is assessed, the committee concluded that there exist gaps in data acquisition and utilization. For instance, they concluded that current data monitoring systems do not adequately track progress of the environmental and policy-related obesity prevention actions recommended in the preceding 2012 IOM report, especially for populations at greatest risk of obesity. They also found that the ability to effectively use current data is limited (especially at the community level) due to inadequate presentation of the data in a useful and timely manner. In the same vein, they concluded that communities generally lack needed guidance and resources for assessing the proximate status of obesity and responding with effective preventative and palliative measures. The committee also determined that, although there appears to be no shortage of data monitoring systems in existence, these efforts lack adequate leadership, coordination, infrastructure, guidance, accountability, and capacity for true effectiveness.
Development of National and Community Evaluation Plans
In response to the identified shortcomings in the nation’s current obesity monitoring and evaluation systems, the committee developed 2 related plans: one to be used at the national level and the other at the community level. The National Obesity Evaluation Plan was designed to organize the planning, implementation, and evaluation of obesity prevention and related policies and programs recommended in the IOM’s 2012 report. This plan integrates existing national surveys and systems that primarily focus on measures of individuals with recommendations for new systems and data that would capture nationwide environmental and policy changes. This national plan also outlines mechanisms for timely feedback to data users and details adaptations that make it appropriate at the state and regional levels.
The Community Obesity Evaluation Plan includes 2 sets of activities: those related to community assessment/surveillance and others associated with community program and intervention monitoring/evaluation. Together, these elements are designed to help health professionals both assess and quickly react to current obesity-related conditions in the local community. The report also provides extensive guidance for implementing each of these components, including indicators and evaluation tools that can be used by a range of communities with varying resources.
It is noteworthy that the report stresses the fact that the National Obesity Evaluation Plan and the Community Obesity Evaluation Plan should not be viewed as separate entities. Instead, they should be considered interdependent because each can and should provide valuable support and feedback to each other. In addition, the committee fully recognizes that major organizational changes will need to be made across multiple federal, state, and local government agencies and departments for these plans to be put in place; implementation will also require adequate resources.
For More Information
A free online version of Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress and information concerning purchasing an electronic or paper copy are available at http://www.iom.edu/Reports/2013/Evaluating-Obesity-Prevention-Efforts-A-Plan-for-Measuring-Progress.aspx. Free copies of the previously published IOM report Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation are available at http://www.iom.edu/Reports/2012/Accelerating-Progress-in-Obesity-Prevention.aspx. The 4 associated films can be viewed free of charge at http://theweightofthenation.hbo.com/. To learn more about the Weight of the Nation 2012 Conference in Washington, DC, go to http://www.weightofthenation.org/.