July 2008

Grant Results

SUMMARY

In 2002, confronted with an obesity epidemic affecting children and adolescents throughout the United States, Congress directed the Institute of Medicine (IOM) to research the problem and develop an action plan to address it.

Key Results

  • On September 30, 2004, the IOM released Preventing Childhood Obesity: Health in the Balance, an action plan with recommendations for ways that families, schools, industry, the media, communities and government could work together to address rising rates of obesity in children and youth.
  • On September 13, 2006, the institute published Progress in Preventing Childhood Obesity: How Do We Measure Up?, an assessment of progress in obesity prevention since 2004. The report calls on key stakeholders to take the lead in preventing childhood obesity, monitoring and evaluating all policies and programs and disseminating promising practices.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this work with three grants totaling $1,247,876 between January 2003 and March 2007.

 See Grant Detail & Contact Information
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THE PROBLEM

According to the Institute of Medicine, the 21st century began with a startling setback in children's health—an epidemic of obesity that threatened to overturn a century of health advances. Over the last three decades the rate of obesity more than doubled for preschool age children aged 2 to 5 and for adolescents aged 12 to 19—and it tripled for children aged 6 to 11.

Overweight and obese children are at immediate and long-term risk for type 2 diabetes, cardiovascular disease and other serious health problems, according to the Institute of Medicine. For example, for individuals born in the United States in 2000, the lifetime risk of being diagnosed with type 2 diabetes is estimated at 30 percent for boys and 40 percent for girls if obesity rates do not decline.

In 2001 the U.S. surgeon general issued a Call to Action to Prevent and Decrease Overweight and Obesity to stimulate the development of specific agendas and actions targeting this public health problem.

In 2002, the U.S. Congress directed the IOM to develop a plan to decrease the number of obese children and youth in the United States. The IOM, a nonprofit organization chartered in 1970 as a part of the National Academy of Sciences, serves as the nation's advisor on issues relating to biomedical science.

The IOM appointed a committee of 19 experts in child health, obesity, nutrition, physical activity and public health to assess the nature of childhood obesity. The committee was asked to examine the behavioral, social, cultural and other broad environmental factors involved in childhood obesity and issue a report on their findings. (See Appendix 1 for list of members.)

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RWJF STRATEGY

In 2007, RWJF committed $500 million to reverse the childhood obesity epidemic by 2015 by improving access to affordable, healthy foods and increasing opportunities for physical activity in schools and communities across the nation. To achieve this goal, RWJF has developed three integrated strategies: evidence, action and advocacy.

Evidence

Investments in building the evidence base will help ensure that the most promising efforts are replicated throughout the nation.

The foundation's major research efforts in this area—Active Living Research (for more information see Grant Results), Healthy Eating Research and Bridging the Gap—are contributing to the nation's collective knowledge about the changes to policies and to community and school environments that are most effective in increasing physical activity and improving nutrition for kids.

RWJF also seeks to evaluate innovative approaches under way in states, schools and communities across the country.

  • For instance, RWJF supported an independent evaluation of efforts to implement Arkansas Act 1220, which mandated a comprehensive approach to addressing childhood obesity in public schools.
  • The foundation also funded a separate initiative to analyze body mass index (BMI) data for all Arkansas public school students. Already, the BMI analysis has indicated that, in just three years, Arkansas has halted the progression of the epidemic in the state.

Action

RWJF's action strategy for communities and schools focuses on engaging partners at the local level, building coalitions and promoting the most promising approaches.

RWJF is working with The Food Trust, a Philadelphia-based advocacy organization whose mission is to ensure that everyone has access to affordable, nutritious food. The Food Trust has been bringing supermarkets back to underserved communities in Pennsylvania, and with RWJF is working together to replicate those results nationwide.

RWJF is working closely with the Alliance for a Healthier Generation (a partnership of the American Heart Association and William J. Clinton Foundation) to support its efforts to improve nutrition, physical activity and staff wellness in schools nationwide.

Advocacy

As staff learns from the evidence and action strategies, RWJF shares results by educating leaders and investing in advocacy, building a broad national constituency for childhood obesity prevention.

RWJF supported the National Governors Association when Arkansas Gov. Mike Huckabee designated wellness in schools, homes and workplaces as his Chairman's Initiative for 2005–2006.

Through its Leadership for Healthy Communities (formerly Active Living Leadership) initiative, RWJF works closely with national organizations that represent elected and appointed officials—such as the National Conference of State Legislatures and the U.S. Conference of Mayors—to educate their members about successful approaches to increasing physical activity and healthy eating among kids. The goal is to support leaders and decision-makers in their efforts to create healthier states, counties and cities.

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THE PROJECT

From 2003 to 2007, RWJF provided three grants to the IOM to research, write and disseminate two studies on childhood obesity.

Activities

The Action Plan
The first grant (ID# 047513) helped the IOM committee produce their initial study, an action plan with recommendations for combating childhood obesity. Between 2003 and the publication of the plan in September 2004, the committee:

  • Carried out literature searches on the topic of childhood obesity that produced a bibliographic database with more than 40,000 references on childhood obesity and related topics. This review found:
    • A lack of extensive evidence-based strategies in many areas of childhood obesity prevention.
    • A lack of comprehensive surveillance and monitoring systems at all levels, especially for grassroots efforts, to determine the extent of progress.
    • The need to assess progress systematically over time.
  • Held six committee meetings and two public workshops.
    • The committee's first public workshop, "Strategies for Developing School-Based Policies That Promote Nutrition and Physical Activity Among Children and Youth," was held in June 2003. In addition to presentations on school-based nutrition and physical activity issues, the committee held an open forum and heard from 12 speakers.
    • In December 2003, the committee held a second workshop, "Understanding the Influences of Marketing, Media and Family Dynamics on the Prevention of Childhood Obesity." Following presentations on these topics, 12 speakers representing a variety of stakeholders spoke at the open forum.

    Each workshop had more than 120 attendees.

Follow-Up Assessment Report
With two subsequent grants (ID#s 052339 and 056982), the IOM prepared a follow-up assessment report that measured the country's progress in implementing the recommendations of the action plan for preventing childhood obesity.

To conduct this assessment, the IOM appointed a Committee on Progress in Preventing Childhood Obesity. Seven experts in program implementation, evaluation and assessment of obesity prevention efforts joined six members of the original committee to comprise the 13-member study panel (see Appendix 2 for list of participants).

In addition to producing the assessment, the committee's task was to conduct three regional symposia bringing together national, state and local decision-makers, community and school leaders, health care providers, public health professionals and grassroots organizations. The purpose of the meetings was to solidify partnerships, galvanize obesity prevention efforts at all levels and promote implementation of the initial action plan in a coordinated fashion.

Between 2004 and publication of the assessment report in September 2006, the committee conducted a literature review and held six meetings, three regional symposia and two public workshops to obtain input and data from a variety of sources. Project staff worked with two consultants to prepare background information on the assessment report.

At their fifth meeting, January 11–12, 2006, the committee held an open session to hear from federal government agencies. Representatives of the U.S. Departments of Agriculture, Education and Health and Human Services discussed childhood obesity prevention activities within their departments.

Other Funding

During the first grant period, the project received support from the federal Office of Disease Prevention and Health Promotion and the Centers for Disease Control and Prevention ($828,102).

Four agencies within the National Institutes of Health contributed $450,000; these were the National Institute of Diabetes and Digestive and Kidney Diseases; the National Heart, Lung, and Blood Institute; the National Institute of Child Health and Human Development; and the Division of Nutrition Research Coordination.

During the follow-up assessment period, in-kind support came from foundations that participated in the three regional symposia and from two communications firms, Burness Communications, Bethesda, Md., and GMMB, Washington.

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RESULTS

  • On September 30, 2004, the Institute of Medicine released Preventing Childhood Obesity: Health in the Balance, an action plan with 10 recommendations and specific implementation strategies to help government, industry and the media, local communities, schools and families combat obesity in children and youth.
    • Recommendation 1: Government at all levels should provide coordinated leadership for the prevention of obesity in children and youth.

      A high-level interdepartmental task force, convened by the Department of Health and Human Services, should coordinate federal actions, including:
      • Developing nutrition standards for foods and beverages sold in schools.
      • Funding state-based nutrition and physical-activity grants with strong evaluation components.
      • Developing guidelines regarding advertising and marketing to children by convening a national conference.
      • Expanding funding for prevention intervention; behavioral and community-based population research; and strengthening support for surveillance, monitoring and evaluation efforts.

      State and local governments should:
      • Promote opportunities for physical activity in the community through changes to ordinances, capital improvement programs and other planning practices. They should also support public health agencies and community coalitions in their collaborative efforts to promote and evaluate obesity prevention interventions.
    • Recommendation 2: Industry should make obesity prevention in children and youth a priority by developing and promoting products, opportunities and information that will encourage healthy eating behaviors and regular physical activity.
    • Recommendation 3: Nutrition labeling should be clear and useful so that parents and youth can make informed product comparisons and decisions to achieve and maintain energy balance at a healthy weight.
    • Recommendation 4: Industry should develop and strictly adhere to marketing and advertising guidelines that minimize the risk of obesity in children and youth.
    • Recommendation 5: The federal Department of Health and Human Services should develop and evaluate a long-term national multimedia and public relations campaign focused on obesity prevention in children and youth.
    • Recommendation 6: Local governments, public health agencies, schools and community organizations should collaboratively develop and promote programs that encourage healthful eating behaviors and regular physical activity, particularly for populations at high risk of childhood obesity.
    • Recommendation 7: Local governments, private developers and community groups should expand opportunities for physical activity including recreational facilities, parks, playgrounds, sidewalks, bike paths, routes for walking or bicycling to school and safe streets and neighborhoods, especially for populations at high risk of childhood obesity.
    • Recommendation 8: Pediatricians, family physicians, nurses and other clinicians should engage in the prevention of childhood obesity. Health care professional organizations, insurers and accrediting groups should support individual and population-based obesity prevention efforts. As a key strategy, health care professionals should:
      • Routinely assess children and youth using the Body Mass Index (BMI), a reliable indicator of overweight and obesity for most children and teens. Providers should offer appropriate counseling and guidance to children and their families based on results of the BMI assessment.
    • Recommendation 9: Schools should provide a consistent environment that is conducive to healthful eating behaviors and regular physical activity. To implement this recommendation, some strategies the federal government, state and local authorities and schools should pursue are:
      • Improve the nutritional quality of foods and beverages served and sold in schools and as part of school-related activities.
      • Increase opportunities for frequent, more intensive and engaging physical activity during and after school.
      • Implement school-based interventions to reduce children's television and other screen time.
      • Develop, implement and evaluate innovative pilot programs for both staffing and teaching about wellness, healthful eating and physical activity.
    • Recommendation 10: Parents should promote healthy eating behaviors and regular physical activity for their children.
  • In 2005, the committee conducted three regional symposia in Kansas, Georgia and California to learn more about efforts to combat childhood obesity and galvanize obesity prevention efforts. IOM staff partnered with local and regional foundations to coordinate the following regional meetings:
    • Progress in Preventing Childhood Obesity: Focus on Schools, in Wichita, Kan.—a collaboration with the Kansas Health Foundation. The symposium drew approximately 90 individuals active in school-based childhood obesity prevention efforts in the Midwest, including teachers, students, principals, health educators, dietitians, food service providers, industry representatives and state government and community leaders.
    • Progress in Preventing Childhood Obesity: Focus on Communities, in Atlanta—a collaboration with the Healthcare Georgia Foundation. Some 90 individuals participated, primarily from the Southeast, including students, community leaders, physicians, health educators, foundation leaders, state and federal officials, researchers and consumer advocates.
    • Progress in Preventing Childhood Obesity: Focus on Industry, in Irvine, Calif.—a collaboration with the California Endowment. The meeting drew representatives from food, beverage and restaurant companies; marketing firms; physical activity and entertainment companies; the media; community leaders; physicians; public health educators; foundation leaders; state and federal government officials; researchers; and consumer advocates.
  • On September 13, 2006, the Institute of Medicine released Progress in Preventing Childhood Obesity: How Do We Measure Up?, an assessment of progress since the publication of the initial action plan in 2004. The report states that the nation's growing recognition of the obesity crisis as a major public concern for children and youth has led to an array of diverse efforts aimed at increasing physical activity and promoting healthful eating.

    These efforts, however, generally remain fragmented and small scale without a system to track and evaluate them. The report made the following recommendations for government, industry, communities, schools and families:
    • Demonstrate leadership and commitment by mobilizing the resources required to identify, implement, evaluate and disseminate effective policies and interventions that support childhood obesity prevention goals.
    • Build the capacity to evaluate all childhood obesity prevention efforts and develop quality interventions that take into account diverse perspectives and use culturally relevant approaches.
    • Expand or develop relevant surveillance and monitoring systems and, as applicable, engage in research to examine the impact of childhood obesity prevention policies, interventions and actions on relevant outcomes, paying particular attention to the unique needs of diverse groups and high-risk populations.
    • Disseminate promising practices and research findings by fostering information-sharing activities through diverse communication channels and media to actively promote the use and scaling up of effective childhood obesity prevention policies and interventions.
  • The IOM distributed more than 1,200 copies of the initial report and more than 750 copies of the follow-up assessment to the U.S. Congress, professional organizations, school and community leaders, news organizations and others.
    • To disseminate information about Preventing Childhood Obesity: Health in the Balance, the Institute of Medicine:
      • Produced nine fact sheets providing an overview of the report and action steps for government, the health care sector, industry, marketing and media, communities, schools and parents.
      • Presented the report findings at meetings of national organizations, including the American Medical Association, the American Public Health Association and the North American Association for the Study of Obesity.
    • To disseminate information about Progress in Preventing Obesity: How Do We Measure Up?:
      • The IOM produced three reports summarizing findings of the regional workshops, three fact sheets and an issue brief.
      • IOM staff briefed the U.S. Senate Committee on Health, Education, Labor and Pensions and the U.S. House Workforce Committee on its findings.
      • RWJF produced a video on the report containing interviews with experts in the area of childhood obesity.
      • IOM staff presented the report findings at meetings of national organizations, including the Society for Adolescent Medicine, Grantmakers In Health and the Department of Health and Human Services Prevention Summit.

    See the Bibliography for details.

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LESSONS LEARNED

  1. Put together a committee of experts with diverse backgrounds when tackling a complicated project. A multidisciplinary problem like childhood obesity needs the perspective and knowledge of many different people to bring depth to its solutions. (Project Director/Liverman)
  2. Partner with local and regional organizations for help in gathering information from a wide range of geographic areas. For its follow-up report on obesity, the IOM wanted to conduct regional meetings around the country but was unfamiliar with the local areas. IOM staff partnered with staff at regional foundations who helped identify the right people and organizations to come to the meetings. (Project Director/Liverman)
  3. When looking for evidence-based prevention strategies to address an emerging threat like obesity, draw lessons from earlier campaigns in other areas of public health. The campaign to reduce tobacco consumption among young people was an example of a successful prevention model with potential relevance for childhood obesity prevention. Committee members examined the tobacco control movement and other campaigns to identify core factors associated with effective health-related social change efforts. (Project Director/Liverman)

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AFTER THE GRANT

In November 2007, RWJF made a four-year, $5.7 million follow-up grant to the Institute of Medicine to establish a standing committee on childhood obesity (ID# 061747). The standing committee, working with RWJF, co-funders and federal agencies, will choose up to five topics for publication on childhood obesity. To develop these publications, the standing committee will appoint ad hoc committees of experts for specific content. These experts will help the standing committee provide timely, national guidance on how to address childhood obesity effectively. At its first meeting, in May 2008, James S. Marks, M.D., M.P.H., senior vice president and director of the Health Group at RWJF, provided the committee with an overview of RWJF's approach for reversing the obesity epidemic.

In July 2008, RWJF began a collaborative research effort on childhood obesity with the National Institutes of Health and the Centers for Disease Control and Prevention through a $316,876 grant ID# 064539 to the Academy for Educational Development.

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GRANT DETAILS & CONTACT INFORMATION

Project

Conducting Research on Obesity and Children

Grantee

National Academy of Sciences-Institute of Medicine (Washington,  DC)

  • Conducting Research on Obesity and Children
    Amount: $ 298,109
    Dates: January 2003 to February 2005
    ID#:  047513

  • Follow-Up Activities to a Report on Preventing Childhood Obesity
    Amount: $ 700,000
    Dates: December 2004 to May 2006
    ID#:  052339

  • Amount: $ 249,767
    Dates: May 2006 to March 2007
    ID#:  056982

Contact

Catharyn T. Liverman, M.L.S.
(202) 334-3986
cliverman@nas.edu

Web Site

http://www.iom.edu/obesity

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Committee on Prevention of Obesity in Children and Youth

Jeffrey P. Koplan, M.D., M.P.H. (Chair)
Woodruff Health Sciences Center
Emory University
Atlanta, Ga.

Dennis M. Bier, M.D.
Children's Nutrition Research Center
Baylor College of Medicine
Houston, Texas

Leann L. Birch, Ph.D.
Department of Human Development and Family Studies
Pennsylvania State University
University Park, Pa.

Ross C. Brownson, Ph.D.
Department of Community Health
St. Louis University School of Public Health
St. Louis, Mo.

John Cawley, Ph.D.
Department of Policy Analysis and Management
Cornell University
Ithaca, N.Y.

George R. Flores, M.D., M.P.H.
The California Endowment
San Francisco, Calif.

Simone A. French, Ph.D.
Division of Epidemiology and Community Health
University of Minnesota
Minneapolis, Minn.

Susan L. Handy, Ph.D.
Department of Environmental Science and Policy
University of California, Davis
Davis, Calif.

Robert C. Hornik, Ph.D.
Annenberg School for Communications
University of Pennsylvania
Philadelphia, Pa.

Douglas B. Kamerow, M.D.
Health Policy; Preventive Medicine; Primary Health Care
RTI International
Washington, D.C.

Shiriki K. Kumanyika, Ph.D., M.P.H.
Center for Clinical Epidemiology and Biostatistics
University of Pennsylvania School of Medicine
Philadelphia, Pa.

Barbara J. Moore, Ph.D.
Shape Up America!
Washington, D.C.

Arie L. Nettles, Ph.D.
School of Education
University of Michigan
Ann Arbor, Mich.

Russell R. Pate, Ph.D.
Department of Exercise Science
University of South Carolina
Columbia, S.C.

John C. Peters, Ph.D.
Snacks and Beverages Technology Division
Procter & Gamble Company
Cincinnati, Ohio

Thomas N. Robinson, M.D., M.P.H.
Division of General Pediatrics and Stanford Prevention Research Center
Stanford University School of Medicine
Palo Alto, Calif.

Charles Royer
Evans School of Public Affairs
University of Washington
Seattle, Wash.

Shirley R. Watkins, M.Ed.
SR Watkins & Associates
Silver Spring, Md.

Robert C. Whittaker, M.D., M.P.H.
Mathematica Policy Research, Inc.
Princeton, N.J.


Appendix 2

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Committee on Progress in Preventing Childhood Obesity

Jeffrey P. Koplan, M.D., M.P.H. (Chair)
Woodruff Health Sciences Center
Emory University
Atlanta, Ga.

Ross C. Brownson, Ph.D.
Department of Community Health
St. Louis University School of Public Health
St. Louis, Mo.

Ann Bullock, M.D.
Health and Medical Division
Eastern Band of Cherokee Indians
Cherokee, N.C.

Susan B. Foerster, M.P.H., R.D.
Chief, Cancer Prevention and Nutrition Section
California Department of Health Services
Sacramento, Calif.

Jennifer C. Greene, Ph.D.
Department of Educational Psychology
University of Illinois Urbana-Champaign
Champaign, Ill.

Douglas B. Kamerow, M.D.
Health Policy; Preventive Medicine; Primary Health Care
RTI International
Washington, D.C.

Marshall W. Kreuter, Ph.D.
Institute of Public Health
College of Health and Human Sciences
Georgia State University
Atlanta, Ga.

Russell R. Pate, Ph.D.
Department of Exercise Science
University of South Carolina
Columbia, S.C.

John C. Peters, Ph.D.
Snacks and Beverages Technology Division
Procter & Gamble Company
Cincinnati, Ohio

Kenneth E. Powell, M.D., M.P.H.
Chronic Disease, Injury and Environmental Epidemiology Section
Division of Public Health
Georgia Department of Human Resources (emeritus)
Atlanta, Ga.

Thomas N. Robinson, M.D., M.P.H.
Division of General Pediatrics and Stanford Prevention Research Center
Stanford University School of Medicine
Palo Alto, Calif.

Eduardo J. Sanchez, M.D., M.P.H.
Texas Department of State Health Services
Austin, Texas

Antronette (Toni) Yancey, M.D., M.P.H.
Department of Health Services and Center to Eliminate Health Disparities
UCLA School of Public Health
Los Angeles, Calif.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Books

Preventing Childhood Obesity: Health in the Balance. Washington: Institute of Medicine, 2004. Available online.

Progress in Preventing Childhood Obesity: How Do We Measure Up? Washington: Institute of Medicine, 2006. Available online.

Reports

Executive Summary. Preventing Childhood Obesity: Health in the Balance. Washington: Institute of Medicine, 2004. Available online.

Fact Sheet. Preventing Childhood Obesity: Advertising, Marketing and Media. Washington: Institute of Medicine, 2004. Available online.

Fact Sheet. Preventing Childhood Obesity: Facts and Figures. Washington: Institute of Medicine, 2004. Available online.

Fact Sheet. Preventing Childhood Obesity: Glossary of Terms. Washington: Institute of Medicine, 2004. Available online.

Fact Sheet. Preventing Childhood Obesity: Overview. Washington: Institute of Medicine, 2004. Available online.

Fact Sheet. Preventing Childhood Obesity: The Role of Communities. Washington: Institute of Medicine, 2004. Available online.

Fact Sheet. Preventing Childhood Obesity: The Role of Government. Washington: Institute of Medicine, 2004. Available online.

Fact Sheet. Preventing Childhood Obesity: The Role of the Health-Care Sector and Providers. Washington: Institute of Medicine, 2004. Available online.

Fact Sheet. Preventing Childhood Obesity: The Role of Industry. Washington: Institute of Medicine, 2004. Available online.

Fact Sheet. Preventing Childhood Obesity: The Role of Parents. Washington: Institute of Medicine, 2004. Available online.

Fact Sheet. Preventing Childhood Obesity: The Role of Schools. Washington: Institute of Medicine, 2004. Available online.

Fact Sheet. What Foundations Can Do to Respond to Childhood Obesity. Washington: Institute of Medicine, 2006. Available online.

Fact Sheet. What Government Can Do to Respond to Childhood Obesity. Washington: Institute of Medicine, 2006. Available online.

Fact Sheet. What Industry Can Do to Respond to Childhood Obesity. Washington: Institute of Medicine, 2006. Available online.

Progress in Preventing Childhood Obesity: Focus on Communities—Brief Summary: Institute of Medicine Regional Symposium. Washington: Institute of Medicine, 2006. Available online.

Progress in Preventing Childhood Obesity: Focus on Industry—Brief Summary: Institute of Medicine Regional Symposium. Washington: Institute of Medicine, 2006. Available online.

Progress in Preventing Childhood Obesity: Focus on Schools—Brief Summary: Institute of Medicine Regional Symposium. Washington: Institute of Medicine, 2006. Available online.

Report Brief. Preventing Childhood Obesity: Health in the Balance. Washington: Institute of Medicine, 2004. Available online.

Report Brief. Progress in Preventing Childhood Obesity: How Do We Measure Up? Washington: Institute of Medicine, 2006. Available online.

World Wide Web Sites

www.iom.edu/obesity. Web site includes links to Institute of Medicine reports on obesity, links to fact sheets on childhood obesity prevention and action steps for schools, communities, families and government.

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Report prepared by: Susan G. Parker
Reviewed by: Jayme Hannay
Reviewed by: Molly McKaughan
Program Officer: Kathryn Thomas

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