Worldwide obesity has more than doubled since 1980 (WHO, 2013). Childhood obesity is at an all time high, an intensifying public health problem affecting as many as 43 million children (Pulgaron, 2013). Current trends and projections estimate that by 2020, over forty five percent of the children and adolescents in America will be overweight (Savino, Pelliccia, Chiarelli, & Mohn, 2009). Prevention, preferable to treatment of a problem, could be a key strategy to controlling the childhood obesity epidemic. Schools are a setting that reaches most of the youth population and could serve as a valuable contributor to the prevention of childhood obesity.This study is a formative outcome evaluation of a nutritional school-focused intervention. A comparative descriptive design was used to evaluate the knowledge, behavior, and self-efficacy related to healthy nutritional eating as a result of the educational school-focused intervention. The sample was a convenience sample of 57 eighth-grade students. The findings suggested that there was not a statistically significant difference between the knowledge, behavior, or self-efficacy scores. Knowledge scores of the control group (M = 4.27, SD = 1.13) were greater than the intervention group (M = 3.88, SD = 1.48). Likewise behavioral scores of the control group (M = 4.10, SD = 1.76) were larger than the intervention group (M = 3.88, SD = 1.51). Although there was not a statistically significant difference for self-efficacy, the intervention group (M = 39.08, SD = 11.98) outscored the control group (M = 38.45, SD = 10.62). As a formative outcome evaluation of a pilot study the sample size was limited. A statistical power analysis for a medium effect size indicated that this sample was underpowered.Results of this study indicate that despite the non-statistical evidence of a difference in the outcome there are encouraging findings. The primary concept of the social cognitive theory is self-efficacy. This human motivator is the belief that an individual has the motivation to adopt new lifestyles (Bandura, 2004). Three years after the school-focused intervention, the intervention group outscored the control group. Higher levels of self-efficacy and expectations of positive outcomes lead to the adjustments needed to maintain behavior change (Anderson, Winnett, & Wojcik, 2011).

Childhood obesity is highly prevalent in the U.S. and has become a global epidemic. The 2007-2008 National Health and Nutrition Examination Survey data showed that 17% of U.S. children and adolescents (ages 2–19) years were obese, and over 30% were overweight or obese. Childhood obesity leads to obesity in adulthood and many other serious health conditions, such as cardiovascular, metabolic, and psychosocial illnesses. To assess the effectiveness of existing childhood obesity prevention efforts, the Johns Hopkins University Evidence-based Practice Center completed a systematic review on childhood obesity prevention studies conducted in high-income countries. This report systematically reviewed seven key questions: What is the comparative effectiveness of school-based interventions for the prevention of obesity or overweight in children? What is the comparative effectiveness of home-based interventions for the prevention of obesity or overweight in children? What is the comparative effectiveness of primary care-based interventions for the prevention of obesity or overweight in children? What is the comparative effectiveness of childcare setting-based interventions for the prevention of obesity or overweight in children? What is the comparative effectiveness of community-based or environment-level interventions for the prevention of obesity or overweight in children? What is the comparative effectiveness of consumer health informatics applications for the prevention of obesity or overweight in children? What is the comparative effectiveness of multi-setting interventions for the prevention of obesity or overweight in children? Though the strength of evidence is moderate to high for school-based interventions, the limited number of studies and insufficient or low strength of evidence to support interventions in other settings made it difficult to conclude that interventions in other settings could effectively prevent childhood obesity. Based on the evidence gaps in these settings, we identified the following as Future Research Needs: Future research is needed on interventions delivered in settings other than schools or home. While there have been other reviews on the effectiveness of interventions on food and nutrition policies at school on changes in children's diet and school food environments, there are still gaps in the literature on some aspects, such as the impact of regulations on food availability and its impact on obesity prevention. Only a few studies that we reviewed used social marketing to deliver messages on nutrition, physical activity and health. This approach might be integrated with other intervention components to create an atmosphere favorable to healthy and active lifestyles and related behavioral changes. Further testing of the value of consumer health informatics products for obesity prevention is needed. In addition, there is a lack of evidence on the impact of regional or national policies on childhood obesity prevention. Further research might be conducted with stratified analyses on subgroups, such as by gender, age, race/ethnicity, or socioeconomic status. There were methodological limitations of the reviewed studies which suggest that future research might improve upon the methods. Few of the studies we reviewed reported process evaluation, which would provide useful insight regarding why some studies might detect desirable effect of the intervention. Future studies need to design innovative approaches that have a high likelihood of sustainability. This may be designed to take advantage of other existing public health, government or other organization supported programs or try to gain more support and engagement from related key stakeholders. The objective of this report is to prioritize the needs for research addressing gaps in the existing literature on the effectiveness of childhood obesity prevention programs by engaging expert stakeholders using a modified Delphi method.

As the public health threat of childhood obesity has become clear, the issue has become the focus of local, state, and national initiatives. Many of these efforts are centered on the community environment in recognition of the role of environmental factors in individual behaviors related to food and physical activity. In many communities, for example, fresh produce is not available or affordable, streets and parks are not amenable to exercise, and policies and economic choices make fast food cheaper and more convenient than healthier alternatives. Community efforts to combat obesity vary in scope and scale; overall, however, they remain fragmented, and little is known about their effectiveness. At the local level, communities are struggling to determine which obesity prevention programs to initiate and how to evaluate their impact. In this context, the Institute of Medicine held two workshops to inform current work on obesity prevention in children through input from individuals who are actively engaged in community- and policy-based obesity prevention programs. Community perspectives were elicited on the challenges involved in undertaking policy and programmatic interventions aimed at preventing childhood obesity, and on approaches to program implementation and evaluation that have shown promise. Highlights of the workshop presentations and discussions are presented in this volume.

OBJECTIVES: Childhood obesity is a serious health problem in the United States and worldwide. More than 30 percent of American children and adolescents are overweight or obese. We assessed the effectiveness of childhood obesity prevention programs by reviewing all interventional studies that aimed to improve diet, physical activity, or both and that were conducted in schools, homes, primary care clinics, childcare settings, the community, or combinations of these settings in high-income countries. We also reviewed consumer health informatics interventions. We compared the effects of the interventions on weight-related outcomes (e.g., body mass index [BMI], waist circumference, percent body fat, skinfold thickness, prevalence of obesity and overweight); intermediate outcomes (e.g., diet, physical activity); and obesity-related clinical outcomes (e.g., blood pressure, blood lipids). DATA SOURCES: We searched MEDLINE(r), Embase(r), PsycInfo(r), CINAHL(r), clinicaltrials.gov, and the Cochrane Library through August 11, 2012. METHODS: Two reviewers independently reviewed each article for eligibility. For each study, one reviewer extracted the data and a second reviewer verified the accuracy. Both reviewers assessed the risk of bias for each study. Together, the reviewers graded the strength of the evidence (SOE) supporting interventions--diet, physical activity, or both--in each setting for the outcomes of interest. We quantitatively pooled the results of studies that were sufficiently similar. Only experimental studies with followup of at least 1 year (6 months for studies in school settings) were included. We abstracted data on comparisons of intervention versus control. RESULTS: We identified 34,545 unique citations and included 131 articles describing 124 interventional studies. The majority of the interventions (104 studies) were school based, although many of them included components delivered in other settings. Most were conducted in the United States and in the past decade. Results of four studies were pooled for BMI and four for BMI z-score in the school-only setting; results of five school-home studies were pooled for BMI. Other studies tested interventions delivered at home (n=6), in primary care (n=1), in childcare (n=4), and in the community (n=9). Six studies tested consumer health informatics interventions. For obesity prevention, the following settings and interventions showed benefit: school-based--diet or physical activity interventions (SOE moderate); school-based with a home component--physical activity interventions (SOE high) and both diet and physical activity (SOE moderate); school-based with home and community components--diet and physical activity interventions (SOE high); school-based with a community component--diet and physical activity interventions (SOE moderate); community with a school component--diet and physical activity interventions (SOE moderate). The strength of the evidence is either low or insufficient for the remainder of the interventions and settings. CONCLUSIONS: The evidence is moderate about the effectiveness of school-based interventions for childhood obesity prevention. Physical activity interventions in a school-based setting with a family component or diet and physical activity interventions in a school-based setting with home and community components have the most evidence for effectiveness. More research is needed to test interventions in other settings, such as those testing policy, environmental, and consumer health informatics strategies.

Obesity is now an epidemic among children and adolescents in the United States. Nationwide, roughly nine million children over six years of age are obeseâ€"with elevated risks of both health conditions, such as diabetes and hypertension, and poor quality of life, possibly throughout adulthood. The Institute of Medicine (IOM) report, Preventing Childhood Obesity: Health in the Balance, was released in September 2004 and identified promising approaches for obesity prevention efforts and a set of recommendations for a variety of stake holders and sectors. The IOM is building on its previous work by initiating a new study to assess progress in childhood obesity prevention efforts. In 2005, the IOM organized three regional meeting in the Midwest, South, and Western United States to galvanize obesity prevention efforts of local, state, and national decision-makers, community and school leaders, grassroots organizations, and industry including the food, beverage, restaurant, leisure, and entertainment industries. In collaboration with the Kansas health Foundation (KHF), the IOM held the study's first regional symposium in Wichita, Kansas on June 27-28, 2005. The symposium was structured to include three panels that focused on challenges and innovations for obesity prevention and school policies, school programs, and additional steps that can be taken by numerous stakeholders to overcome barriers to progress. Three break-out sessions focused on creating and strengthening linkages with other sectors to promote childhood obesity prevention including links between schools and home, community, and health care; links between schools and industry; and links between schools and the built environment. This brief summary highlights the recurring themes for accelerating change and moving forward with obesity prevention efforts that emerged from the symposium; forge strategic partnerships; empower local schools and communities; educate stakeholders; evaluate obesity prevention efforts; document the benefits of obesity preventions; innovate to address barriers; use a systems approach; and develop a long-term strategic plan. The findings of this summary, along with those of two other symposia, and a more detailed discussion of insights and regional examples will be incorporated in the committee's final report that will be released in 2006.

Obesity is one of the biggest public health challenges in the 21st century. Devising effective policy and practice to combat childhood obesity is a high priority for many governments and health professionals internationally. This book brings together contributors from around the world and showcases the latest evidence-based research on community and policy interventions to prevent unhealthy weight gain and improve the health and well-being of children. The authors highlight from the evidence available what is and what is not effective and provide recommendations on how to implement and evaluate promising interventions for obesity prevention. This book is an essential read for all public health practitioners, early childhood professionals, health care providers and clinicians working to reduce the prevalence of childhood obesity in their communities.