Institute of Medicine Convenes New Obesity Roundtable

Public health, obesity, school, business and community experts convened in Washington, D.C. last week at the inaugural workshop of the Institute of Medicine (IOM) new Roundtable on Obesity Solutions.

The Roundtable will spend the next few years holding meetings, public workshops and innovation collaboratives and producing background papers with a goal of creating consensus on strategies to prevent and reduce obesity said Bill Purcell, co-chair of the Roundtable who previously was the mayor of Nashville, Tenn.

The half day meeting focused on presentations by experts in early childhood education, schools, business, community and public health and speakers were asked to suggest innovations for the Roundtable to consider. Many ideas were repeated as the day wore on, but several novel ideas were presented, among them:

  • Make physical activity a core component of the school day
  • Share what works, in communities and worksites, by sharing effective, evidence-based strategies rather than one-off innovations in individual communities
  • Respect cultural differences and recognize that not all communities will act similarly when it comes to habits and change

Positive trends in reducing obesity that that speakers pointed to during the meeting included data published earlier this year that found a significant downward trend in the levels of obesity in low income preschoolers in 18 states and a plateauing of obesity among women, although rates remain higher among Hispanics and Blacks than among whites.

Bill Dietz, MD, Ph.D., a former director of the Division of Nutrition and Physical Activity at the Centers for Disease Control and Prevention and now a consultant to the IOM, pointed out that in the area of tobacco control, rates of smoking plateaued before policy initiatives were introduced once awareness of the dangers were communicated to the public. “The declines, [in obesity] where they exist, are pretty modest, but [increased awareness] may account for the decreases we’re seeing,” said Dietz.

“We need to focus on policy, which is the most sticky thing we can do, it’s often sustainable, and if done correctly has the opportunity to address equity issues, and is scaleable for different communities,” said Marion Standish, Director of Community Health at the California Endowment.*

Other critical features of obesity initiatives, according to Standish, are that policies have to be enforceable and measureable and “we need to identify those opportunities where we can meaningfully engage community to help build sustainable momentum for change.”

One example of enforceable initiatives presented at the meeting came from Cheryl Bartlett, the Massachusetts Health Commissioner, who said that executive orders from the governor, such as healthy food purchases for schools, were helping the state to create sustainable measures.

Standish also focused on the need to leverage partners including community development, sustainable food groups, health care providers, climate change experts and educators.  “There are all partners we need to engage more actively if we are going to be successful,” said Standish.

Several key officials from the U.S. Department of Health and Human Services spoke or attended, among them, Howard Koh, MD, MPH, the department’s assistant secretary for health.  “Obesity is an area that for so long viewed as hopeless. This round table is about turning no hope into new hope,” Koh said. His talk focused a on physical activity which he called “not magic and not a pill but it is lifesaving and the more attention we can pay to that, the better off we will be because health doesn’t start in a doctor’s office, but where they live, labor, live, play and pray.”

Koh pointed to a new initiative of the President’s Council on Physical Activity, Fitness and Nutrition, a youth fitness test, which created a snapshot of each child based on standards and encourages kids to take on physical activity as a lifelong commitment, as well as obesity related screening and behavioral counseling that are now components of the Affordable Care Act.

“When it comes to obesity, the community is the primary care provider,” said Loel Solomon, Ph.D, vice president for community health at Kaiser Permanente at the company’s headquarters in Oakland, Calif., “and we need to make the healthy choice the easier choice.” Solomon added, “Engagement, not motivation is the issue for obesity care.”  

In an effort to drive action following the meeting, several days after the Roundtable workshop took place, IOM staff sent out a survey to attendees to better gauge how well the initial meeting got all issues on the table and to see how the ideas shared might be carried out in communities.

* The California Endowment is a funder of the California Health Report.

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