It Does, Indeed, Take a Village: Schools, Families, and Beyond for Weight Control in Children

摘要

Childhood obesity rates have risen alarmingly for decades, and while recent data suggest a possible plateau, obesity is seen in ever-younger children, and is increasingly severe. The proximal cause of obesity is energy imbalance; the root cause is modern living. Throughout most of human history, calories were relatively scarce and hard to get, and physical activity was unavoidable. We have devised a modern world in which physical activity is scarce and hard to get, and calories are unavoidable. The "obesigenic" environment propagates a veritable daily flood of influences into the lives of children and adults alike that favor excess intake of energy-dense foods and inadequate energy expenditure. The requisite defense against this flood is a commensurate barrier of programs, policies, and practices that cultivate the will, and pave the way for the pursuit of better eating, more activity, and better health. Each individual program, policy, or practice that is part of this composite solution constitutes a sandbag in the levee needed to turn the tide of childhood obesity. Since children live with adults, and since family is the basic functional unit of our society, children and adults will attain weight control and achieve health together-or they are unlikely to attain it at all. Studies to date showing limited successes have, by and large, expected too much from a single 'sand bag.' School-based obesity prevention and control interventions, for example, may well be necessary, but are almost certainly not sufficient in the absence of complementary programming in diverse community settings. When, and only, we take enough corrective actions in enough settings; when we reach all members of households in all the places they live, love, work, and play; when the levee stands above the height of the obesigenic flood tide, will we see that tide turn. It will, indeed, take the whole village to get there from here.