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Office of the Surgeon General (US). The Surgeon General's Vision for a Healthy and Fit Nation. Rockville (MD): Office of the Surgeon General (US); 2010.

Cover of The Surgeon General's Vision for a Healthy and Fit Nation

The Surgeon General's Vision for a Healthy and Fit Nation.

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Opportunities for Prevention

Interventions to prevent obesity should focus not only on personal behaviors and biological traits, but also on characteristics of the social and physical environments that offer or limit opportunities for positive health outcomes. Critical opportunities for interventions can occur in multiple settings: home, child care, school, work place, health care, and community.

Individual Healthy Choices and Healthy Home Environments

As a society, we have to begin to change our habits one healthy choice at a time. Change starts with the individual choices we as Americans make each day for ourselves and those around us. Balancing good nutrition and physical activity while managing daily stressors is always a challenge, but one that can be achieved. Finding time to shop for and prepare healthy meals after work and between family activities requires planning. Stress and a lack of available healthy and affordable foods are some of the reasons why many people turn to fast food as a regular source for meals. Eating excess calories contributes to obesity, but so does watching too much television48 and sitting for hours in front of a computer.

This fact is especially true for children and teenagers. Technological advancements have made our lives more convenient—but also more sedentary. Research shows that leading an inactive life not only increases the risk of becoming overweight or obese, but also contributes to an increased risk for disease and disability.51

The good news is that we can overcome these challenges—and the reward is the creation of a healthy and fit nation. Healthy choices include:51–53

  • Reducing consumption of sodas and juices with added sugars.
  • Reducing consumption of energy dense foods that primarily contain added sugars or solid fats.
  • Eating more fruits, vegetables, whole grains, and lean proteins.
  • Controlling your portions.
  • Drinking more water.
  • Choosing low-fat or non-fat dairy products.
  • Limiting television viewing time and consider keeping televisions out of children’s rooms.
  • Becoming more physically active throughout the day.
  • Breastfeeding exclusively to 6 months.

Creating a Healthy Home Environment

As adults, we need to help our children get off to a good start. The earliest risks for childhood obesity begin during pregnancy. Excess weight gain, diabetes, and smoking during pregnancy are not just health risks for the mother—they also put children at risk for obesity early in life. Keeping pregnancy weight gain within recommended limits will help prevent diabetes in the mother. Stopping cigarette smoking and abstaining from alcohol and drug use will protect the health of the mother and the baby.

The earliest decisions regarding food, activity, and television viewing occur in the home. Parents and other caregivers play a key role in making good choices for themselves and their loved one. Children and teenagers look to their mothers and fathers and other caregivers to model healthy lifestyle habits, and adults need to teach by example. In some households, several generations may live together or have responsibility for children at different times during the day. This sharing of duties requires coordination and consistency in activities and habits related to food shopping and preparation, access to physical activity, and limits on television and computer use.

Both young children and teenagers learn from the choices they see adults make. One way to help children learn is to involve all family members in family-based physical activities and in planning, shopping for, and preparing meals. These activities provide both an education in healthy nutrition and exercise, as well as a critical foundation for how to make healthy lifestyle choices.

Healthy Food Choices

The first decision that parents make about what to feed their child occurs during pregnancy. After the baby is born, mothers should breastfeed whenever possible because it provides the highest quality of nutrition and helps to prevent early childhood obesity.46 By age 2, children should be drinking low-fat or non-fat milk. As parents, we are in charge of the foods we provide to our children. Creativity with food preparation can often solve the problems presented by picky eaters. Adults also should offer children small portions and show them how to eat slowly and enjoy their meal.

Healthy Teenagers

The teenage years present unique challenges. Adolescence is a time of vulnerability to the development of psychiatric disorders, including eating disorders, depression, drug and alcohol abuse. Adolescent boys and girls are subjected to significant peer pressure related to eating and exercise, and most school systems provide limited opportunities for physical activity. Teenagers often drink more carbonated and caffeinated beverages and eat more fast foods. These multiple stresses and unhealthy habits make teenagers particularly vulnerable to becoming sedentary, overweight, and obese. An obese teenager has a greater than 70% risk of becoming an obese adult.34 Parents should guide their teenagers to become fit and healthy adults while being cautious not to trigger unhealthy eating behaviors or eating disorders.

Physical Activity

Scheduling time for the recommended levels of physical activity is essential to overall health. Physical activity can help control weight, reduce risk for many diseases (heart disease and some cancers), strengthen your bones and muscles, improve your mental health, and increase your chances of living longer.51

Adults should do at least 150 minutes of moderate-intensity physical activity per week.51 Aerobic activity such as brisk walking or general gardening should be done in episodes of at least 10 minutes and preferably should be spread throughout the week. For children and teenagers, the recommendation is for 1 hour of daily physical activity that includes vigorous activities and activities that strengthen their bones.51

Making physical activities fun can affect how children and teenagers respond to changes in their routine. Programmed, repetitious exercise may work for adults, but it rarely works for children. Look for ways to add physical activity throughout the day. When possible, parents should walk with children to and from school, and children should have scheduled time to play. Because safety is a real concern in many neighborhoods, citizens should talk with their local elected officials and members of law enforcement to find ways to improve safety so everyone can walk or play outdoors.

Television and Computer Use

In recent years, we have witnessed an explosion of technological advances in televisions, home entertainment centers, computers, and video game players. A new report released in 201054 found that nearly two-thirds of kids aged 8 – 18 say the TV is usually on during meals and nearly half report the TV is left on “most of the time” in their home. Seven in ten young people have a TV in their bedroom and 50% also have a console video game player in their room. Overall, 8–18 year-olds spend over 7 hours per day using entertainment media (TV, video games, computers) amounting to more than 53 hours a week.

The hours that adults, teenagers, and children are spending in front of a television or computer screen contribute to their sedentary lifestyle and increase their risk for obesity. In particular, the more time children spend watching television, the more likely they are to eat while doing so and the more likely they are to eat the high-calorie food that are heavily advertised to both adults and children.55

Most parents either do not set limitations on screen time or don’t enforce them. Studies have shown that when parents establish rules and implement them, screen time declines by 2 hours per day, leaving opportunities for more physical activity. Parents need to be role models by limiting their own television time and spending more time with their children.

Creating Healthy Child Care Settings

Early childhood settings, including child care and early childhood education programs, affect the lives of millions of U.S. children. In 2005, 61% of children aged 0–6 years who were not yet in kindergarten (about 12 million children) received some form of child care on a regular basis from someone other than their parents.56 Child care programs should identify and implement approaches that reflect expert recommendations on physical activity, screen time limitations, good nutrition, and healthy sleep practices. Early childhood providers, like parents, should model healthy lifestyle behaviors and teach children how to make healthy choices. They also should reach out to parents to encourage them to practice and promote healthy habits at home.

To choose a healthy child care environment, parents should:

  • Ask childcare providers about their approach to promoting healthy lifestyles for children.
  • Visit the setting to see how childcare providers model and teach physical activity, good nutrition, and healthy sleep practices.
  • Ask childcare providers how they keep parents informed about what they can do at home to support their child’s physical activity, good nutrition, and healthy sleep practices.
  • Ask childcare providers about their support of breastfeeding, breast milk storage and handling.

Child care providers should:

  • Identify and use resources that recommend effective approaches to promoting physical activity, good nutrition, and healthy sleep in early childhood settings.
  • Establish and post policies, procedures, and practices that support these approaches in ways that respect local communities and cultures.
  • Stay current in these approaches through required regular training.
  • Educate and involve parents in trainings and other activities.

State regulations regarding physical activity, nutrition, and screen time vary greatly among child care settings by state and type (e.g., Head Start, center-based child care, family-based child care). Standardized national goals for early child care—especially ones related to healthy weight—would improve the quality of early childhood settings and give childcare providers and parents a foundation to improve their knowledge and skills to support these goals.

For example, recommended policies that can help child care programs support healthy weight for young children include the following:

  • Require 60 minutes of a mix of structured and unstructured daily physical activity.
  • Establish nutrition requirements in child care by using national recommendations such as the Dietary Guidelines for Americans.
  • Use a structured approach to training child care providers how to promote physical activity and good nutrition and how to educate and involve parents in these activities.
  • Give parents materials that reinforce the practices of child care settings that promote physical activity and good nutrition and limit screen time.

Creating Healthy Schools

Schools play a pivotal role in preventing obesity among children and teenagers. Each school day provides multiple opportunities for students to learn about health and practice healthy behaviors that affect weight, including physical activity and good nutrition. Well-designed school programs can promote physical activity and healthy eating, reduce the rate of overweight and obesity among children and teenagers, and improve academic achievement.57–64

To ensure that nutrition and physical activity programs are effective, school administrations need physical education specialists, health education specialists, and certified food service staff. Schools should encourage and reinforce healthy dietary behaviors by providing nutritious and appealing foods and beverages in all venues accessible to students, including the cafeteria, vending machines, school stores, and concession stands. A substantial percentage of students’ recommended physical activity can be provided through a comprehensive school-based physical activity program that includes high-quality physical education, recess and other physical activity breaks, intramurals and physical activity clubs, interscholastic sports, and walk- and bike-to-school initiatives.65–66

High-quality physical education gives young people a chance to learn the skills needed to establish and maintain physically active lifestyles throughout their lives. States and local school districts set requirements for physical activity levels.

In 2006, few schools provided daily physical education or its equivalent for the entire school year to all students.67 Nationwide, only 30% of high school students attended physical education classes 5 days in an average school week, compared with 42% in 1991.68

To help students develop healthy habits, schools should have comprehensive wellness plans that include:

  • An active school health council to guide health-related policy decisions.
  • A planned and sequential health education curriculum for pre-kindergarten through grade 12. This curriculum should be based on national standards and address a clear set of behavioral outcomes that empower students to make healthy dietary choices and meet physical activity recommendations.
  • A school and school workplace wellness policy that includes teachers and other school employees to model healthy behaviors.
  • A comprehensive professional development and credentialing program for staff that addresses health education, physical education, food service, and health services.
  • Partnerships with parent-teacher organizations, families, and community members to support healthy eating and physical activity policies and programs.

To promote healthy nutrition, schools should:

  • Establish nutrition standards that promote healthy nutritious foods.
  • Ensure availability of appealing, healthy food options that that enable students to comply with recommendations in the U.S. Dietary Guidelines for Americans, including fresh fruits and vegetables, whole grains, and lean proteins.
  • Use presentation, marketing, and education techniques to encourage students to eat more fruits and vegetables, whole grains, and lean proteins and to drink more water and low-fat or non-fat beverages.
  • Make sure water is available throughout the school setting.
  • Limit amounts of high calorie snack options, including beverages in vending machines.

To promote physical activity, school systems should:

  • Require daily physical education for students in pre-kindergarten through grade 12, allowing 150 minutes per week for elementary schools and 225 minutes per week for secondary schools.
  • Require and implement a planned and sequential physical education curriculum for pre-kindergarten through grade 12 that is based on national standards.
  • Require at least 20 minutes daily recess for all students in elementary schools.
  • Offer students opportunities to participate in intramural physical activity programs during after-school hours.
  • Implement and promote walk- and bike-to-school programs.
  • Establish joint use agreements with local government agencies to allow use of school facilities for physical activity programs offered by the school or community-based organizations outside of school hours.

Creating Healthy Work Sites

The majority of the 140 million men and women who are employed in the United States spend a significant amount of time each week at their work site. Wellness programs in the workplace are an effective way to support people’s efforts to achieve and maintain a healthy weight.69 Because obesity reduces worker productivity70–71 and increases health care costs, employers are becoming more aware of the need to address risk factors for poor nutrition and physical inactivity through workplace initiatives.

Research has shown that health promotion programs in the workplace can be cost effective and well worth the ongoing costs of implementing these programs.72–75 Because the health and productivity of an employer’s workforce is affected by the vitality of the communities in which employees reside, businesses will benefit from being actively involved in health promotion efforts within their communities.76

To create healthy work sites, employers can:

  • Establish and promote creative work site wellness programs, ask employees to be wellness champions, and set up ongoing employee challenges.
  • Support employees who want to breastfeed by providing written policies and designated private, clean spaces for breastfeeding or expressing milk.
  • Create a culture of wellness by integrating messages about the benefits of physical activity and healthy eating into the workplace.
  • Provide opportunities and incentives for physical activity through onsite facilities, group classes or personal training, outdoor exercise areas, walking paths, and stairwell programs.
  • Make healthy food and beverage available and affordable in the workplace.
  • Become active partners in the health promotion efforts of local community groups, such as community coalitions and task forces.
  • Sponsor community health events.
  • Help develop government policy and legislative initiatives that support employee wellness programs.
  • Provide health benefits that offer employees and their dependents coverage for obesity-related services and programs.

Mobilizing the Medical Community

In 2002, Americans made an estimated 166 million visits to medical offices.77 People access the health care system through multiple channels, and medical care settings are an important avenue for preventing and controlling overweight and obesity. Clinicians are often the most trusted source of health information and can be powerful role models for healthy lifestyle habits.

Clinicians should make it a priority to teach their patients about the importance of achieving and maintaining a healthier body weight, becoming more physically active, selecting healthier food options and managing stress. They should provide comprehensive resources to help patients make healthy lifestyle choices. These resources should include in-office access or referrals to registered dietitians, health educators, counselors, psychologists, and fitness professionals, as well as to links to community resources.78

To help their patients make healthy lifestyle choices, clinicians should:

  • Measure patients’ BMI and explain the connection between BMI and increased risk for disease and disability.
  • Record patients’ physical activity levels and stress the importance of consistent exercise and daily physical activity.
  • Assess and record information on patients’ dietary patterns.
  • Use terms that are appropriate for families and children to define healthy weight and BMI and explain how to achieve this goal.
  • Work as a team to provide a comprehensive assessment and learning experience for each patient.
  • Ensure that patients are referred to resources (both internal and external) that will help them meet their psychological, nutritional, and physical activity needs
  • Promote awareness about the connection between mental and addiction disorders and obesity.
  • For treatment of people with severe mental illness who are at risk for overweight or obesity, consider medications that are more weight neutral.

To support clinicians and their staff, the health care system should:

  • Encourage clinicians and their staff to practice healthy lifestyle behaviors and be role models for their patients.
  • Use best practice guidelines to teach health professional students and clinicians how to counsel patients on effective ways to achieve and maintain healthy lifestyle habits.
  • Promote effective prenatal counseling about maternal weight gain, breastfeeding, the relationship between obesity and diabetes, and the need to avoid alcohol, tobacco, and drug use during pregnancy.
  • Help clinicians and their staff advocate for community strategies that improve nutrition and physical activity resources for their patients.
  • Promote innovative ways that clinicians and their staff can advocate for policy changes at local, state, and federal levels that will make it easier for their patients to adopt and sustain healthy habits.

Improving Our Communities

Americans need to live and work in environments that help them practice healthy behaviors. The social, cultural, physical, and economic foundations of a community are important factors in its ability to support a healthy lifestyle for its citizens. For example, government and private organizations should pool their resources to increase access to healthy foods—such as ensuring that all neighborhoods, especially in low-income areas, have full-service and safe options for physical activities, such as walking and bike paths, sidewalks, and parks.

To reverse the obesity epidemic, every neighborhood and community should become actively involved in grassroots efforts to create healthier environments for all citizens, from infants to older adults. Individuals and groups of private citizens should work closely with community leaders to make the changes needed to support healthy lifestyles.

To help lead our nation toward healthy eating and active living, The Centers for Disease Control and Prevention has recommended the following strategies:79

  • Increase availability of healthy, affordable food and beverage choices in public service venues.
  • Improve geographic availability of supermarkets in underserved areas.
  • Improve access to fresh fruits and vegetables by providing incentives for the production, distribution, and procurement of foods from local farms.
  • Limit advertisements of less-healthy foods and beverages.
  • Increase support for breastfeeding.
  • Promote exclusive breastfeeding and worksite accommodations to express human milk.
  • Improve access to outdoor recreational facilities.
  • Build or enhance infrastructures to support more walking and bicycling.
  • Support locating schools within easy walking distance of residential areas.
  • Improve access to public transportation.
  • Support mixed-use development.
  • Enhance personal and traffic safety in areas where people are or could be physically active.
  • Participate in community coalitions or partnerships to address obesity.

Community coalitions across the United States are working with their leaders, advocating for change, and seeing real results. All communities across the country should have community coalitions that focus on the health and wellness of their citizens. The most effective coalitions include representation from all sectors—businesses, clinicians, schools, academia, government, and the faith community. These groups work together to assess the physical and social community, develop a plan when change is needed, and take action. History has shown that grassroots movements can make positive changes in their communities.


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