Weight of the Nation (WON) is a national forum for obesity prevention leaders who are “game changers” — those who are leading the field of innovative obesity prevention practice — to provide opportunities to expand and advance evidence-based and emerging solutions to the epidemic and brainstorm on collaborative efforts to apply these solutions in settings that reach individuals across the lifespan. WON is hosted by the U.S. Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Nutrition, Physical Activity, and Obesity (DNPAO). WON is unique for its conference style which focuses participants on population-level approaches that can be implemented in select settings and sectors and in its use of social media and long-distance training to increase participation and information dissemination.

The Early Care and Education (ECE) track presentations from CDC’s Weight of the Nation (WON) 2012 conference showcased innovative national, state, and community obesity prevention efforts. The track was organized around CDC’s “Spectrum of Opportunities” for obesity prevention in ECE (the Spectrum; Table 1), which outlines a common set of opportunities that can enhance the ECE environment with respect to nutrition, breastfeeding support, physical activity, and screen time — all important areas for obesity prevention targeting young children. Participants discussed the opportunities on the spectrum that had been pursued, the obesity prevention standards and best practices that had been the emphasis of their efforts, and common steps for developing, implementing, and evaluating initiatives. This paper provides background information on why ECE is an important component of any jurisdiction’s obesity prevention efforts, references for the primary national reports offering standards and best practice recommendations, an introduction to the Spectrum, and brief summaries of the WON ECE track presentations.

Engaging the health care setting at the systems level to support healthy eating and active living and prevent obesity can help address the problem of obesity. A number of key attributes of the clinical realm impacts population-level obesity prevention. Health care facilities serve large groups of people, including patients seen at the medical facility, the family and friends who accompany them for visits, as well as the large number of employees who provide care and service the facilities. Thus, system-level improvements to the health care setting have great potential for large reach and impact. In 2011 there were more than 5,700 hospitals registered with the American Hospital Association, with more than 36 million inpatient admissions in the U.S. Even more medical facilities are included in the reach of clinics and other places providing care. These facilities also have the potential to influence the health of the surrounding community by serving as promoters and models of healthy eating and active living, which may influence good health practices. A health care facility services communities by integrative work in both the primary care and public health domains.

With more than 95% of school-aged youth enrolled in schools for 6 hours per day for up to 13 years, schools offer a broad reach to obesity prevention initiatives. Schools reach students of all races and ethnic backgrounds, income levels, and U.S. regions. Therefore, integrating health promotion activities into schools may equalize health disparities by providing access to a healthy environment for most of the nation’s youth, regardless of background. In addition, health behaviors, including physical activity (PA) and nutrition, are related to academic achievement.

Across the nation, local, state, territorial, and tribal governments are engaged in successful efforts to protect and promote the health of their citizens by supporting healthy eating and active living initiatives. The ten essential services define a role for public health at multiple levels of influence (see Table 1). These functions provide a framework for obesity prevention that is consistent with the systems approach presented by the Institute of Medicine in “Accelerating Progress in Obesity Prevention.”

Governmental public health authorities can contribute to public health efforts to address obesity by monitoring prevalence of obesity and association risk factors, investigating the contributing factors, informing the public, and work with the citizens in their jurisdiction to develop solutions that fit the needs and sensibilities of the people.

Worksites are an important setting to promote healthy behaviors as 143 million adults are employed full-time and spend 8-10 hours per day at the workplace. Participation in health promotion programs have been shown to have a “dose response” relationship with health care costs, meaning health care costs decrease as employee involvement in health promotion activities in the workplace increase. Also from the employer perspective, it is important to note that obesity is a risk factor for many other chronic conditions, diabetes, heart disease, and cancer and is known to be related to increase injuries and health care costs. Motivating employees to participate in a number of wellness activities may provide benefits not only for obesity prevention but other desired outcomes such as: risk reduction, risk avoidance, reduced health costs, and improved productivity measures. Employers should be concerned as forecasts suggest that by 2030, 42% of the adult population will be obese. In fact, among employers, the costs of medical expenses and absenteeism increase as employees become more obese. The cost burden of obesity (BMI 30 or greater) ranges from $462-$2,027 among men and $1,372-$2,164 among women in comparison to normal-weight employees. However, halting this trend over the next few decades by maintaining (vs. increasing) current prevalence of obesity could potentially save billions in medical care expenditures related to obesity. Employers can be part of the solution by offering workplace wellness programs and facilitating opportunities for physical activity, access to healthier foods and beverages, and incentives for disease management and prevention to help prevent weight gain among their employees.

Physical inactivity is one of the leading “actual” causes of preventable premature mortality due in large part to its role in obesity and associated morbidities. Currently, less than half (47%) of U.S. adults meet recommendations for aerobic physical activity. For children the numbers are also low, 29% of high school students reported meeting the goal of 60 minutes of daily physical activity over the last week. There has also been a decline in the proportion of children walking or biking to school from 48% in 1969 to 13% in 2009. As a result, promoting physical activity both as recreational exercise and as a part of day-to-day utilitarian travel by foot or bicycle has emerged as a central goal of national and international efforts, often as part of obesity prevention and control efforts.

On May 7-9, 2012, obesity prevention leaders, including public health professionals across federal, state and local levels, policymakers and decision makers, community leaders as well as researchers engaged in policy, systems and environmental (PSE) efforts related to obesity prevention, convened at the Weight of the Nation (WON) conference in Washington, D.C. In recognition of the growing interest in the relationship between the food system and public health, and obesity in particular, organizers of the WON invited leading experts from multiple disciplines to work as a committee to plan five sessions related to these topics. These experts decided to expand the focus of the sessions to include public drinking water systems and to organize sessions with the goal of identifying solutions to create a healthy, sustainable, and equitable food and water system. This paper presents the key themes, challenges, and potential solutions and discussed within the Food and Water System: Agriculture, Access and Sustainability track (hereinafter referred to as the “Food and Water System Track”).

Each of the five main goals set out in the IOM’s report, Accelerating Progress in Obesity Prevention (“IOM Report”), includes recommended strategies and actions that raise questions of law and legal authority. In many instances, the IOM’s recommendations can be accomplished most directly and efficiently through mandatory regulation or legislation — for example, imposing taxes to decrease consumption of sugar-sweetened beverages (SSBs), passing laws that require substantial physical education periods in schools, or promulgating regulations that ensure nutrition standards for foods and beverages sold or served in educational settings. Much has been written on using legislation to support obesity prevention efforts. The route of direct legislation, however, is not always readily available — as the so-far-unsuccessful effort to pass taxes on SSBs, for example, vividly illustrates.