Edited by Jeffrey P.Koplan, Catharyn T.Liverman, Vivica I.Krak, and ShannonLewisham . Published by The National Academies Press , Washington DC , 2007 . Hardback , 475 pages with index . ISBN 9780309102087 . RRP $A86

Reviewed by Boyd Swinburn

School of Exercise and Nutrition Sciences, Deakin University, Victoria

This book critically examines the recent US action on childhood obesity and for the US audience it is right on the button; for the non-US audience, it has some very valuable lessons. It is written by the US Institute of Medicine (IOM) and the title's byline ‘How do we measure up?’ is answered by evaluating progress on the recommendations from their 2005 report Preventing childhood obesity: Health in the balance. How enlightened to have the premier source of independent health advice to the government undertaking a detailed (475 pages) evaluation of government, industry and community progress towards reducing childhood obesity – the first take home message from the book. While this review only relates to the US, many of the lessons learned in this evaluation exercise will be directly or indirectly transferable to the Australasian situation. Naturally, the twin laments throughout the book are the lack of progress in many areas and the widespread lack of evaluation to measure progress. The five conclusions are that: awareness has been raised but investment is still too low; a variety of action is under way in all sectors but more based on values and beliefs than on evidence; current data are inadequate to assess progress; adequate resources need to be committed to evaluation of policies and programs (including monitoring programs) and; all sectors need to conduct different types of evaluation to build the evidence which stimulates action.

The need to strengthen the three areas of evidence-based policy making (knowledge generation, knowledge exchange, and knowledge uptake) is the recurring theme from the book and many practical examples of how this needs to happen are provided. A common evaluation framework has been applied to each sector and this provides a logical and practical way to assess progress across each sector. The language used is measured and accessible and there are many examples of real progress, lack of progress and better ways to measure progress.

The dearth of government leadership and investment (except in isolated cases) is highlighted and parents are also called upon to take a greater responsibility for their children's diet and physical activity. The section on progress made by industry in some ways reflects the US cultural norm of a greater acceptance of commercialisation than is found outside the US. Many challenges are put to the industry but the recommendations don’t address one of the biggest areas of private sector influence – undermining, through effective political lobbying, the progress of public health policies and regulations to reduce the obesogenicity of the food environment. Most of the current positive actions made by the food industry align to their existing business models, albeit with some improvements in nutrient composition of their products. The tougher changes to corporate behaviour to achieve real social responsibility are mentioned but not stressed.

The four broad recommendations are to increase the leadership, policy and resource commitment to childhood obesity action, to evaluate all major intervention programs and policies, to increase monitoring programs (including the public analysis of large proprietary datasets on food purchases and consumption trends), and to foster information sharing activities. A set of specific actions to achieve these are identified and there is no doubt that implementing all these actions would dramatically advance the efforts to reduce childhood obesity. There is also no doubt that having the IOM take a leadership role in making recommendations and monitoring their implementation is also a very important driver for change.

The task of turning around the childhood obesity epidemic in the US is probably much more difficult than in Australia and New Zealand because the food industry is such a dominant force in creating the US culture, environment and policies. Nevertheless, we would greatly benefit from having the equivalent of the IOM producing regular, in-depth reports such as this one on the state of action on childhood obesity down under. I highly recommend this book as a dynamic case study in public health action and inaction from the mecca of obesogenic environments. The readership for the book is likely to be rather limited because it has a specific purpose to report on previous IOM recommendations. However, as action on obesity spreads beyond the health sector into urban planning, transport, the whole food supply chain and community organisations, stakeholders from these other sectors would certainly benefit from looking at the US progress in their sector.