Appendix A: Examples of Federal Programs and Initiatives

Programs on overweight and obesity span multiple departments, offices, and agencies in the Federal Government and promote valuable research and action in various settings. These programs are amplified by State, Tribal, local, and private-sector activities. Some examples of Federal initiatives on overweight and obesity, and the programs that support them, are listed below. For more information on a number of these programs, please see appendix B.

Setting 1: Families and Communities

1. The Centers for Disease Control and Prevention (CDC) has a community planning tool called the Planned Approach to Community Health (PATCH). This tool can be valuable in the process of developing and sustaining action.
2. The Federal Highway Administration, the Environmental Protection Agency, and the Georgia Department of Transportation have developed Strategies for Metropolitan Atlanta’s Regional Transportation and Air Quality, a document that provides a framework for assessing which factors of land use and transportation investment policies have the greatest potential to reduce the level of automobile dependence, which may consequently increase walking and bicycling activities while promoting the economic and environmental health of the Atlanta metropolitan region.
3. The Head Start Bureau of the Administration for Children and Families, in conjunction with members of the community and various Federal agencies, will convene a focus group in fall 2002 to identify issues, effective practices, and recommendations addressing overweight in children of the Head Start Program.
4. The Head Start Bureau has published a Training Guide for the Head Start Learning Community: Enhancing Health in the Head Start Workplace. The guide addresses the importance of health in the workplace and presents health promotion principles and activities that can be applied to a variety of workplace health issues, including achieving and maintaining a healthy weight.
5. The Health Resources and Services Administration (HRSA) has sponsored Statewide Partnerships in Women's Health that have begun a new prevention initiative entitled WISEWOMAN. Three Statewide Partnerships in Women's Health grantees (Alaska, North Carolina, and Vermont) have WISEWOMAN programs in their States. These grantees are encouraged to collaborate with the WISEWOMAN programs in their States and with other community-based partners to support cardiovascular screenings for women aged 40 to 64 years who then receive nutrition counseling and physical activity support.
6. Under the Healthy People 2010 initiative, the Department of Health and Human Services (HHS) has produced the document Healthy People in Healthy Communities: A Community Planning Guide Using Healthy People 2010. This document is a guide to developing an action plan through building community coalitions, creating a vision, measuring results, and creating partnerships. It outlines strategies to help start community activities.
7. HHS sponsored the development of a Healthy People 2010 Toolkit to provide guidance, technical tools, and resources to groups as they develop and sustain a successful plan of action. The Toolkit is organized around common elements of health planning and improvement and provides useful tips for getting started.
8. HHS has recently released a Blueprint for Action on Breastfeeding. The Blueprint for Action, which was developed by health and scientific experts from 14 Federal agencies and 23 health care professional organizations, offers action steps for the health care system, families, the community, researchers, and the workplace to better focus attention on the importance of breastfeeding.
9. HHS, the U.S. Department of Agriculture (USDA), and other organizations have collaborated to form the United States Breastfeeding Committee. They have developed Breastfeeding in the United States: A National Agenda, which is a strategic plan to protect, promote, and support breastfeeding.
10. The Indian Health Service and Head Start Bureau have partnered in the development of an initiative, Healthy Children, Healthy Families, and Healthy Communities: A Focus on Diabetes and Obesity Prevention, which has focused on obesity and diabetes prevention activities for Head Start children, families, staff, and communities.
11. The National Institutes of Health (NIH) Pathways research fosters culturally appropriate healthy eating practices and increased physical activity among American Indian children, their families, food service staff, and physical education and classroom teachers.
12. NIH and the National Recreation and Park Association have developed the Hearts N’ Parks program, which will create national dissemination magnet sites for implementing activities encouraging healthy eating and physical activity.
13. NIH has developed a health awareness campaign called Sisters Together: Move More, Eat Better to encourage African American women in Boston to maintain or achieve a healthier weight by increasing their physical activity and eating healthy foods. NIH is currently expanding this program to other sites.
14. The Office for American Indian, Alaska Native, and Native Hawaiian Programs has developed the Wisdom Steps Health Promotion Program for Elders, a partnership between the Tribes and Minnesota’s State Unit on Aging. The program promotes health awareness, with major emphasis on assisting elders in weight loss, participation in exercise programs, improvement of diet, and smoking cessation.
15. The Office on Women’s Health has developed the Girls and Obesity Initiative, serving to identify existing government obesity programs and to adapt these programs toward gender-specific guidance for girls.
16. USDA’s Cooperative State Research, Education, and Extension Service (CSREES) has developed a nationwide project, Reversing Childhood Obesity Trends: Helping Children Achieve Healthy Weights. This project will achieve its goals through the integration of research, education, and innovative approaches to help children achieve healthy weights. The project will test a number of program interventions designed to reduce the prevalence of childhood overweight and obesity in various populations. Both quantitative and qualitative methodologies will be employed in determining the most appropriate and effective program intervention for a specific population.
17. CSREES also funds WIN the Rockies (Wellness IN the Rockies), which seeks to improve attitudes and behaviors about food, physical activity, and body image among rural residents of Idaho, Montana, and Wyoming in order to reverse the rising tide of obesity. Interventions will be community based and will target youth, limited-resource audiences, and overweight or obese adults.
18. The Women, Infants, and Children (WIC) Farmer’s Market Nutrition Program was established by Congress to provide fresh and nutritious foods from farmers’ markets to low-income families participating in the WIC program.

Setting 2: Schools

1. The Assistant Secretary for Health, the Assistant Secretary of Elementary and Secondary Education, and USDA’s Under Secretary for Food, Nutrition, and Consumer Services co-chair a Federal Interagency Committee on School Health that serves to integrate efforts across three Cabinet departments to improve the health and education of young people, including efforts to prevent and decrease obesity.
2. CDC currently supports 20 State education agencies for coordinated school health programs to reduce the following chronic disease risk factors: tobacco use, poor eating habits, physical activity, and obesity. CDC also has developed guidelines for school health programs based on a review of published research and input from academic experts.
3. School Health Index for Physical Activity and Healthy Eating: A Self-Assessment and Planning Guide, is a guide developed by CDC that enables schools to identify strengths and weaknesses of their physical activity and nutrition policies and programs; develop an action plan for improving student health; and involve teachers, parents, students, and the community in improving school services.
4. CDC and USDA are developing a mentoring curriculum to promote nutrition and physical activity in 11- to 18-year-old African American males in an effort to address racial disparities in nutrition and physical activity.
5. CDC, the President’s Council on Physical Fitness and Sports (PCPFS), and the Department of Education have developed a report, Promoting Better Health for Young People Through Physical Activity and Sports, in which they describe strategies to increase the number of youth engaging in physical activity.
6. PCPFS has developed the President’s Challenge Physical Activity and Fitness Awards Program, incorporating the Presidential, National, Participant, and Health Fitness Awards, and for the first time this year, the Presidential Active Lifestyle Award; the State Champion Award; the National School Demonstration Program; and the Presidential Sports Award Program as means of encouraging individual children and schools to adopt and maintain an active, fit, and healthy lifestyle.
7. USDA has launched efforts to foster healthy school environments that support proper nutrition and the development of healthful eating habits, including re-emphasizing regulations that prohibit serving foods of minimal nutritional value in the food service area during meal periods.
8. USDA’s Team Nutrition includes a multitude of nutrition education materials for children ranging from prekindergarten through high school that support concepts to maintain a healthy weight. Team Nutrition provides grants to States promoting the Federal Dietary Guidelines for Americans, healthy food choices, and physical activity.
9. USDA’s Team Nutrition resources include a Food and Nutrition Service’s “action kit,” Changing the Scene: Improving the School Nutrition Environment, which can be used at the State and local levels to educate decision makers about the role school environments play in helping students meet the goals of the Dietary Guidelines for Americans.

Setting 3: Health Care

1. The Agency for Healthcare Research and Quality is supporting the U.S. Preventive Services Task Force’s update to the 1996 Guide to Clinical Preventive Services chapter on screening for obesity. The report will be expanded to address screening and counseling for overweight and obesity and will assess the effectiveness of primary care-based interventions to prevent or treat obesity.
2. CDC has been active in leading discussions about reimbursement, or inclusion as a member benefit, for services relating to the prevention and treatment of overweight and obesity.
3. CDC is focusing on the prevention of pediatric overweight in the primary care setting.
4. The Department of Defense has developed the LEAN Program, a healthy lifestyle model for the treatment of obesity administered in the Tripler Army Medical Center.
5. HRSA and other partners including PCPFS, NIH, and CDC have developed Bright Futures in Practice: Physical Activity. These guidelines and tools emphasize health promotion, disease prevention, and early recognition of physical activity issues and concerns of infants, children, and adolescents.
6. HRSA, in collaboration with other partners, has developed Bright Futures in Practice: Nutrition. These nutrition guidelines provide a thorough overview of nutrition supervision during infancy, childhood, and adolescence. The guidelines also highlight how partnerships among health professionals, families, and communities can improve the nutritional status of infants, children, and adolescents.
7. HRSA sponsors a Diabetes and Hypertension Collaborative that includes nutrition and weight management education for patients in community health centers.
8. NIH has developed the Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: Evidence Report, which has been formatted into various products suitable for use by physicians and other health professionals.
9. NIH has collaborated with other Federal agencies to conduct and promote research on obesity and associated diseases. These studies focus on biologic and environmental determinants of human overweight and obesity, prevention strategies, and treatment modalities.
10. NIH has developed a Weight-control Information Network to provide health professionals and consumers with science-based materials on obesity, weight control, and nutrition.
11. HHS has charged members of NIH’s National Task Force on Prevention and Treatment of Obesity to publish evidence reviews of overweight and obesity in leading medical journals to provide clinicians with the latest and most accurate information.

Setting 4: Media and Communications

1. CDC is using existing surveillance systems to develop biennial reports on national, State, and local trends in the prevalence of cardiovascular disease, cancer, and diabetes; the risk factors related to these diseases; and the school-based programs that may reduce these risk factors.
2. CDC, in conjunction with PCPFS and other private and public agencies, is Promoting Better Health for Young People Through Physical Activity and Sports, a document that reports on the strategies being used to involve families, school programs, recreation programs, community structural environment, and media campaigns on physical activity.
3. The PCPFS Research Digest, a quarterly publication, synthesizes scientific information on specific topics in physical fitness, exercise science, and sports medicine for dissemination to fitness professionals and citizens.

Setting 5: Worksites

1. CDC has developed the Personal Energy Plan (PEP), a self-help program that promotes healthy eating and physical activity in the workplace. Worksites are encouraged to supplement the PEP self-help kits with added activities and modifications to the nutritional and physical environment.
2. CDC has a Web site, Ready, Set, It’s Everywhere You Go: CDC’s Guide to Promoting Moderate Physical Activity, which provides resources and information on how adults can incorporate physical activity into their routines at the workplace.
3. CDC has provided funding to State departments of health in Maine, Montana, New York, and North Carolina for the establishment of health promotion programs at multiple worksites. The programs are intended to formulate and implement policy and environmental changes that support increased physical activity and healthy eating.