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INTRODUCTION

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  • What national policies have been proposed to improve obesity prevention?

  • What are obesity-related messages that I can use in advocating for childhood obesity?

  • What steps can I take to prepare to give legislative testimony?

  • Which national organizations are working on obesity-related policies and advocacy?

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This chapter will address the following American College of Graduate Medical Education competencies: medical knowledge and systems-based practice.

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Medical Knowledge: Medical knowledge of the etiology, epidemiology, and sociobehavioral aspects of obesity is foundational to being an effective advocate at the national level. This chapter will help the pediatric health care provider understand available evidence-based approaches and resources that will allow them to craft both specific and broad-based obesity prevention and treatment policy strategies.

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Systems-Based Practice: Knowledge of the wider system allows health care providers to participate in the larger advocacy effort to end childhood obesity. This chapter will help providers respond to the larger socioecological context and be able to effectively call on resources in the health care system to enhance their work in childhood obesity.

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Pediatric health care providers have a crucial role to play in addressing childhood obesity at the national level. In the Institute of Medicine (IOM) report, “Accelerating Progress in Obesity Prevention,”1 the health care sector was 1 of the 5 environments singled out as crucial in accelerating a solution to the obesity epidemic. It is not hard to appreciate the impact of obesity on population and individual health and on both the direct and indirect costs to the economy. More than 60% of US adults have overweight or obesity, a major driver of cardiovascular and metabolic disease. Over ⅓ of adults aged 40 to 59 years and ¾ of adults older than 60 years have either high blood pressure, coronary heart disease, heart failure, or stroke. Approximately 10% of adults have type 2 diabetes and 37% have prediabetes.2 Over 30% of US children have overweight or obesity,3 representing a major reservoir of chronic illness with escalating costs for physician visits, hospitalizations, and medication.4 Just over 20% of US annual health care spending is accounted for by obesity-related expenditures,5 and it is estimated that reducing obesity-related comorbidities could save $24.7 billion annually.6 The human cost of obesity in terms of decreased function, discrimination, underemployment, and inability to support societal infrastructure (military, emergency, police, and fire) makes advocacy for solutions a societal imperative.

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The ability of pediatric health care providers to focus on population health will be instrumental in finding societal solutions to the increasing shift toward positive energy balance in the population. For example, decreases in active transportation (walking or biking), decreases in the availability and intensity of physical education classes, and increased use of television and other electronic media are compromising the achievement of recommended levels of physical activity in the population.

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Energy intake has escalated directly due to ...

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