Childhood obesity: successes and failures of preventive interventions Berit L Heitmann, Jeffrey Koplan, and Lauren Lissner Despite progress toward assuring the health of today's young population, the 21 st century began with an epidemic of childhood obesity. There is general agreement that the situation must be addressed by means of primary prevention, but relatively little is known about how to intervene effectively. The evidence behind the assumption that childhood obesity can be prevented was discussed critically in this roundtable symposium. Overall, there was general agreement that action is needed and that the worldwide epidemic itself is sufficient evidence for action. As the poet, writer, and scholar Wittner Bynner (1881–1968) wrote, “The biggest problem in the world could have been solved when it was small”. © 2009 International Life Sciences Institute INTRODUCTION In the spirit of the quote above, many obesity researchers believe that preventing obesity in childhood is the key to addressing the global obesity epidemic. This report sum- marizes the main points of the session titled “Prevention of Childhood Obesity” held at the I World Congress of Public Health Nutrition, during which the evidence behind this assumption was discussed critically. The three speakers offered overviews on the general problem, described failures and successes, and discussed how to move forward. OVERVIEW OF THE PROBLEM Despite steady progress over the past century toward assuring the health of today’s young population, the 21 st century began with a major setback – an epidemic of childhood obesity. 1 In the last two decades, for example, the percentage of 10-year-olds with obesity in Sweden nearly quadrupled, while the rate of overweight more than doubled. 2 In Denmark the prevalence of childhood obesity has increased over 20-fold since World War II. 3 Viewed in a broader perspective, however, the rates of childhood obesity in Scandinavia remain lower than in other regions, such as the United States, where approxi- mately 9 million schoolchildren are currently considered obese. 4 In cultures that stigmatize this condition, child- hood obesity involves risks of serious psychosocial prob- lems as well as immediate and long-term risks to physical health. In addition to personal burdens to obese children and their families, societies face considerable economic costs related to childhood obesity, and these will only escalate when today’s children enter adulthood. Children live in a world that has changed dramati- cally in the four decades of the obesity epidemic. As described elsewhere, 4 longer working hours of parents, changes in the school and preschool food environments, and more meals eaten outside the home – together with changes in physical activity patterns – often affect what children eat, where they eat, how much they eat, and the amount of energy they expend during the day. Other changes, such as the growing diversity of the population, influence cultural views and marketing patterns. Televi- sion viewing and the use of computers and video games Affiliation: BL Heitmann is with the Research Unit for Dietary Studies, Institute of Preventive Medicine, Copenhagen University Hospital, Centre for Health and Society, Copenhagen, Denmark. J Koplan is with the Woodruff Health Science Center, Global Health Institute, Emory University, Atlanta, Georgia, USA. L Lissner is with the Public Health epidemiology unit, Department of Public Health and Community Medicine, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden. Correspondence: L Lissner, Department of Public Health and Community Medicine, Sahlgrenska Academy at Göteborg University, Box 454, Göteborg, SE 405 30 Sweden. E-mail: lauren.lissner@medfak.gu.se, Phone +46-31-786-6847, Fax +46-31-778-1704. Key words: childhood obesity, intervention, prevention doi:10.1111/j.1753-4887.2009.00167.x Nutrition Reviews® Vol. 67(Suppl. 1):S89–S93 S89