c o 1 ( m Thearticle byWang and colleagues in this issue of the American Journal of Preventive Medicine provides important data that highlight the promise of prevention and raise the challenge of treatment in children and adolescents. The authors have calculated the caloric deficits necessary either to return the prevalence of child and adolescent obesity to 5% as it was in the 1970s, thereby achieving the Healthy People (HP) 2010 goal by 2020, or to reduce the current prevalence estimates by 10%, achieving the HP 2020 goal. As indicated in their article, the caloric deficits needed to achieve the HP 2010 goal by 2020 are 33 kcal/day for children aged 2–5 years; 149 kcal/day for those aged 6–11 years; and 177 kcal/day for those aged 12–19 years. To achieve the HP 2020 goal of reducing the prevalence of obesity by 10%, smaller deficits of approximately 5 kcal/day for the first group, 40 kcal/day for the second, and 31 kcal/day for the third, respectively, will be required. A focus on mean weights helps set the caloric goals for population-based prevention efforts. However, because the distribution of BMI and body weight among adolescents is not normally distributed but is skewed toward the upper end of the distribution, use of mean weights for these calculations does not adequately address the substantially greater caloric deficits needed to reduce weight among obese children and adolescents. Obesity prevention and control programs have emphasized policy initiatives to change the food and nutrition environments in which children spend time, such as early care and education centers, schools, and out-ofschool activities. Because the caloric deficit in children aged 2–5 years is so small, prevention is likely be achieved through the implementation of many of the policy measures that are currently under way or are being considered. For example, the Let’s Move Child Care initiative startedbyMichelleObama(www.healthykidshealthyfuture. org) calls for early care and education centers to volun-
Read full abstract