National commitment to recess, healthy food, environment, and research are keys to childhood obesity

Evaluating the Let's Move! Initiative, Dr. Melinda Sothern, Professor of Public Health and Jim Finks Chair of Health Promotion at LSU Health Sciences Center New Orleans, calls First Lady Michelle Obama brave for taking on the challenge of childhood obesity and suggests that she now consider working to move it up to the policy level. Dr. Sothern, a national authority on childhood obesity, The issue includes a foreword by the First Lady and a guest editorial coauthored by New Orleans Saints quarterback and NFL Offensive Player of the Year Drew Brees.

"As we move forward, I would like for her to consider: Can her agenda become a policy that will have a great and lasting impact on children's health?" says Dr. Sothern. "Perhaps the Let's Move! campaign can be elevated into a 'Let's Move Our Families Toward a Healthier Lifestyle Act,' for example, which reduces the emphasis on and homework in schools and acknowledges the value of physical fitness and , and requires recess and healthy nutrition. This should also include an increased emphasis on smart planning using a multilevel approach and shared resources to restructure neighborhood environments so that they promote —not act as a barrier to the prevention of . And, if she needs the researchers to provide information to assist with this process, we are here. We can do that for her."

Dr. Sothern, an exercise physiologist and author of Trim Kids and two volumes of The Handbook of Pediatric Obesity, stresses the importance of recess and free outdoor play for children. "Nationwide, we need to reinstate unstructured free play, recess, in the school environment." She also notes one of the biggest barriers to physical activity for children is the lack of safe places to play outside. But preventive intervention should begin much sooner.

"I think that health education for parents to prevent childhood obesity needs to begin with the first visit to the OB/GYN office during the initial pregnancy exam," says Dr. Sothern.

Dr. Sothern, whose Trim Kids program was recognized by the National Cancer Institute as a gold standard for risk reduction, notes that while lack of funding limits enforcement of policies like those recently developed for the National School Lunch Program, they still raise awareness and affect the social norm.

"I do think that there are things communities can do regardless of policy," Dr. Sothern maintains. "There are healthy community projects where multiple levels of society are brought in—industry, the medical community, hospitals, schools, universities—and they all come together and form a coalition. Then they basically decide together what initiative to pursue to help improve youth access to healthy foods and safe areas to engage in physical activity. The results of these coalitions are sometimes really surprising."

Dr. Sothern concludes that more research is needed to close the gap in preventing and controlling obesity. "Epigenetic research is vital. The research to examine the genetic, epidemiological, and behavioral factors that promote this resistant obesity—the kind of obesity that, once we see these children in our practices, is very difficult to treat and to manage. We need more research dollars for examining the link between obesity, inflammation, and metabolic disease. We need long-term studies of intense, behavioral, family-based programs that focus on multiple generations of obesity and attempt to break the cycle."

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