Computer Prompt Software to Reduce Sedentary Behavior and Promote Physical Activity Among Desk-Based Workers: A Systematic Review.

OBJECTIVE: Do computer prompt software programs at the workplace reduce sitting time and/or increase physical activity at work? BACKGROUND: Many products are promoted and being used in the workplace; however, their effectiveness and use are unknown or the evidence base that they work to change behavior is lacking. METHOD: We searched for relevant papers published between 2005 and 2020. The inclusion criteria were computer prompt software programs installed as behavioral change interventions; interventions implemented during work hours and delivered through a work personal computer or laptop; and measures of sedentary behavior and/or physical activity. To minimize risk of bias, three recommended best-evidence synthesis criteria were used: random assignment, sample size, and external validity. Based on these criteria, articles were selected and evaluated. RESULTS: Six publications met the quality threshold for review. Seven articles did not meet the quality threshold. Four of the six included publications found that computer prompt software programs decreased sedentary behavior and/or increased physical activity. Two publications reported inconsistent results. CONCLUSIONS: The promising results from this systematic review indicate that there is potential for computer prompt software programs to improve the health of desk-based workers. For conclusive findings, more high-quality, scientific studies are needed. APPLICATION: The best-evidence publications in this review can serve as a guide in selecting and implementing computer prompt software programs at the workplace to decrease sedentary behavior and increase physical activity.

Understanding Variations in the Health Consequences of Sedentary Behavior: A Taxonomy of Social Interaction, Novelty, Choice, and Cognition.

The study of sedentary behaviors requires taxonomies (classification schemes) to standardize data collection, measurements, and outcomes. Three taxonomies of sedentary behaviors have been identified, but none address an important challenge in sedentary behavior research, which is to distinguish between beneficial and detrimental health effects of various sedentary behaviors. Some sedentary behaviors (e.g., reading) are associated with positive health outcomes, whereas other sedentary behaviors (e.g., television viewing) are associated with adverse health outcomes. To address directly this complexity and present a different conception and understanding of discrepant findings related to health outcomes, a new taxonomy is needed. The development of the new taxonomy is guided by analysis of literature and selection of a relevant and informative behavioral sciences theoretical framework (i.e., self-determination theory). Because older adults are an increasing percentage of the population and report a high prevalence of sedentary behaviors, the new taxonomy was designed for older adults with potential application to all age groups. Taylor's taxonomy of sedentary behaviors is parsimonious with four domains: social interaction (i.e., not solitary, companionship, interacting, and connecting with others); novelty (i.e., refreshingly new, unusual, or different); choice (i.e., volition, preferred option or alternative, the power, freedom, or decision to choose); and cognition (i.e., mentally stimulating and engaging).

Delayed gratification and adherence to exercise among patients with claudication.

Few studies have explicitly identified factors that explain an individual's willingness to engage in community-based exercise for claudication. Identifying the unique characteristics of those inclined toward physical activity would inform interventions that encourage walking. We examined the utility of behavioral economics-related concepts in understanding walking among Veterans with claudication. Patients who received care at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, were surveyed on symptom severity, behavioral economics, stress, and depression. The primary outcome was a binary variable measuring current walking for exercise and defined as walking for at least 30 minutes every day. Multivariable logistic regression models were used to identify variables, both clinically and statistically significant, at a p-value < 0.05. Between April 2017 and March 2018, we received 148 (30%) responses. A total of 35% (n = 51) of respondents indicated that they walked recreationally for exercise compared to 65% (n = 94) who did not. Characteristics that were significantly associated with walking included regularly saving money (adjusted odds ratio (aOR) = 10.7, p = 0.001), seeking complex problem-solving (aOR = 0.12, p = 0.002), and severe symptoms (aOR = 0.24, p = 0.017). Individuals describing a preference for the future rather than immediate benefit also reported currently walking for exercise. Defining the characteristics of those who exercise may help inform strategies designed to increase walking among those who do not adhere to recommendations.

Successful Smoking Cessation Associated with Walking Behavior in Patients with Claudication.

BACKGROUND: Behavioral economics theories suggest that a preference for delayed benefits promotes positive behavioral change, a concept relevant to both smoking cessation and community-based exercise regimens for claudication. Given the high rate of smoking among older veterans, we were interested in examining the association between smoking cessation, exercise regimen adherence, and preferences for delayed versus immediate benefits. METHODS: Between April 2017 and March 2018, patients with claudication at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, received questionnaires collecting information on social, behavioral, and psychological characteristics. A dual validation system, via the electronic medical record and survey data, measured the primary outcome-smoking cessation versus current smoking. Self-reported physical activity was measured through the validated Ainsworth's compendium of Physical Activities and binary survey questions. The Walking Impairment and Barratt's Impulsivity Questionnaires measured subjective symptom severity and behavioral economics factors, respectively. Multivariable, logistic regression models identified significant associations. RESULTS: The survey was mailed to 500 patients who met the eligibility criteria. We received responses from 148 individuals (30%), and 67 of 141 (48%) indicated that they had successfully quit smoking. In unadjusted comparisons, the median cognitive complexity score in the smoking cessation group was higher than that in the current smoking group. A greater proportion of patients who reported walking for exercise (n = 46) also reported successful smoking cessation (28/46, 61%). Among those who were not walking for exercise (n = 88), more individuals reported current smoking (49/88, 56%). In the multivariable model, individuals who had successfully stopped smoking were older (odds ratio [OR]: 7.59, P < 0.001), more likely to walk for exercise (OR: 3.94, P = 0.009), more interested in the future than in the present (OR: 1.73, P = 0.030), and more likely to regularly save money (OR: 3.49, P = 0.046). CONCLUSIONS: We found that participants who reported successful smoking cessation were more likely to report walking for exercise. Our findings suggest that adherence to walking may be less challenging for patients who have already successfully implemented and continue to implement another beneficial health behavior (smoking cessation). Patients with claudication who are current smokers may be less likely to adopt exercise recommendations.

Exploring relationships among social integration, social isolation, self-rated health, and demographics among Latino day laborers.

OBJECTIVES: Research indicates social integration and social isolation are related to health, and Latino day laborers (LDLs) tend to be socially isolated and, thus, at high risk for adverse health consequences. relationships among social isolation, social integration, self-rated health (SRH), and demographics were examined in a sample of LDLs to contribute to the literature on social networks and health in this and other migrant populations. DESIGN: We analyzed data from 324 LDLs who participated in Proyecto SHILOS (Salud del Hombre Inmigrante Latino), a Houston-based survey of Latino immigrant men's health. Based on the literature, we hypothesized SRH would be (1) positively associated with social integration and (2) negatively associated with social isolation. All proposed measures were first entered into a correlation matrix to identify significant bivariate relationships (p ≤ .05, two-tailed). Associations between variables that were directly correlated with SRH and variables that were, in turn, proximally associated with these variables were then used to develop a structural equation path model of SRH. Individual paths in the model were measured for significance, and goodness of fit was assessed by the model chi-square, the Comparative Fit Index, and the Root Mean Square Error of Approximation. RESULTS: Inconsistent with the first hypothesis, SRH was negatively associated with social integration, as measured by the number of trusted friends. Consistent with the second hypothesis, SRH was negatively associated with social isolation, as measured by needing someone to talk to. More frequent contact with family was also negatively associated with social isolation. DISCUSSION: Our findings suggest social integration may not always protect and promote health. Therefore, assessing the quality of LDLs' different relationships, not just the quantity, is vital. Future studies should further analyze the effects that social resources have on perceptions of social isolation and health in LDLs and other migrant populations.

How Do Stages of Change for Physical Activity Relate to Employee Sign-Up for and Completion of a Worksite Physical Activity Competition?

INTRODUCTION: This study evaluated whether stages of change for physical activity (PA) predict sign-up, participation, and completion in a PA competition. METHOD: Deidentified data were provided to evaluate a PA competition between 16 different institutions from a public university system. Employees who completed a health assessment (HA) prior to the start of the PA competition ( n = 6,333) were included in the study. Participants completed a self-report HA and logged their PA throughout the competition. Multivariable logistic regression models tested whether stages of change predicted PA competition sign-up and completion. An ordinal logistic regression model tested whether stages of change predicted number of weeks of PA competition participation. RESULTS: Stages of change predicted PA competition sign-up and completion, but not weeks of participation. The odds for PA competition sign-up were 1.64 and 1.98 times higher for employees in preparation and action/maintenance (respectively) compared with employees in precontemplation/contemplation. The odds for PA competition completion were 4.17 times higher for employees in action/maintenance compared with employees in precontemplation/contemplation/preparation. CONCLUSION: The PA competition was more likely to reach employees in preparation, action, or maintenance stages than precontemplation/contemplation. Most of the completers were likely participating in regular PA prior to the competition.

Identifying correlates and determinants of physical activity in youth: How can we advance the field?

This commentary provides a critical discussion of current research investigating the correlates and determinants of physical activity in young people, with specific focus on conceptual, theoretical and methodological issues. We draw on current child and adolescent literature and our own collective expertise to illustrate our discussion. We conclude with recommendations that will strengthen future research and help to advance the field.

Impact of Booster Breaks and Computer Prompts on Physical Activity and Sedentary Behavior Among Desk-Based Workers: A Cluster-Randomized Controlled Trial.

INTRODUCTION: The 15-minute work break provides an opportunity to promote health, yet few studies have examined this part of the workday. We studied physical activity and sedentary behavior among office workers and compared the results of the Booster Break program with those of a second intervention and a control group to determine whether the Booster Break program improved physical and behavioral health outcomes. METHODS: We conducted a 3-arm, cluster-randomized controlled trial at 4 worksites in Texas from 2010 through 2013 to compare a group-based, structured Booster Break program to an individual-based computer-prompt intervention and a usual-break control group; we analyzed physiologic, behavioral, and employee measures such as work social support, quality of life, and perceived stress. We also identified consistent and inconsistent attendees of the Booster Break sessions. RESULTS: We obtained data from 175 participants (mean age, 43 y; 67% racial/ethnic minority). Compared with the other groups, the consistent Booster Break attendees had greater weekly pedometer counts (P < .001), significant decreases in sedentary behavior and self-reported leisure-time physical activity (P < .001), and a significant increase in triglyceride concentrations (P = .02) (levels remained within the normal range). Usual-break participants significantly increased their body mass index, whereas Booster Break participants maintained body mass index status during the 6 months. Overall, Booster Break participants were 6.8 and 4.3 times more likely to have decreases in BMI and weekend sedentary time, respectively, than usual-break participants. CONCLUSION: Findings varied among the 3 study groups; however, results indicate the potential for consistent attendees of the Booster Break intervention to achieve significant, positive changes related to physical activity, sedentary behavior, and body mass index.

Sedentary behavior, body mass index, and weight loss maintenance among African American women.

OBJECTIVES: Relationships among sedentary behavior, weight gain, and weight loss and regain are understudied particularly for African Americans, a high risk group for obesity. The hypotheses were: sedentary behavior is positively associated with current body mass and % of weight loss maintained after initial weight loss; these associations differ by physical activity status. DESIGN: Cross-sectional. SETTING: National survey. PATIENTS OR PARTICIPANTS: 1,110 African American women. INTERVENTIONS: Observational study. MAIN OUTCOME MEASURES: A cross-sectional survey was administered to African Americans who had intentionally lost 10% of their body weight. Those who lost weight and maintained at least a 10% weight loss for a year were classified as weight loss maintainers; all others were classified as weight loss re-gainers. Participants were classified into one of four categories based on low and high levels of sedentary behavior and physical activity. The high physical activity, low sedentary behavior category was the reference group. Sociodemographic characteristics and health conditions were covariates. Data were collected in 2009 and analyzed in 2013. RESULTS: Each additional daily hour of sedentary time was associated with an increase in BMI (P<.001) and poorer weight loss maintenance (P<.01). Regardless of sedentary behavior, low physically active participants had BMIs that were greater (P<.001) compared to the reference group. Sedentary behavior had an independent effect on BMI and % of weight loss maintained for high but not low physically active participants. CONCLUSIONS: High levels of sedentary behavior were associated with poorer weight-loss maintenance among African American women even for those with high levels of physical activity. The implications of this study are that physical activity and sedentary behavior, independently and combined, are associated with BMI and weight-loss maintenance.

Fracture risk assessment in older adults using a combination of selected quantitative computed tomography bone measures: a subanalysis of the Age, Gene/Environment Susceptibility-Reykjavik Study.

Bone mineral density (BMD) and geometric bone measures are individually associated with prevalent osteoporotic fractures. Whether an aggregate of these measures would better associate with fractures has not been examined. We examined relationships between self-reported fractures and selected bone measures acquired by quantitative computerized tomography (QCT), a composite bone score, and QCT-acquired dual-energy X-ray absorptiometry-like total femur BMD in 2110 men and 2682 women in the Age, Gene/Environment Susceptibility-Reykjavik Study. The combined bone score was generated by summing gender-specific Z-scores for 4 QCT measures: vertebral trabecular BMD, femur neck cortical thickness, femur neck trabecular BMD, and femur neck minimal cross-sectional area. Except for the latter measure, lower scores for QCT measures, singly and combined, showed positive (p < 0.05) associations with fractures. Results remained the same in stratified models for participants not taking bone-promoting medication. In women on bone-promoting medication, greater femur neck cortical thickness and trabecular BMD were significantly associated with fracture status. However, the association between fracture and combined bone score was not stronger than the associations between fracture and individual measures or total femur BMD. Thus, the selected measures did not all similarly associate with fracture status and did not appear to have an additive effect on fracture status.

Features of the built environment related to physical activity friendliness and children's obesity and other risk factors.

OBJECTIVES: We investigated the relationships among environmental features of physical activity friendliness, socioeconomic indicators, and prevalence of obesity (BMI status), central adiposity (waist circumference, waist-height ratio), and hypertension. DESIGN AND SAMPLE: The design was cross-sectional; the study was correlational. The sample was 911 kindergarteners through sixth graders from three schools in an urban school district residing in 13 designated neighborhoods. MEASURES: Data from walking environmental community audits, census data for socioeconomic indicators, body mass index, waist circumference, waist-height ratio, and blood pressure were analyzed. A modified Alfonzo's Hierarchy of Walking Needs model was the conceptual framework for environmental features (i.e., accessibility, safety, comfort, and pleasurability) related to physical activity. RESULTS: Accessibility was significantly and negatively correlated with prevalence of obesity and with prevalence of a waist-height ratio >0.50. When neighborhood education was controlled, and when both neighborhood education and poverty were controlled with partial correlational analysis, comfort features of a walking environment were significantly and positively related to prevalence of obesity. When poverty was controlled with partial correlation, accessibility was significantly and negatively correlated with prevalence of waist-height ratio >0.50. CONCLUSIONS: The built environment merits further research to promote physical activity and stem the obesity epidemic in children. Our approach can be a useful framework for future research.

Parental and peer factors associated with body image discrepancy among fifth-grade boys and girls.

Many young adolescents are dissatisfied with their body due to a discrepancy between their ideal and actual body size, which can lead to weight cycling, eating disorders, depression, and obesity. The current study examined the associations of parental and peer factors with fifth-graders' body image discrepancy, physical self-worth as a mediator between parental and peer factors and body image discrepancy, and how these associations vary by child's sex. Body image discrepancy was defined as the difference between young adolescents' self-perceived body size and the size they believe a person their age should be. Data for this study came from Healthy Passages, which surveyed 5,147 fifth graders (51 % females; 34 % African American, 35 % Latino, 24 % White, and 6 % other) and their primary caregivers from the United States. Path analyses were conducted separately for boys and girls. The findings for boys suggest father nurturance and getting along with peers are related negatively to body image discrepancy; however, for girls, fear of negative evaluation by peers is related positively to body image discrepancy. For both boys and girls, getting along with peers and fear of negative evaluation by peers are related directly to physical self-worth. In addition, mother nurturance is related positively to physical self-worth for girls, and father nurturance is related positively to physical self-worth for boys. In turn, physical self-worth, for both boys and girls, is related negatively to body image discrepancy. The findings highlight the potential of parental and peer factors to reduce fifth graders' body image discrepancy.

Guidelines to conduct research in computer-prompt software studies to decrease sedentary behaviors and increase physical activity in the workplace.

BACKGROUND: Computers are ubiquitous in the workplace and facilitate prolonged sitting, which has adverse health consequences. Various computer-prompt software programs are designed to decrease sedentary behaviors and increase physical activity in the workplace. However, specific guidelines that would improve research in this area have not been published. OBJECTIVE: The objective of this article is to present recommendations for improving computer-prompt software research, to decrease sedentary behaviors and increase physical activity in the workplace. METHODS: Ten domains were identified based on deficiencies in the current literature combined with quality assessment tools to reduce the risk for bias. The ten domains include composition of the research team, behavioral sciences theoretical frameworks, research design, alert types, outcome measures, confounding factors, intervention duration, carryover effects, racial/ethnic composition, and organizational culture. RESULTS: Specific recommendations are presented for each domain. The research team should include all stakeholders contributing as copartners in designing the intervention. For theory, a systems science framework was presented. Clustered randomized controlled trials were recommended, rather than randomization at the individual level. Distinct types of alerts (visual, auditory, or both) and frequency of alerts (hourly, randomly generated, or based on prolonged sitting patterns) are described. Outcome measures include average duration of sitting bouts, longest sitting bout, and number of sitting bouts. CONCLUSION: Prolonged sitting and physical inactivity at work lead to major health problems. Adherence to the recommendations presented here should facilitate high-quality research and improve the health of desk-based workers by decreasing sedentary behaviors and increasing physical activity.

Self-efficacy and barriers to multiple behavior change in low-income African Americans with hypertension.

Behavioral risk factors are among the preventable causes of health disparities, yet long-term change remains elusive. Many interventions are designed to increase self-efficacy, but little is known about the effect on long-term behavior change in older, low-income African Americans, especially when facing more problematic barriers. A cohort of 185 low-income African-Americans with hypertension reported barriers they encountered while undergoing a multiple behavior change trial from 2002 to 2006. The purpose of the present study was to explore the relationships between self-efficacy, barriers, and multiple behavior change over time. Higher self-efficacy seemed to be partially helpful for smoking reduction and increasing physical activity, but not for following a low-sodium diet. Addiction was indirectly associated with less reduction in smoking through lower self-efficacy. Otherwise, different barriers were associated with behavior change than were associated with self-efficacy: being "too busy" directly interfered with physical activity and "traditions" with low-sodium diet; however, they were neither the most frequently reported barriers, nor associated with lower self-efficacy. This suggests that an emphasis on self-efficacy alone may be insufficient for overcoming the most salient barriers encountered by older African Americans. Additionally, the most common perceived barriers may not necessarily be relevant to long-term behavioral outcomes.

Booster Breaks in the workplace: participants' perspectives on health-promoting work breaks.

Increasing sedentary work has been associated with greater cardiovascular and metabolic risk, as well as premature mortality. Interrupting the sedentary workday with health-promoting work breaks can counter these negative health effects. To examine the potential sustainability of work-break programs, we assessed the acceptance of these breaks among participants in a Booster Break program. We analyzed qualitative responses from 35 participants across five worksites where one 15-min physical activity break was taken each workday. Two worksites completed a 1-year intervention and three worksites completed a 6-month intervention. Responses to two open-ended questions about the acceptance and feasibility of Booster Breaks were obtained from a survey administered after the intervention. Three themes for benefits and two themes for barriers were identified. The benefit themes were (i) reduced stress and promoted enjoyment, (ii) increased health awareness and facilitated behavior change, and (iii) enhanced workplace social interaction. The barrier themes were the need for (iv) greater variety in Booster Break routines and (v) greater management support. This study provides empirical support for the acceptance and feasibility of Booster Breaks during the workday. Emphasizing the benefits and minimizing the barriers are strategies that can be used to implement Booster Breaks in other workplaces.

Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors.

BACKGROUND: Health-related quality of life (HRQOL), body mass index (BMI), and physical activity (PA) levels have all been associated with prognosis following breast cancer and may explain partially the higher mortality for breast cancer in certain racial/ethnic subgroups. In this study, associations between PA, BMI, and HRQOL by race were examined in a sample of breast cancer survivors. METHODS: Measures of PA, BMI, and HRQOL as well as demographic and medical characteristics of women (N = 3013, 13% nonwhite) who participated in the Women's Healthy Eating and Living Study were assessed at baseline. Analysis of covariance was used to examine the relationship between PA and obesity with HRQOL outcomes. Statistical tests were 2-sided. RESULTS: African American women were less likely to meet guidelines for PA and more likely to be obese than women from other ethnic groups (P < .05). In adjusted models, women who met guidelines for PA reported significantly higher physical health composite (point differences ranged from 10.5 to 21.2 points, all P < .05) and vitality (point differences ranged from 9.9 to 16.5 points, all P < .05) scores than those who did not, regardless of race/ethnicity. Associations between obesity and HRQOL were mixed with fewer associations for Asian American and African American women and stronger associations for whites. CONCLUSIONS: Breast cancer survivors from racially and ethnically diverse populations have lower levels of PA and higher rates of obesity that are generally associated with poorer HRQOL. Culturally sensitive PA and weight loss interventions may improve these lifestyle characteristics and result in improved HRQOL.

Community energy balance: a framework for contextualizing cultural influences on high risk of obesity in ethnic minority populations.

INTRODUCTION: Increases in the availability, affordability, and promotion of high-calorie foods and beverages and decreased obligations for routine physical activity have fostered trends of increased obesity worldwide. In high-income, plural societies, above average obesity prevalence is often observed in ethnic minority communities, suggesting that obesity-promoting influences are more prevalent or potent in these communities. METHODS: An interdisciplinary group of scholars engaged in multiple rounds of focused discussion and literature review to develop a Community Energy Balance Framework (CEB). The objective was to explore the nature of the excess obesity risk in African descent and other ethnic minority populations and identify related implications for planning and evaluating interventions to prevent obesity. RESULTS: A key principle that emerged is that researchers and programmers working with ethnic minority communities should contextualize the food- and physical activity-related sociocultural perspectives of these communities, taking into account relevant historical, political, and structural contexts. This perspective underscores the fallacy of approaches that place the entire burden of change on the individual, particularly in circumstances of social disadvantage and rapid cultural shifts. CONCLUSION: The CEB framework is proposed for use and further development to aid in understanding potential health-adverse effects of cultural-contextual stresses and accommodations to these stresses.

Environmental Audits of Friendliness toward Physical Activity in Three Income Levels.

An important research area is the relationship among income status, health, and the environment. This study examined the relationships among income levels, features of the environment and friendliness toward physical activity. We investigated whether low-, middle-, and high-income neighborhoods differ in terms of four environmental characteristics that affect the degree to which an area is conducive to physical activity: population density, land use diversity, street design, and physical disorder in the environment. In a large, urban southwestern county, 30 block groups were randomly selected to represent low-, middle-, and high-income neighborhoods. Using the St. Louis Environmental Checklist Audit, walking audits were conducted and analyzed. The low-income neighborhoods had significantly greater density and land use diversity than the high-income neighborhoods. High- and middle-income neighborhoods had significantly fewer manifestations of physical disorder and incivility than low-income neighborhoods. Features of physical activity-promoting environments were found in each income level neighborhood.

Long-term physical activity outcomes of home-based lifestyle interventions among breast and prostate cancer survivors.

PURPOSE: Few studies have investigated long-term effects of physical activity (PA) interventions. The goal of this study was to evaluate whether or not increased levels of moderate to vigorous physical activity (MVPA) were maintained by cancer survivors 1 year after receipt of two home-based interventions. METHODS: The FRESH START trial randomized 543 breast and prostate cancer survivors to 1-of-2 mailed print diet and exercise interventions: sequentially-tailored vs. standardized (attention control). Each arm received eight mailings over a 1-year period, with follow-up at 1 and 2 years. This analysis focuses solely on the 400 participants who had suboptimal levels of MVPA at baseline (measured by the 7-Day Physical Activity Recall) and who completed the 2-year study. RESULTS: Median minutes of MVPA at baseline, 1-year and 2-year follow-up in the tailored intervention arm were as follows: 0, 90, and 60 min/week, respectively. The corresponding values in the attention control group were 0, 30, and 30 min/week. Significant improvements in MVPA from baseline to 2-year follow-up were observed in both study arms (p < 0.01). While significant between-arm differences were observed at 1-year follow-up (p < 0.01), there was only the suggestion of a trend (p = 0.08) at 2-year follow-up. CONCLUSIONS: This study provides evidence that mailed-print exercise interventions result in significant and sustainable improvements in MVPA among newly diagnosed cancer survivors that are observed well after the intervention is complete. While tailored interventions, as compared to standardized materials, appear to produce superior improvements in MVPA initially, these differences diminish over time.

Childhood obesity: a framework for policy approaches and ethical considerations.

Although obesity rates among US children have increased during the past 3 decades, effective public policies have been limited, and the quest for workable solutions raises ethical questions. To address these concerns, in 2010, the Robert Wood Johnson Foundation convened an expert panel to consider approaches to the ethics problems related to interventions for childhood obesity. On the basis of recommendations from the expert panel, we propose frameworks for policy approaches and ethical aspects of interventions and evaluation. We present these frameworks in the context of other papers in this collection and make recommendations for public health practice.