Government and school progress to promote a healthful diet to American children and adolescents: A comprehensive review of the available evidence

Context: The IOM released an expert committee report in 2005 that assessed the nature, extent, and influence of food and beverage marketing practices on American children's and adolescents' diets and health. The report concluded that prevailing marketing practices did not support a healthful diet and offered recommendations for diverse stakeholders to promote a healthful diet. The investigators evaluated progress for government and schools to achieve the IOM report recommendations over 5 years. Evidence acquisition: A literature review was conducted of evidence available between December 1, 2005, and January 31, 2011. Evidence selection was guided by the IOM LEAD principles (i.e., locate, evaluate, and assemble evidence to inform decisions) and five qualitative research criteria and validated by triangulation. The analysis was conducted between February and June 2011. The investigators categorized 80 data sources into three evidence tables to evaluate public-sector progress (i.e., none, limited, moderate, and extensive). Evidence synthesis: Schools made moderate progress. Government made limited progress to strengthen the nation's research capacity to understand how marketing influences diets; and no progress either to create a national "healthy eating" social marketing campaign, or to designate a responsible agency to monitor and report on progress for all actions. Conclusions: Public-sector stakeholders have missed opportunities to promote healthy eating environments for young people. Government could optimally use all policy toolsincentives and disincentives, education, legislation, regulation, and legal actions. Schools could more effectively engage parents, promote national nutrition standards and available guidelines, provide technical assistance, require mandatory reporting of wellness policies, and evaluate collective efforts.