May 8, 2012 -- Obesity in America is a crisis that threatens national security -- and urgent action is needed, says the Institute of Medicine.

The IOM's plan: Totally change the way Americans approach exercise and nutrition.

How? By asking every single American to become involved, says Daniel R. Glickman, chair of the IOM committee that issued the 478-page plan. Glickman, former secretary of agriculture under President Bill Clinton, is executive director of congressional programs for the Aspen Institute.

"When you have a national epidemic of this size, it is in the hands of every individual to make this happen," Glickman said today in a presentation to the CDC's Weight of the Nation Conference in Washington, D.C.

"When people understand the consequences of not taking action, they will understand," IOM committee member Christina Economos, PhD, of Tufts University, said at the meeting. "This will require bold actions from all sections of society."

The IOM report "issues a blunt, strong challenge that the obesity threat is imminent and enduring to our children and to our nation. It holds everyone accountable," said James Marks, MD, MPH, senior vice president for health at the Robert Wood Johnson Foundation, which funded the IOM study.

Part of this "threat" is economic. The estimated cost of obesity is $190 billion a year in the U.S., Marks said at a news teleconference. And part of the threat is that the two-thirds of Americans who are overweight or obese are at risk of diabetes, cancer, and early death.

What can we do about it? The IOM report spells out a detailed, extensive, and expensive plan. The plan calls for individual, community, school, and workplace action. It also calls on government to confront entrenched interests in revising agricultural subsidies, restricting the advertising of sugared beverages and fast foods, and regulating restaurants that offer calorie-dense foods to children.

"These things all must be done and done now if we are going to roll back this problem," Glickman said. "The question used to be, 'Can we reverse the obesity epidemic?' The question now is, 'Will we?'"

The IOM Obesity Plan

On the face of it, the IOM plan is simple. There are five main goals:

1. Make physical activity an integral and routine part of life.
2. Create food and beverage environments that ensure that healthy food and beverage options are the routine, easy choice.
3. Transform messages about physical activity and nutrition.
4. Expand the roles of health care providers, insurers, and employers.
5. Make schools a national focal point.

As usual, the devil is in the details. For each of these broad goals there are distinct proposals. And as committee members made clear, it's an integrated plan. It won't work if policy makers act only on one part and not on others.

Making Americans more physically active includes:

• Improving communities to create access to places and programs where people can be active in safe, fun ways.
• Ongoing, high-visibility programs to promote physical activity.
• Requiring child-care providers to offer 30 minutes of physical activity for each half day of care.

Creating healthy food and beverage environments includes:

• Ensuring that chain restaurants decrease offerings of calorie-dense foods to children and increase healthy options at competitive prices.
• Setting nutritional standards for all foods and beverages sold or provided by the government, and ensuring "that these healthy options are available in all places frequented by the public."
• In low-income communities, limiting the concentration of fast-food restaurants and convenience stores, and encouraging or attracting supermarkets and other healthy-food outlets.
• The president should create a task force to review agricultural policies, including farm subsidies.

Transforming messages about physical activity and nutrition includes:

• Federal funding of a sustained program of "culturally appropriate messages aimed at specific audiences." The messages would urge things like taking a daily walk, drinking fewer sugar-sweetened beverages, and learning how to read the new front-of-package nutrition labels.
• An "or else" threat to the food, beverage, restaurant, and media industries: They must "take broad, common, and urgent voluntary action to make substantial improvements in their marketing aimed directly at children" and teens. If a "substantial majority" of these "marketing standards" have not been met within two years, government should set "mandatory nutritional standards for marketing" to this age group.
• A single standard nutritional labeling system for all packages and store shelves. Chain restaurants must provide calorie labeling on menus.

Programs to promote physical activity include:

• Standards of care for health care providers for prevention, screening, diagnosis, and treatment of overweight and obesity for children, teens, and adults.
• Requiring health insurers to cover obesity prevention, screening, diagnosis, and treatment.
• Encouraging employers to encourage "active living and healthy eating at work."

The focus on schools includes:

• Changes to federal law to require all schools to have a grade K-12 physical education program with regular proficiency evaluations.
• State funding of daily physical education at school for all students.
• Ensuring that schools have strong nutritional programs that shift away from obesity-promoting foods and beverages (sugary beverages, fatty foods) to fruits, vegetables, and high-fiber grains.
• Teaching kids "food literacy."

Will any of this really happen? Glickman is optimistic.

"We have reached a tipping point," he says. "You see the federal budget deficit, and the biggest part of the problem is health care costs. We can't sustain that. ... We have enough good ideas now about what the right things are to do. And we need to do them all, not just focus on one thing."