In a Perspective article appearing in this week's New England Journal of Medicine, public health researchers examine how recommendations in a new report from the Institute of Medicine (IOM) -- "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation" -- square with American's opinions about the obesity epidemic.

Over the last 30 years, rates of obesity have doubled among adults and tripled among children. The new IOM report summarizes growing evidence that these increases have been driven by a complex interaction of changes in the environments in which we live -- our schools, our workplaces, our communities, in the media and in our food and beverage systems.

While praising the IOM report's scope and vision, Colleen L. Barry, PhD, MPP, associate professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and lead author of "Are Americans Ready to Solve the Weight of the Nation?" says that it is critical to understand how the public thinks about the problem of obesity. Barry notes that one recent poll found that 64 percent of Americans believe personal decisions -- overeating, lack of exercise, watching too much television -- are the biggest contributors to obesity. However, only 18 percent of Americans attribute environmental factors, such as safe places for children to play, access and availability of healthy foods and exposure to junk food, as major contributors.

"If people think obesity is all about individuals and parents making bad choices, they will be much less likely to embrace changes in schools, communities and food marketing practices aimed at creating healthier environments," said Barry.

Jeff Niederdeppe, PhD, assistant professor of communication at Cornell University and a co-author of the article, emphasized the need for "a research-driven communication strategy to encourage a better understanding of the environmental determinants of obesity among the public, and to emphasize the importance of waging a collective response to the epidemic." The IOM report was accompanied by a four-part HBO documentary series, "The Weight of the Nation," which Niederdeppe described as a great example of the kind of communication partnerships that are needed.

However, communications efforts on obesity should include careful attention to "the potential to increase already high levels of stigma toward obese adults and children, which can have lifelong psychological, social and health consequences," according to Sarah E. Gollust, PhD, assistant professor at the University of Minnesota School of Public Health and a co-author of the Perspective article. Gollust noted that the IOM recognized this concern and explicitly included as a guiding principle the notion that obesity prevention should not be achieved at the expense of overweight or obese individuals' well-being.

The authors concluded that while widespread awareness of obesity's causes and consequences will be necessary, increased awareness alone will not be sufficient to put in place the extensive actions that the IOM report stipulated will be necessary. A favorable political environment as well as leadership in multiple sectors and grassroots advocacy will be needed to support the efforts of the public health community to reduce obesity