The microbiome is integral to human physiology, health, and disease. The microbiome is arguably the most intimate connection that humans have with their external environment, mostly through diet. Given the emerging nature of research on the microbiome, some important methodology issues might still have to be resolved with respect to undersampling and a lack of causal and mechanistic studies. Dietary interventions intended to have an impact on host biology via their impact on the microbiome are being developed, and the market for these products is seeing tremendous success. However, the current regulatory framework poses challenges to industry interest and investment.
The IOM brought together policy makers from the U.K. and U.S. for a workshop on October 22, 2009, to discuss the challenges of and promising approaches to the struggle against obesity. Presenters spoke about current policies, programs, and partnerships that are addressing the obesity epidemic and evidence for effective strategies to change perception and behaviors. The workshop, summarized in this document, provided an opportunity for both countries to learn from each other's efforts and to consider how to apply new strategies at home.
Enhancing Food Safety begins with a brief review of the Food Protection Plan (FPP), FDA's food safety philosophy developed in 2007. The lack of sufficient detail and specific strategies in the FPP renders it ineffectual. The book stresses the need for FPP to evolve and be supported by the type of strategic planning described in these pages. It also explores the development and implementation of a stronger, more effective food safety system built on a risk-based approach to food safety management. Conclusions and recommendations include adopting a risk-based decision-making approach to food safety; creating a data surveillance and research infrastructure; integrating federal, state, and local government food safety programs; enhancing efficiency of inspections; and more.
Although food safety is the responsibility of everyone, from producers to consumers, the FDA and other regulatory agencies have an essential role. In many instances, the FDA must carry out this responsibility against a backdrop of multiple stakeholder interests, inadequate resources, and competing priorities. Of interest to the food production industry, consumer advocacy groups, health care professionals, and others, Enhancing Food Safety provides the FDA and Congress with a course of action that will enable the agency to become more efficient and effective in carrying out its food safety mission in a rapidly changing world.
Weight Gain During Pregnancy is intended to assist practitioners who care for women of childbearing age, policy makers, educators, researchers, and the pregnant women themselves to understand the role of gestational weight gain and to provide them with the tools needed to promote optimal pregnancy outcomes.
The symposium included three plenary panels that focused on food and physical activity products, portfolio shifts, and packaging innovations; retailing healthy lifestyles with regard to food and physical activity; and the business response to childhood obesity. Participants also engaged in two break-out sessions. The first session focused on marketing communication strategies that promote both healthful products and physical activity opportunities. The second session focused on public and private education campaigns and industry self-regulation of advertising to children. A program agenda is at the end of this summary. The symposium provided a useful forum for stakeholders to explore viable strategies and exchange information about promising practices for addressing barriers to obesity prevention initiatives, and to identify how public health interests can coincide with the business interests of companies to have a positive impact on reversing the childhood obesity trend.
This summary highlights the recurring themes for accelerating change and how industry collectively can move forward with obesity prevention efforts that emerged from the symposium. The themes include reverse the obesity trend; market health and nutrition; make a business commitment to health; change the food and physical activity environment; forge strategic partnerships; garner political support to ally public health and industry; educate stakeholders; collect, disseminate, and share local data; and evaluate programs and interventions. This summary, along with those of two other symposia summaries and a more detailed discussion of insights and regional examples, will be incorporated in the IOM committee's final report on progress in preventing childhood obesity that will be released in the fall of 2006.
A variety of strategies are beginning to be employed throughout the health system to address the central issue of value, with the goal of improving the net ratio of benefits obtained per dollar spent on health care. However, despite the obvious need, no single agreed-upon measure of value or comprehensive, coordinated systemwide approach to assess and improve the value of health care exists. Without this definition and approach, the path to achieving greater value will be characterized by encumbrance rather than progress.
To address the issues central to defining, measuring, and improving value in health care, the Institute of Medicine convened a workshop to assemble prominent authorities on healthcare value and leaders of the patient, payer, provider, employer, manufacturer, government, health policy, economics, technology assessment, informatics, health services research, and health professions communities. The workshop, summarized in this volume, facilitated a discussion of stakeholder perspectives on measuring and improving value in health care, identifying the key barriers and outlining the opportunities for next steps.
What are the primary hazards associated with the food supply? What gaps exist in the current system for ensuring a safe food supply? What effects do trends in food consumption have on food safety? What is the impact of food preparation and handling practices in the home, in food services, or in production operations on the risk of food borne illnesses? What organizational changes in responsibility or oversight could be made to increase the effectiveness of the food safety system in the United States?
Current concerns associated with microbiological, chemical, and physical hazards in the food supply are discussed. The book also considers how changes in technology and food processing might introduce new risks. Recommendations are made on steps for developing a coordinated, unified system for food safety. The book also highlights areas that need additional study. Ensuring Safe Food will be important for policymakers, food trade professionals, food producers, food processors, food researchers, public health professionals, and consumers.
Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America.
Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers:
A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems.
Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year.
Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles -- including limits on nurses' scope of practice -- should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care.
In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.
Safety of Silicone Breast Implants presents a well-documented, thoughtful exploration of the safety of these devices, drawing conclusions from the available research base and suggesting further questions to be answered. This book also examines the sensitive issues surrounding women's decisions about implants. In reaching conclusions, the committee reviews:
The history of the silicone breast implant and the development of its chemistry.
The wide variety of U.S.-made implants and their regulation by the Food and Drug Administration.
Frequency and consequences of local complications from implants.
The evidence for and against links between implants and autoimmune disorders, connective tissue disease, neurological problems, silicone in breast milk, or a proposed new syndrome.
Evidence that implants may be associated with lower frequencies of breast cancer.
Safety of Silicone Breast Implants provides a comprehensive, well-organized review of the science behind one of the most significant medical controversies of our time.
This book provides a solid documentary base that can be used to develop an agenda to guide research and health policy formulation on female health--both for Sub-Saharan Africa and for other regions of the developing world. This book could also help facilitate ongoing, collaboration between African researchers on women's health and their U.S. colleagues. Chapters cover such topics as demographics, nutritional status, obstetric morbidity and mortality, mental health problems, and sexually transmitted diseases, including HIV.
However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sector--yet protect them as consumers and patients.
This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed care--how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters.
The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.
To address these issues, a workshop was held on June 1 and 2, 2006. The workshop included presentations that were structured around three focus sessions: human genetic variation, epigenetics, and systems biology. A fourth session presented discussions on the implications of nutrigenomics for the future of nutrition science research.
Numerous themes emerged from the workshop presentations. First, nutrigenomics is a complex field because it addresses issues related to multigenetic traits that can be modified by a number of nutritional and other environmental factors. Such complexity presents a challenge to the field; and the ensuing research opportunities will require cooperative work among scientific disciplines and across government, academic, and industrial centers, as well as adequate funding, to be realized.
Additionally, the ability to stretch the limits of conventional research methodologies afforded by new genetic and genomic applications at the level of the individual opens the door to a wealth of potential benefits to areas such as disease prevention and wellness, bearing in mind the necessity of ethical safeguards. This potential, however, must be wisely exploited to avoid the pitfalls of overpromising research results and prematurely setting unrealistic expectations for beneficial outcomes. Finally, careful and rigorous research must be employed to optimize outcomes and assure acceptance by the scientific community. In summary, nutrition science is uniquely poised to serve as the crossroads for many disciplines and, using genomics tools, can bring this knowledge together to better understand and address diet-related chronic diseases and molecular responses to dietary factors.
The USDA asked the IOM to review and recommend improvements, as necessary, to the CACFP meal requirements in order to keep them aligned with other federally funded food assistance programs and with the Dietary Guidelines for Americans. The 2011 IOM report, Child and Adult Care Food Program Aligning Dietary Guidance for All, reviewed the program in detail and provided recommendations for improvement.
In February 2012, at the request of the USDA, the IOM conducted an additional workshop to examine research methods and approaches that could be used to design and conduct a nationally representative study assessing children's dietary intake and participation rates in child care facilities, including CACFP-sponsored child care centers and homes. Research Methods to Assess Dietary Intake and Program Participation in Child Day Care: Application to the Child and Adult Care Food Program Workshop Summary is the report that summarizes the workshop.
Texas leaders at the workshop expressed the strong belief that the state's economic vitality and security depend on the health of its population. Accordingly, the state is no longer simply describing the personal, community, and financial costs of its obesity crisis; it is taking proactive steps to address the problem through strategic initiatives. An overarching strategy is to address obesity by targeting the state's youth, in whom it may be possible to instill healthy behaviors and lifestyles to last a lifetime. A guiding principle of these efforts is that they should be evidence based, community specific, sustainable, cost-effective, and supported by effective partnerships. Moreover, the goal is for the responsibility to be broadly shared by individuals, families, communities, and the public and private sectors.
To explore the body of evolving science that examines the nexus of biology, environment, and developmental stage on risk of childhood obesity, the Institute of Medicine and the National Research Council convened a workshop in February 2015. The workshop focused on the prenatal period, infancy, and early childhood and addressed evidence from both animal and human studies. Workshop objectives were to (1) identify epigenetic-mediated relationships between exposure to risk factors during sensitive periods of development (gestation through age 3) and subsequent obesity-related outcomes; (2) explore the science around periods of plasticity and potential reversibility of obesity risk in the context of early childhood development; and (3) examine the translation of epigenetic science to guide early childhood obesity prevention and intervention to reduce obesity risk. This report summarizes the information presented and discussed at the workshop.
To explore what actions can be taken to help close the gap between what is required in the informed consent process and communicating it in a health-literate and meaningful manner to individuals, the Institute of Medicine's Roundtable on Health Literacy convened a one-day public workshop featuring presentations and discussions that examine the implications of health literacy for informed consent for both research involving human subjects and treatment of patients. Topics covered in this workshop included an overview of the ethical imperative to gain informed consent from patients and research participants, a review of the current state and best practices for informed consent in research and treatment, the connection between poor informed consent processes and minority underrepresentation in research, new approaches to informed consent that reflect principles of health literacy, and the future of informed consent in the treatment and research settings. Informed Consent and Health Literacy is the summary of the presentations and discussion of the workshop.
Blue Water Navy Vietnam Veterans and Agent Orange Exposure comprehensively examines whether Vietnam veterans in the Blue Water Navy experienced exposures to herbicides and their contaminants by reviewing historical reports, relevant legislation, key personnel insights, and chemical analysis to resolve current debate on this issue.
• The evolving role of EMS as an integral component of the overall health care system.
• EMS system planning, preparedness, and coordination at the federal, state, and local levels.
• EMS funding and infrastructure investments.
• EMS workforce trends and professional education.
• EMS research priorities and funding.
Emergency Medical Services is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.
Training Physicians for Public Health Careers focuses on the critical roles that physicians play in maintaining and strengthening the public health system, identifies what these physicians need to know to engage in effective public health actions, explores the kinds of training programs that can be used to prepare physicians for public health roles, and examines how these training programs can be funded. Medical schools, schools of public health, health care and public health care professionals, medical students and students of public health will find this of special interest.
The Environmental Health Sciences Decision Making workshop, the first in a series, was convened to inform the Roundtable on Environmental Health Sciences, Research, and Medicine on emerging issues in risk management, "weight of evidence," and ethics that influence environmental health decision making.
The workshop, summarized in this volume, included an overview of the principles underlying decision making, the role of evidence and challenges for vulnerable populations, and ethical issues of conflict of interest, scientific integrity, and transparency. The workshop engaged science interest groups, industry, government, and the academic sector.
The Health of Lesbian, Gay, Bisexual, and Transgender People assesses the state of science on the health status of LGBT populations, identifies research gaps and opportunities, and outlines a research agenda for the National Institute of Health. The report examines the health status of these populations in three life stages: childhood and adolescence, early/middle adulthood, and later adulthood. At each life stage, the committee studied mental health, physical health, risks and protective factors, health services, and contextual influences. To advance understanding of the health needs of all LGBT individuals, the report finds that researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research.
The Health of Lesbian, Gay, Bisexual, and Transgender People is a valuable resource for policymakers, federal agencies including the National Institute of Health (NIH), LGBT advocacy groups, clinicians, and service providers.
Licensed nurses and unlicensed nursing assistants are critical participants in our national effort to protect patients from health care errors. The nature of the activities nurses typically perform â€" monitoring patients, educating home caretakers, performing treatments, and rescuing patients who are in crisis â€" provides an indispensable resource in detecting and remedying error-producing defects in the U.S. health care system.
During the past two decades, substantial changes have been made in the organization and delivery of health care â€" and consequently in the job description and work environment of nurses. As patients are increasingly cared for as outpatients, nurses in hospitals and nursing homes deal with greater severity of illness. Problems in management practices, employee deployment, work and workspace design, and the basic safety culture of health care organizations place patients at further risk.
This newest edition in the groundbreaking Institute of Medicine Quality Chasm series discusses the key aspects of the work environment for nurses and reviews the potential improvements in working conditions that are likely to have an impact on patient safety.
Recent epidemiologic studies report an association between the development of ALS and prior service in the U.S. military. The studies evaluated either veterans of the 1991 Persian Gulf War or veterans who served in the military in the period 1910-1982. Due to these findings, the Department of Veterans Affairs (VA) asked the National Academies to conduct an assessment of the potential relationship between military service and the later development of ALS. The project was assigned to the Institute of Medicine (IOM), which appointed a committee and gave it the task of evaluating the scientific literature on ALS in veterans.
The committee began its work by identifying medical and scientific literature on ALS. PubMed, a database created and managed by the National Library of Medicine. Amyotrophic Lateral Sclerosis in Veterans; Review of the Scientific Literature presents the findings of this committee. The committee reviewed, evaluated, and summarized the scientific literature on ALS in veterans, composed primarily of peer-reviewed, published literature. This report includes the recommendations of the committee.
In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patientsâ€™ and providersâ€™ attitudes, expectations, and behavior are analyzed.
How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve providerâ€"patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.
Historically, drug repurposing has been largely an unintentional, serendipitous process that took place when a drug was found to have an offtarget effect or a previously unrecognized on-target effect that could be used for identifying a new indication. Perhaps the most recognizable example of such a successful repositioning effort is sildenafil. Originally developed as an anti-hypertensive, sildenafil, marketed as Viagra and under other trade names, has been repurposed for the treatment of erectile dysfunction and pulmonary arterial hypertension. Viagra generated more than $2 billion worldwide in 2012 and has recently been studied for the treatment of heart failure.
Given the widespread interest in drug repurposing, the Roundtable on Translating Genomic-Based Research for Health of the Institute of Medicine hosted a workshop on June 24, 2013, in Washington, DC, to assess the current landscape of drug repurposing activities in industry, academia, and government. Stakeholders, including government officials, pharmaceutical company representatives, academic researchers, regulators, funders, and patients, were invited to present their perspectives and to participate in workshop discussions. Drug Repurposing and Repositioning is the summary of that workshop. This report examines enabling tools and technology for drug repurposing; evaluates the business models and economic incentives for pursuing a repurposing approach; and discusses how genomic and genetic research could be positioned to better enable a drug repurposing paradigm.
Priorities for the National Vaccine Plan examines the extraordinarily complex vaccine enterprise, from research and development of new vaccines to financing and reimbursement of immunization services. The book makes recommendations about priority actions in the update to the National Vaccine Plan that are intended to achieve the objectives of disease prevention and enhancement of vaccine safety. It is centered on the plan's five goals in the areas of vaccine development, safety, communication, supply and use, and global health.
The Medical Follow-up Agency is a living tribute to the vision, energy, and effectiveness of Michael E. DeBakey, M.D. Dr. DeBakey created the idea for the agency, obtained the appropriate approvals, staffed its initial creation, and 50 years later, spoke on the occasion of its golden anniversary. This sequence of events must be unique in the history of veterans' health and medical research.
Sex differences in health throughout the lifespan have been documented. Exploring the Biological Contributions to Human Health begins to snap the pieces of the puzzle into place so that this knowledge can be used to improve health for both sexes. From behavior and cognition to metabolism and response to chemicals and infectious organisms, this book explores the health impact of sex (being male or female, according to reproductive organs and chromosomes) and gender (one's sense of self as male or female in society).
Exploring the Biological Contributions to Human Health discusses basic biochemical differences in the cells of males and females and health variability between the sexes from conception throughout life. The book identifies key research needs and opportunities and addresses barriers to research.
Exploring the Biological Contributions to Human Health will be important to health policy makers, basic, applied, and clinical researchers, educators, providers, and journalists-while being very accessible to interested lay readers.
Despite their obvious importance, very little is actually known about the processes and factors that influence the assembly, function, and stability of microbial communities. Gaining this knowledge will require a seismic shift away from the study of individual microbes in isolation to inquiries into the nature of diverse and often complex microbial communities, the forces that shape them, and their relationships with other communities and organisms, including their multicellular hosts.
On March 6 and 7, 2012, the Institute of Medicine's (IOM's) Forum on Microbial Threats hosted a public workshop to explore the emerging science of the "social biology" of microbial communities. Workshop presentations and discussions embraced a wide spectrum of topics, experimental systems, and theoretical perspectives representative of the current, multifaceted exploration of the microbial frontier. Participants discussed ecological, evolutionary, and genetic factors contributing to the assembly, function, and stability of microbial communities; how microbial communities adapt and respond to environmental stimuli; theoretical and experimental approaches to advance this nascent field; and potential applications of knowledge gained from the study of microbial communities for the improvement of human, animal, plant, and ecosystem health and toward a deeper understanding of microbial diversity and evolution. The Social Biology of Microbial Communities: Workshop Summary further explains the happenings of the workshop.
This book looks at worker safety in the changing workplace and the challenge of ensuring a supply of top-notch OSH professionals. Recommendations are addressed to federal and state agencies, OSH organizations, educational institutions, employers, unions, and other stakeholders.
The committee reviews trends in workforce demographics, the nature of work in the information age, globalization of work, and the revolution in health care delivery-exploring the implications for OSH education and training in the decade ahead.
The core professions of OSH (occupational safety, industrial hygiene, and occupational medicine and nursing) and key related roles (employee assistance professional, ergonomist, and occupational health psychologist) are profiled-how many people are in the field, where they work, and what they do. The book reviews in detail the education, training, and education grants available to OSH professionals from public and private sources.
In this report, the IOM determines that Gulf War service causes post-traumatic stress disorder (PTSD) and that service is associated with multisymptom illness; gastrointestinal disorders such as irritable bowel syndrome; alcohol and other substance abuse; and anxiety disorders and other psychiatric disorders. To ensure that our veterans receive the best possible care, now and in the future, the government should continue to monitor their health and conduct research to identify the best treatments to assist Gulf War veterans still suffering from persistent, unexplained illnesses.
• The role and impact of the emergency department within the larger hospital and health care system.
• Patient flow and information technology.
• Workforce issues across multiple disciplines.
• Patient safety and the quality and efficiency of emergency care services.
• Basic, clinical, and health services research relevant to emergency care.
• Special challenges of emergency care in rural settings.
Hospital-Based Emergency Care is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.
The prevalence, health impact, and evidence of changeability all have resulted in calls for action to increase physical activity across the lifespan. In response to the need to find ways to make physical activity a health priority for youth, the Institute of Medicine's Committee on Physical Activity and Physical Education in the School Environment was formed. Its purpose was to review the current status of physical activity and physical education in the school environment, including before, during, and after school, and examine the influences of physical activity and physical education on the short and long term physical, cognitive and brain, and psychosocial health and development of children and adolescents.
Educating the Student Body makes recommendations about approaches for strengthening and improving programs and policies for physical activity and physical education in the school environment. This report lays out a set of guiding principles to guide its work on these tasks. These included: recognizing the benefits of instilling life-long physical activity habits in children; the value of using systems thinking in improving physical activity and physical education in the school environment; the recognition of current disparities in opportunities and the need to achieve equity in physical activity and physical education; the importance of considering all types of school environments; the need to take into consideration the diversity of students as recommendations are developed.
This report will be of interest to local and national policymakers, school officials, teachers, and the education community, researchers, professional organizations, and parents interested in physical activity, physical education, and health for school-aged children and adolescents.
Dietary Reference Intakes for Calcium and Vitamin D provides reference intake values for these two nutrients. The report updates the DRI values defined in Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride, the 1997 study from the Institute of Medicine. This 2011 book provides background information on the biological functions of each nutrient, reviews health outcomes that are associated with the intake of calcium and vitamin D, and specifies Estimated Average Requirements and Recommended Dietary Allowances for both. It also identifies Tolerable Upper Intake Levels, which are levels above wish the risk for harm may increase. The book includes an overview of current dietary intake in the U.S. and Canada, and discusses implications of the study. A final chapter provides research recommendations.
The DRIs established in this book incorporate current scientific evidence about the roles of vitamin D and calcium in human health and will serve as a valuable guide for a range of stakeholders including dietitians and other health professionals, those who set national nutrition policy, researchers, the food industry, and private and public health organizations and partnerships.
Between 1997 and 2005, the IOM published a series of six DRI reports covering a total of 45 nutrients, energy, and other food components. The IOM also issued two reports describing ways to apply the DRIs in assessment and planning. Together, these eight reports contain more than 450 research recommendations and thus a wealth of information pertinent to a nutrition research agenda. To make the recommendations more accessible, the Food and Nutrition Board undertook a project with two major elements: (1) the development of a searchable database of all the DRI research recommendations, and (2) the Dietary Reference Intakes
Research Synthesis Workshop, held June 7-8, 2006, which was designed to provide a venue for hearing and discussing experts' perspectives on the research recommendations identified in the DRI reports.
Two members of the workshop planning group-Drs. John W. Suttie and Susan J. Whiting-moderated the DRI Research Synthesis Workshop. After an overview and demonstration of the DRI Research Synthesis Database, panels of experts addressed DRI research recommendations related to each of the six DRI nutrient reports, the two DRI applications reports, and three cross-cutting topics: (1) setting DRIs for children, (2) Tolerable Upper Intake Levels, and (3) relevant new and underutilized research techniques. This report is a summary of the workshop presentations and discussions.
On October 21, 2010, the Institute of Medicine (IOM) held a workshop to bring together stakeholders to discuss the current and future legal strategies aimed at combating childhood obesity. Legal Strategies in Childhood Obesity Prevention summarizes the proceedings of that workshop. The report examines the challenges involved in implementing public health initiatives by using legal strategies to elicit change. It also discusses circumstances in which legal strategies are needed and effective. This workshop was created only to explore the boundaries of potential legal approaches to address childhood obesity, and therefore, does not contain recommendations for the use of such approaches.
The Current State of Obesity Solutions in the United States is the summary of a workshop convened in January 2014 by the Institute of Medicine Roundtable on Obesity Solutions to foster an ongoing dialogue on critical and emerging implementation, policy, and research issues to accelerate progress in obesity prevention and care. Representatives of public health, health care, government, the food industry, education, philanthropy, the nonprofit sector, and academia met to discuss interventions designed to prevent and treat obesity. The workshop focused on early care and education, schools, worksites, health care institutions, communities and states, the federal government, and business and industry. For each of these groups, this report provides an overview of current efforts to improve nutrition, increase physical activity, and reduce disparities among populations.
This new series of references greatly extends the scope and application of previous nutrient guidelines. For each nutrient the book presents what is known about how the nutrient functions in the human body, what the best method is to determine its requirements, which factors (caffeine or exercise, for example) may affect how it works, and how the nutrient may be related to chronic disease.
This volume of the series presents information about thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline.
Based on analysis of nutrient metabolism in humans and data on intakes in the U.S. population, the committee recommends intakes for each age group--from the first days of life through childhood, sexual maturity, midlife, and the later years. Recommendations for pregnancy and lactation also are made, and the book identifies when intake of a nutrient may be too much. Representing a new paradigm for the nutrition community, Dietary Reference Intakes encompasses:
Estimated Average Requirements (EARs). These are used to set Recommended Dietary Allowances.
Recommended Dietary Allowances (RDAs). Intakes that meet the RDA are likely to meet the nutrient requirement of nearly all individuals in a life-stage and gender group.
Adequate Intakes (AIs). These are used instead of RDAs when an EAR cannot be calculated. Both the RDA and the AI may be used as goals for individual intake.
Tolerable Upper Intake Levels (ULs). Intakes below the UL are unlikely to pose risks of adverse health effects in healthy people.
This new framework encompasses both essential nutrients and other food components thought to pay a role in health, such as dietary fiber. It incorporates functional endpoints and examines the relationship between dose and response in determining adequacy and the hazards of excess intake for each nutrient.
At this early phase in addressing the epidemic, actions have begun on a number of levels to improve the dietary patterns and to increase the physical activity levels of young people. Schools, corporations, youth-related organizations, families, communities, foundations, and government agencies are working to implement a variety of policy changes, new programs, and other interventions. These efforts, however, generally remain fragmented and small in scale.
Moreover, the lack of systematic monitoring and evaluation of interventions have hindered the development of an evidence base to identify, apply, and disseminate lessons learned and to support promising efforts to prevent childhood obesity.
Progress in Preventing Childhood Obesity: How Do We Measure Up? examines the progress made by obesity prevention initiatives in the United States from 2004 to 2006. This book emphasizes a call to action for key stakeholders and sectors to commit to and demonstrate leadership in childhood obesity prevention, evaluates all policies and programs, monitors their progress, and encourages stakeholders to widely disseminate promising practices. This book will be of interest to federal, state, and local government agencies; educators and schools; public health and health care professionals; private-sector companies and industry trade groups; media; parents; and those involved in implementing community-based programs and consumer advocacy.
Cross-Sector Responses to Obesity is a summary of a workshop convened by the Institute of Medicine Roundtable on Obesity Solutions in September 2014 to explore models of cross-sector work that may reduce the prevalence and consequences of obesity. This report identifies case studies of cross-sector initiatives that engage partners from diverse fields, and lessons learned from and barriers to established cross-sector initiatives.
On July 13-14, 1999, the forum convened a workshop on Food Safety Policy, Science, and Risk Assessment: Strengthening the Connection. The purpose of the workshop was to address many of the issues that complicate the development of microbiological food safety policy, focusing on the use of science and risk assessment in establishing policy and in determining the utilization of food safety resources. The purpose was not to find fault with past food safety regulatory activities or food safety policy decisions. Rather, the goal was to determine what actions have been taken in the past to address food safety issues, to consider what influences led to the policies that were put in place, and to explore how improvements can be made in the future.
This report is a summary of the workshop presentations. It is limited to the views and opinions of those invited to present at the workshop and reflects their concerns and areas of expertise. As such, the report does not provide a comprehensive review of the research and current status of food safety policy, science, and risk assessment. The organization of the report approximates the order of the presentations at the workshop. The identification of a speaker as an "industry representative" or a "Food and Drug Administration representative" is not intended to suggest that the individual spoke for that organization or others who work there.
The marketing of high-calorie, low-nutrient foods and beverages is linked to overweight and obesity. A major 2006 report from the Institute of Medicine (IOM) documents evidence that television advertising influences the food and beverage preferences, requests, and short-term consumption of children aged 2-11 (IOM, 2006). Challenges and Opportunities for Change in Food Marketing to Children and Youth also documents a body of evidence showing an association of television advertising with the adiposity of children and adolescents aged 2-18. The report notes the prevailing pattern that food and beverage products marketed to children and youth are often high in calories, fat, sugar, and sodium; are of low nutritional value; and tend to be from food groups Americans are already overconsuming. Furthermore, marketing messages that promote nutrition, healthful foods, or physical activity are scarce (IOM, 2006). To review progress and explore opportunities for action on food and beverage marketing that targets children and youth, the IOM's Standing Committee on Childhood Obesity Prevention held a workshop in Washington, DC, on November 5, 2012, titled "New Challenges and Opportunities in Food Marketing to Children and Youth."