Yes, whether you snack on a carrot or a doughnut is a personal choice, ultimately. But the report by the Institute of Medicine says local environments hugely influence those choices - and it calls on city and county governments to make it easier for families to make healthier decisions.
"In some communities, actually doing the healthy thing is not as easy as it might be in other places," said Dr. Eduardo Sanchez, chief medical officer of Blue Cross and Blue Shield of Texas, who chaired the institute's report.
"Single actions can make a difference, and one at a time can start you in the right direction," he added.
Two-thirds of Americans are either overweight or obese, and childhood obesity has tripled in the past three decades. Nearly 18 percent of adolescents now are obese, and doctors worry that we're raising generations who no longer may outlive their parents.
Preventing obesity boils down to being more active and eating more fruits and vegetables instead of fatty fast food and treats. But Tuesday's report was sparked because a local government official asked an institute scientist what practical steps communities can take to do that. How do you get grocery stores that carry healthy produce to build in inner cities, for example? What will make restaurants offer healthier fare?
The report offers a menu of suggestions and highlights how some communities are making them work. Among them:
-Require chain restaurants to post calorie counts. New York City is among a handful of cities that have begun this, and a city survey found more than a third of fast-food customers said the calorie information affected what they ordered.
-Use tax credits and other incentives to attract supermarkets to underserved neighborhoods; offer grants to small stores to help them stock healthier items, and create community shuttle services or special bus routes to help residents reach supermarkets.
In New Orleans, where inner city access to grocery stores was limited even before Hurricane Katrina, the police department is being tapped for store security as city leaders plan how to get more healthy-food sellers back into business.
-Use zoning laws to restrict fast-food restaurants, junk-food carts and even billboards advertising unhealthy fare near schools and playgrounds.
-Consider a junk-food tax. The report says there's limited evidence about the impact of such a tax, but Sanchez notes that taxes have helped discourage another unhealthy habit, tobacco.
-Require that publicly run after-school and child-care programs limit video game and TV time, and offer healthy foods and beverages.
-Build and maintain sidewalks, bike paths, playgrounds and parks to allow safe and comfortable outdoor activity. Use community policing to improve security in high-crime areas so that families will get outdoors, and work with education departments to create programs that allow children to walk or bike to school safely.
In a suburb of Boston, a "Shape Up Somerville" program slowed weight gain among first- to third-graders, starting with better school food and a push for safe walking and biking paths to schools. And rural Shelby, Mont., built a fitness center and persuaded major employers to subsidize their workers' memberships, in addition to walking trails.
-Encourage breastfeeding, which prevents obesity later in childhood. In Shelby, the county's public health nurse calls each new mother to encourage breastfeeding.
The Institute of Medicine is part of the National Academies, an independent organization chartered by Congress to advise the government on scientific matters.