Childhood obesity remains a global health problem, with the number of children identified as overweight or obese expected to reach 60 million by 2020 (Malik, Willett, & Hu, 2013). Rates of obesity have more than tripled among children and adolescents over the past 30 years (Gollust, Niederdeppe, & Barry, 2013), with increased prevalence in lower-income and racial/ethnic minority populations, and communities with decreased access to healthy foods and safe places to play (Brennan, Brownson, & Orleans, 2014). Although there have been reports that rates of childhood obesity have declined in recent years, NHANES data from 1999 to 2016 indicate an increase in childhood obesity prevalence in the United States (Skinner, Ravanbakht, Skelton, Perrin, & Armstrong, 2017). There is no shortage of information on the potential complications of childhood obesity, including comorbidities such as heart disease and Type 2 diabetes, subsequent healthcare costs, and the impact on the psychosocial well-being of the children we serve. In addition, high rates of childhood obesity threaten our national security, with 25% of 17- to 24-year-old Americans currently above the weight threshold to serve in the U.S. military (Gollust et al., 2013). It is clear that comprehensive policy changes are needed to make a substantial impact in combating these problems. Pediatric healthcare providers, serving at the front lines, can play an integral role in policy change yet often struggle with where to begin in this daunting process.

A common challenge when advocating for healthy lifestyle policy change is that many policy makers, as well as members of the general public, view obesity as a direct result of personal responsibility and poor decision making. Even in childhood, many give the responsibility of healthy eating and exercise habits to parents and caregivers rather than focusing on schools, healthcare professionals, the government, or food industry as major players in the obesity epidemic (Gollust et al., 2013). As healthcare professionals, one of our most important tasks is framing our policy message to contextualize childhood obesity in much broader terms, encompassing not only children and their caregivers but also the community as a whole (Gollust et al., 2013). By being thoughtful about our message, we can increase support for policies that include a wider range of initiatives including food regulations and taxes as well as safe places to play. It is important to emphasize that the fundamental drivers of a chronic disease like obesity are often outside an individual or family's control (Reeve, Ashe, Farias, & Gostin, 2015). This is particularly true for children, who often lack the resources needed to make informed healthy lifestyle decisions (Reeve et al., 2015).

In a recent survey of 444 respondents who identified themselves as conservative, moderate, or liberal, 11 messages that provided reasons the government should address childhood obesity were evaluated (Gollust et al., 2013). Regardless of political affiliation, a message about the long-term health consequences of childhood obesity was perceived as the strongest message for the sample. This message included information on the increased risk of Type 2 diabetes mellitus, heart disease, arthritis, and cancers that can occur into adulthood. In respondents who identified themselves as conservatives, messages regarding the threat to national security, citing data that highlighted the number of youth rejected from the military because of weight, were also viewed as powerful. Respondents who identified themselves as moderates found that the psychosocial implications of obesity, such as increased bullying, were a strong message, whereas those that identified themselves as liberals cited increased healthcare costs, at roughly $14 billion per year, as an important message (Gollust et al., 2013). Providing thoughtful messaging that highlights the serious health consequences of childhood obesity and subsequent threats to national security, psychosocial health, and financial implications to our healthcare system provides a great framework to start a conversation on the need for policy change.

Our nation's current political climate can make the idea of advocating for policy change a daunting task for even the most seasoned healthcare provider. Federal policy often faces constraints from industry lobbying, budgeting problems, and partisan conflict, making it difficult to get any type of policy passed (Reeve et al., 2015). Although we often think of federal policy as being the most impactful, it is important to remember that state and local municipalities are powerful players in making positive change in the communities we serve. These local leaders are often closer to their constituents than federal lawmakers, creating an opportunity to serve as a change agent and developing community ownership of policy changes (Reeve et al., 2015).

The close relationship between healthy populations, economic growth, and lower healthcare costs provides additional incentive to see the firsthand impact policy change can make in the places we live (Reeve et al., 2015). Policy change can range from small-scale nutritional and physical activity change to much larger initiatives such as transport and urban planning and media campaigns (Malik et al., 2013). Examples of local policy change include New York City's sugar-sweetened beverage portion limits, San Francisco County's Healthy Food Incentives Ordinance that prevents free toys in fast food meals that fail to meet nutrition standards, and a joint use agreement in the city of Tucson, Arizona, opening up 12 school sites to the public with extra policy patrol to improve opportunities for play and community safety (Reeve et al., 2015).

As healthcare providers, we play a unique role in crafting a message that garners attention as well as in leading change to transform the communities where we live and serve. Refocusing our attention on local and state governments, so that they lead our nation in obesity prevention efforts, provides a unique approach in childhood obesity policy change. Local municipalities have the ability to create policy that can be easily replicated and diffused horizontally (to other localities) as well as vertically (statewide and nationally; Reeve et al., 2015). Finding your political voice and focusing on local initiatives is a great first step in making impactful policy change.

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