SPECIAL TOPIC
A Framework for Addressing the Global Obesity Epidemic at a Local Level: The Child Health Ecological Surveillance System (CHESS)

Figure. Framework for Action on Healthy Body Weight in Children

The diagram overall is a circle. The upper left side of the circle has the caption “Leadership and Will to Act.”  To the right of this caption is a small cog labeled “Policy Practice and Scientific Leadership.”  This cog is linked to a large cog inside the overall circle. The small cog is also inside an arrow labeled “Mobilize and sustain action on: Modification of components, Factor in knowledge derived, Identification of knowledge gaps, Refinement of metrics, theory, and interventions.”  This arrow narrows in toward the center of the overall circle and the large cog inside the overall circle.

The interior of this large cog has four segments: the top segment is labeled “Child Health.”  The segment on the left has a small cog labeled “Genetics and Biology.”  Inside this cog, in a circle around the edge, are these terms: “Cell,”  “Organ,”  “System,”  and “Whole Body.”  Between each term are two arrows, one each pointing toward and away from each term. This small cog is connected to another small cog in the segment at the bottom; the small cog is labeled “Individual Lives.”  Inside the cog, in a circle around the edge, are these terms: “Attitudes and Beliefs,”  “Physical Activity,”  and “Eating Behavior.”  Between each term are two arrows, one each pointing toward and away from each term. Inside the circle around the edge is another circle, with these terms: “Family,”  “Friends,”  “Peers,”  and “Networks.”  Between each term are two arrows, one each pointing toward and away from each term. This small cog is connected to a third small cog in the segment above and to the right of the cog on the bottom; the small cog is labeled “Environments.”  Inside this cog, in a circle around the edge, are these terms: “Social,”  “Physical,”  “Community,”  “Economic,”  “Policy,”  and “Organizational.”  Between each term are two arrows, one each pointing toward and away from each term. Above the segment labeled “Child Health,”  outside the large cog, are four segments, labeled “Biomedical,”  “Clinical,”  “Health Services,”  and “Population Health.”

To the right of these segments, on the upper right side of the overall circle, is the caption “Outcomes.”  Between this caption and the inner large cog are three cogs, each separately connected to the inner large cog. From top to bottom, the first cog is labeled “Service/System Outcomes,”  the second is “Research and Knowledge Outcomes,”  and the third is “Health Outcomes.”  These three cogs are in an arrow that is labeled “Self-Calibrating Surveillance System”  that points back around toward the “Leadership and Will to Act”  caption, and is captioned “Infrastructure.”

Volume 5: No. 3, July 2008