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.?nbsp; To the right of this caption is a small cog labeled “Policy Practice and Scientific Leadership.?nbsp; 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.?nbsp; 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.?nbsp; The segment on the left has a small cog labeled “Genetics and Biology.?nbsp; Inside this cog, in a circle around the edge, are these terms: “Cell,?nbsp; “Organ,?nbsp; “System,?nbsp; and “Whole Body.?nbsp; 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.?nbsp; Inside the cog, in a circle around the edge, are these terms: “Attitudes and Beliefs,?nbsp; “Physical Activity,?nbsp; and “Eating Behavior.?nbsp; 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,?nbsp; “Friends,?nbsp; “Peers,?nbsp; and “Networks.?nbsp; 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.?nbsp; Inside this cog, in a circle around the edge, are these terms: “Social,?nbsp; “Physical,?nbsp; “Community,?nbsp; “Economic,?nbsp; “Policy,?nbsp; and “Organizational.?nbsp; Between each term are two arrows, one each pointing toward and away from each term. Above the segment labeled “Child Health,?nbsp; outside the large cog, are four segments, labeled “Biomedical,?nbsp; “Clinical,?nbsp; “Health Services,?nbsp; and “Population Health.?

To the right of these segments, on the upper right side of the overall circle, is the caption “Outcomes.?nbsp; 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,?nbsp; the second is “Research and Knowledge Outcomes,?nbsp; and the third is “Health Outcomes.?nbsp; These three cogs are in an arrow that is labeled “Self-Calibrating Surveillance System?nbsp; that points back around toward the “Leadership and Will to Act?nbsp; caption, and is captioned “Infrastructure.?

Volume 5: No. 3, July 2008