It is good to see that the state’s Department of Health and the state Legislature are giving attention to the issue of overweight, especially its more extreme form, obesity.

The soda tax bill offers a means for raising money to reduce obesity, but it does not say how the goal would be achieved. There is a need for a concrete plan of action, one that would give us confidence that the goal would be achieved.

Here is an outline of a program that could be considered:

» The program would work through schools, public or private, that choose to participate.

» The objective would be to steadily reduce the incidence of obesity in children in these schools over time, and then maintain it at a low level, to be determined, based on assessments of the proportion of 10-year-old children who are obese.

» Obesity would be defined in terms of the widely accepted Body Mass Index, which is based on measurements of height and weight, as explained by the U.S. Centers for Disease Control at http://www.cdc.gov/healthyweight/assessing/bmi. The CDC has a specific tool for assessing children’s BMI at http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/tool_for_schools.html.

» The anti-obesity program in each school would include a variety of activities relating to children’s diet, physical activity, classroom learning and other factors likely to influence child obesity.

» Particular attention would be given to children’s learning in relation to the choices they make regarding diet and physical activity.

» The schools would involve children in the program in early grades and continue until they leave the school. While the key data collections would focus on 10-year-olds, most children would participate in the program over several years.

» The children would be actively involved in measuring their own heights and weights, calculating their individual BMIs, and plotting the trend over time.

» Parents and children who prefer not to participate would be allowed to opt out of the measurement activities.

» Means would be worked out for protecting individual children from embarrassment and protecting the confidenti- ality of any data that are collected.

» The cohort of 10-year-old children would be defined as all children in the participating schools who have their 10th birthday in the calendar year. The obesity rate for any given year would be the proportion of children in this group who are obese as determined by their BMIs.

» Methods would be devised to assess the impacts of each type of activity on child obesity. The overall impact of each type of activity would be estimated each year.

» A designated committee established to manage the anti-obesity program in each school would have the power to modify the program each year, depending on what it learns from monitoring activities in their own and other schools.

Funding for these activities could come from a number of different sources. Continued funding should be based on evidence-based demonstration of reductions in the incidence of child obesity over time.

Funding should be continued only until child obesity is no longer a major public health concern in Hawaii.