Fighting obesity will require changes everywhere Americans live, work, play and learn, says a major new report that outlines dozens of options — from building more walkable neighborhoods to zoning limits on fast-food restaurants to selling healthier snacks in sports arenas.

But schools should be a national focus because that’s where children spend most of their day, eat a lot of their daily calories — and should be better taught how to eat healthy and stay fit, the influential Institute of Medicine said Tuesday.

University of Hawaii President M.R.C. Greenwood served as vice chairwoman of the study, "Accelerating Prog­ress in Obesity Prevention: Solving the Weight of the Nation." She said that in the past 15 years, Hawaii’s rate of obesity more than doubled to 23 percent in 2010 from 11 percent in 1995.

The Institute of Medicine is the health arm of the National Academy of Sciences, which provides advice to decision makers and the public.

One in 3 children entering kindergarten in Hawaii are already overweight or obese, she said.

"This is an unprecedented epidemic. … Across-the-board societal changes need to take place," said Greenwood, who specializes in obesity and diabetes research.

She said the cost of obesity for health care in the United States is $200 billion a year and that people can spend money on preventive measures to change eating and exercise behavior or face the health consequences.

"It’s sort of a pay-now-or-pay-later issue," Greenwood said.

For schools the report recommends that students get at least 60 minutes of physical activity every day — a combination of physical education, recess and other activities. Many schools have slashed PE and cut into recess in recent years in an effort to increase learning time amid tighter budgets. The report also says schools should serve healthier food, backing national school nutrition standards, and teach nutrition.

The report also recommends looking at giving agricultural tax breaks to farmers who grow healthier alternatives such as fruits and vegetables.

Among the most controversial of the recommendations: Communities could consider taxing sugary sodas, and offering price breaks for healthier beverage choices.

Greenwood said a sugar tax could be looked upon as a cigarette tax, but the recommendation prompted outrage from the American Beverage Association.

"Advocating discriminatory policies that uniquely focus on sugar-sweetened beverages is the wrong approach," said an association statement that added that those drinks account for just 7 percent of calories in the average person’s diet.

After a failed attempt to get support for a tax on sugary sodas and drinks in 2011, Gov. Neil Abercrombie called for a task force on childhood obesity. The Legislature passed Senate Bill 2778 to establish a Childhood Obesity Task Force this year to develop and make recommendations to the Legislature.

To promote healthier eating habits, the Hawaii state Department of Education banned the sale of soda beverages in the state’s public schools several years ago.

Also in Hawaii, some restaurants are listing nutritional information about their meals. "Most of the chain (restaurants) are trying to stay in front by posting calorie information," said Peter Oshiro, manager of the state food labeling program.

"I think there’s a lot of public pressure. Lots of people are on diet restrictions."

Most people know they should eat less and move more, but the institute makes clear the problem isn’t just an individual one, but a societal one: For a host of reasons, sedentary lives have become the norm, and Americans are surrounded by cheap, high-calorie food.

The report offers a map of the most promising strategies to change that — and argues that solutions can’t be implemented piecemeal.

"Each of us has this role. We can’t sit back and let the schools do it, or let a mayor do it or think somehow the federal government’s going to solve it," said report co-author William Purcell III. "These recommendations require concerted effort among all."

A health advocacy group urged governments, industry and schools to adopt the recommendations. "The country has begun to address obesity, but we are still doing far too little given the tremendous burden it places on our health and health care costs," said Margo Wootan of the Center for Science in the Public Interest.

Two-thirds of U.S. adults and almost a third of children are either overweight or obese, and prog­ress to stop this epidemic has been too slow, the Institute of Medicine concluded.

"It’s really disturbing," said University of Hawaii professor Jay Maddock, director of the Department of Public Health Sciences. "It could be worse than tobacco in the next couple of decades, especially in Hawaii."

Officials said that in conjunction with the release of the report, cable television network HBO will stream the documentary "Weight of the Nation" in two parts next week at www.hbo.com/ documentaries/index.html.

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Star-Advertiser reporter Gary T. Kubota and Associated Press reporter Lauran Neergaard contributed to this report.