In Reply to Dr. Anchondo and the Ellyn Satter Institute RE: MA-CORD.

[Author Affiliation]Elsie M. Taveras. 1 Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA. 2 Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA.Kirsten K. Davison. 2 Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA. 3 Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA.Meghan E. Perkins. 1 Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.Steven Gortmaker. 3 Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA.Thomas Land. 4 Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA.Address correspondence to: Elsie M. Taveras, MD, MPH, Chief, Division of General Academic Pediatrics, Department of Pediatrics, Director, Pediatric Population Health Management, MassGeneral Hospital for Children, Associate Professor of Pediatrics and Population Medicine, Harvard Medical School, Associate Professor of Nutrition, Harvard T.H. Chan School of Public Health, 125 Nashua Street, Suite #860, Boston, MA 02114-1101, E-mail: elsie.taveras@mgh.harvard.eduTo the Editor:While we agree with Dr. Anchondo and colleagues that it is time to think differently about childhood obesity prevention, we profoundly disagree that "WIC, schools, afterschool, and community-wide programs, as well as society at large ... should not encourage children to eat foods (deemed healthy) or exercise in prescribed ways." The approach adopted by the Massachusetts and the other Childhood Obesity Research Demonstration (CORD) sites has been to optimize and promote the use of best available evidence in these environments where children spend their time eating, sleeping, playing, and learning and to evaluate the effects of collaborative programs such as ours that are integrated across multiple settings. Evidence reviews using transparent methodology have shown that interventions across settings where children spend their time can benefit child health through improved nutrition and physical activity behaviors.1,2 As pointed out in a recent Lancet series on obesity prevention, "how we develop food preferences and make choices" is impacted by the settings in which we spend our time.3 Hawkes and colleagues call for comprehensive actions that create an enabling environment for infants and children to learn healthy food preferences, and Roberto and colleagues point out that "people bear some personal responsibility for their health, but environmental factors can readily support or undermine the ability of people to act in their own self-interest."3,4 CORD's multilevel, multisector approach is consistent with the Robert Wood Johnson Foundation's Building a Culture of Health Framework and the recommendations for systems-level interventions suggested by the Institute of Medicine Committee on Accelerating Progress in Obesity Prevention.5,6Dr. Anchondo and colleagues also suggest that MA-CORD is simply rehashing ineffective strategies of the past. In fact, some of these previous studies (e.g., Child and Adolescent Trial for Cardiovascular Health; CATCH) did show that children made changes to a more healthful diet and increased physical activity as a result of the intervention, and more recent replication studies where community support has been included to enhance the school- and individual-level efforts of CATCH have shown significant changes in child obesity rates, especially among low-income, ethnically diverse populations.7 In reality, CORD is quite different from previous interventions in seeking to implement and disseminate programs that have already been shown to be effective and in its aim to integrate clinical and public health approaches, rather than focus on single sectors as in the studies cited by Dr. …