Book Review  |   July 2009
Generation XL: The Childhood Obesity Pandemic: A Community-Based Solution
Author Affiliations
  • Ronald V. Marino, DO, MPH
    New York College of Osteopathic Medicine of New York Institute of Technology, Old Westbury, Clinical Professor of Pediatrics, State University of New York Medical School, Stony Brook Associate Chairman of Pediatrics, Winthrop University Hospital, Mineola, NY
    Adjunct Clinical Professor of Pediatrics
Article Information
Book Review   |   July 2009
Generation XL: The Childhood Obesity Pandemic: A Community-Based Solution
The Journal of the American Osteopathic Association, July 2009, Vol. 109, 349-350. doi:
The Journal of the American Osteopathic Association, July 2009, Vol. 109, 349-350. doi:
Generation XL: The Childhood Obesity Pandemic: A Community-Based Solution is a description of a community-based approach to fighting childhood obesity. This 120-page monograph serves as a step-by-step guide for communities to implement the Children's Health Initiative Program (CHIP) developed, directed, and nurtured in Roya Oak and Southfield, Mich, by the author and family physician Paul R. Ehrmann, DO. This program is a result of collaboration among community physicians, other healthcare providers, elementary schools, business leaders, government officials, and families.1 The program—which carries a government-like cachet (similar to the Children's Health Insurance Program of the Centers for Medicare and Medicaid Services)—earned Dr Ehrmann a “Health Care Hero Award” in 2008 from Crain's Detroit Business. The concept of active participation by patients in their own health maintenance and disease prevention, reflected in Dr Ehrmann's CHIP, is consistent with the “DO difference” and osteopathic tenets and principles for patient care as described by Rogers et al.2 
Dr Ehrmann's book is part history and part “how-to” manual. It consists of six chapters, each of which is generously sprinkled with inspirational quotations from various luminaries (ranging from Marian Wright Edelman to Colin Powell and Vince Lombardi), helping to make the book more enjoyable for readers. 
In chapter 1, “CHIP—The Conception of an Idea,” Dr Ehrmann notes that he felt compelled to develop the program after attending a 2003 meeting in which US Surgeon General Richard Carmona, MD, was quoted as saying, “...if we do not win the battle against childhood obesity, there would be a good possibility that our children would not outlive their parents.” Dr Ehrmann writes that, from the program's outset, he envisioned CHIP to be “...a grassroots, community-based healthy living program, encouraging involvement from local community leadership in the areas of health, education, business, and government.” These “CHIP stakeholders” are outlined in one diagram included in this chapter. For example, under “Health” in this diagram, the elements include physician, registered dietician, healthy cook, exercise physiologist, and mental health professional. Diagrams in succeeding chapters highlight various other important aspects of the text. 
In chapter 2, “The Birth of a Plan,” Dr Ehrmann describes how he developed the objectives, mission statement, and other aspects of the program—such as by presenting his ideas to local public school boards and parent-teacher groups for feedback. He also discusses the makeup of the management and instructional teams that participated in planning and development meetings. These teams determined that CHIP would consist of five midweek 90-minute sessions for students and their families to learn about nutrition, exercise, and healthy cooking and grocery shopping habits. After each session, healthy foods donated by local restaurants would be served. At the end of the 5-week program, a convocation and awards ceremony would be held. 
Dr Ehrmann writes in chapter 3, “Putting CHIP into Action,” that families were recruited into the program through take-home flyers distributed to students in grades 3, 4, and 5, and through speeches delivered at school assemblies. He also breaks down the contribution sources and planned expenses of the CHIP budget and summarizes the program's public relations (ie, local media) strategy. 
The bulk of chapter 3 provides curriculum details of each part of the 5-week program, including objectives, at-school activities, and at-home assignments. The titles of the five sessions are, from week 1 to week 5: “Overview and Behavioral Assessment,” “Fitness and Fun,” “Food and Fun, Part 1,” “Food and Fun, Part 2,” and “Convocation and Award Ceremony.” Helpful figures in this chapter include a version of the 10-item Rosenberg Self-Esteem Scale for use in pre-assessment testing. 
Chapter 4, “CHIP Mentorship—Paying it Forward,” notes that the CHIP mentorship program was designed to encourage the replication of CHIP throughout the United States. Dr Ehrmann describes the development and implementation of the program. 
Chapter 5 is the book's conclusion and covers “What did we learn—and where do we go from here?” Dr Ehrmann and his team continue to refine CHIP. He states that though initial outcome data on the program are inconclusive, he is confident that CHIP “...made a difference in the families and communities we served... “ 
In chapter 6, the author provides numerous testimonials regarding the success of CHIP. There are also 16 appendices and an extensive bibliography consisting of journal references and a list of additional resources. The reader will find some of the appendices of practical assistance—such as a sample waiver-of-liability form, a compendium of healthy recipes, and lists of nutrition and grocery-shopping tips. However, other appendices, such as the author's resume and a copy of the CHIP promotional brochure, are not necessary. 
The premise behind Generation XL is sound—namely, that a collaborative community-based approach to public health requires the involvement of a strong advocate and consensus builder. Unfortunately, the evaluation of CHIP's results and outcome data is very limited. Only in appendix P is there any mention of outcomes, and this mention is general and anecdotal (eg, “47% increase in eating breakfast at 30 days... “, “Positive effects on other family members... “). Nevertheless, given the magnitude of the obesity epidemic in the United States, any effort to draw attention to this public health problem—with or without proof of efficacy—is welcome. 
Generation XL may be of interest to community-minded coalition builders who need some inspiration to start a public health program. In addition, it is refreshing to see a committed osteopathic family physician, like Dr Ehrmann, document the community linkages that a concerned energetic individual can make to address a vexing public health issue. 
 By Paul R. Ehrmann, DO. 120 pp, $14.95. ISBN: 0-9768347-6-6. Warren, Mich: ML Publishing; 2008.
Children's Health Initiative Program Web site. Available at: Accessed June 30, 2009.
Rogers FJ, D'Alonzo Jr GE, Glover JC, Korr IM, Osborn GG, Patterson MM, et al. Proposed tenets of osteopathic medicine and principles for patient care. J Am Osteopath Assoc. 2002;102:63-65. Available at: Accessed June 30, 2009.♦