Already considered a national health crisis, the number of overweight and obese children continues to rise annually.

As much as $7 billion is being spent this year to curb the problem through programs reaching nearly 5 million youngsters.

But a new survey out Wednesday has found that most initiatives are not focusing on the few things known to make a difference – and overall there is no consensus on what works best.

“There are some substantial holes in our efforts,” said Dr. David McCarron, executive director of Shaping America’s Youth, which commissioned the survey of 1,100 organizations that work with children.

“For example, if you look at the data, most of the programs are directed at the middle-school years and older, yet we know if a child enters first grade and is overweight, they’re (more likely) to be overweight” for life.

The survey is the first undertaking by Shaping America’s Youth, a partnership of government and private groups that plans to offer guidance on preventing and treating weight problems in children.

No one disagrees about the severity of the issue, with the number of overweight children more than doubling from 1980 to 2000. By 2003, fully 15 percent of youngsters ages 6 to 18 years were overweight – up from 11 percent just a year earlier.

The extra pounds contribute to myriad health dangers that already are emerging in younger and younger people – type 2 diabetes, high blood pressure, sleep apnea and elevated cholesterol levels. Unless something is done, overweight children are bound for a lifetime of health struggles.

“Adult diseases begin in childhood, so once you become an obese adolescent, you become an obese adult and that becomes a life-shortening disease,” said Dr. Carden Johnston, president of the American Academy of Pediatrics.

The speed and scope of the problem is feeding the multitude of community, government, private and school-based programs aimed at improving children’s health. But, as the survey found, the hodge-podge efforts may not be as effective as they could be.

For example:

-About 78 percent of the programs run for less than a year.

-Just 8 percent involve the whole family.

-Most have direct contact with children less than once a week.

-Many programs focus on providing youngsters with educational information, rather than making changes in children’s environments that are conducive to maintaining a healthy weight.

Another problem is that few programs have ways to measure their effectiveness, McCarron said, even though most claim that “outcome-based” programs are their goal.

“People who fund these programs say it’s important, yet only half the programs had outcome measures identified when they set out, and less than half of them ever looked at them,” McCarron said.

Shaping America’s Youth plans to build on the survey by holding large town meetings throughout the country to solicit ideas and, eventually, to develop a national plan for preventing childhood obesity and weight gain.

The group includes a diverse membership from the U.S. Surgeon General’s office and the American Academy of Pediatrics to Campbell Soup Co. and Nike Inc.

In the meantime, Johnston said parents who are concerned about a child’s weight should talk to their pediatricians and try to implement some simple steps to improve health.

Make sure children “get outside and play, eat five fruits and vegetables a day and turn off the TV,” he said.

In the end, McCarron said it’s much more effective to prevent weight gain and obesity because children and adults alike have a very difficult time shedding the pounds once they have accumulated.

“Our hope is in prevention,” McCarron said. “That’s why we need to direct our efforts to infants, toddlers and pre-schoolers because that’s where it needs to start.

“Families need to understand, in the early stages of a child’s life, they need to be setting a pattern of exercise and eating that is conducive to maintaining a healthy weight.”