Obesity…What Gives?

Contrary to what you might think, obesity is still an ongoing and growing problem that is spreading at pandemic proportions across the globe. Given all the recent drama, conflict, and turmoil that has seemed to fester inside whatever news media you swear too, it is not hard to imagen that your interest in and perceptions of the present state of obesity in America may have been distilled down to a fraction of what they once were. Despite this assumption, the obesity epidemic has continued to grow and evolve as a source of physical and emotional suffering that effects nearly 78 million adults and 13 million children in the US along, accounting for approximately $190 billion in medical cost (American Heart Association, 2016).

Why is this still such a prevalent issue? As it turns out, there is far more to this mounting obesity epidemic than meets the eye. In other words, the steady rise in obesity prevalence over the past 4 decades has and continues to be driven by factors that are out of the control of the average citizen. For example, the broadcasting of advertisements, the walkability of a neighborhood, or the availability of healthy foods are health factors that greatly impact a person’s health behaviors, yet they are rarely factors that can be easily amended or altered at an individual level. The 1988 article, An Ecological Perspective on Health Promotion Programs, points out, early on, that there are major shortcomings with obesity interventions focused on individual responsibility, “it instructs people to be individually responsible at a time when they are becoming less capable as individuals of controlling their total health environment.” (McLeroy, 1988). Thereby, a larger and broader scope of influence aimed at policy, system, and environmental change involving cross-sector support and ongoing direction from the community to protect the health of that community, despite the increasingly uncontrolled health environments they live. One important distinction being that promoting health via community interventions are highly effective as long as the definition of community does not shy away from the relationships that shape them (McLeroy, 1988).

As with most problem-solving tasks, before a solution can be drawn, one must first identify and understand the problem and its underlining causes. The socioecological model (SEM) is commonly applied in this context to help communities identify and classify the key causal factors supportive of obesity at various levels of influence (i.e. individual, interpersonal, organizational, community, and public policy).

Figure 1: an example of an SEM and how different influences might be classified. Image from Amy Meinen’s PowerPoint slides titled, Changing Behavior Effectively.

This model can also be helpful in designing multilevel and multifaceted improvement strategies to address the multilevel and interrelated factors negatively influencing obesity through coordinate action across multiple settings and sectors of influence.

Multi-level strategies targeting policy, system, and environmental changes is now seen as gold-standard for obesity prevention work. Policies are common targets for impacting in a broader context because they can be applied broadly, allow for accountability and enforcement, promote institutionalization of good ideas, and establishes relationships and responsibilities through consistent implementation (Public Health Law and Policy, 2012).

In closing, I invite you to step outside your individual bubble to connect and collaborate with other community members to identify needs and potential opportunities to improve the health environment in which you live through a policy and system-based approach.

References:

American Heart Association: life is why. Understanding the American Obesity Epidemic. Last Updated: Mar. 9, 2016. Accessed: September 26, 2017. Website: http://www.heart.org/HEARTORG/HealthyLiving/WeightManagement/Obesity/Understanding-the-American-Obesity-Epidemic_UCM_461650_Article.jsp#.Wcta_TOZPVp

McLaughlin, I., Mongeon, C., Eight Essential Elements for Strong Public Health Policy. Public Health Law & Policy. 2012. PowerPoint slides. Accessed: September 26th, 2017.

McLeroy, K., Bibeau, D., Steckler, A., Glanz, K. An Ecological Perspective on Health Promotion Programs. Health Education Quarterly. Published: Winter 1988.

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