Intersections

Obesity 1

Having spent fifteen years researching obesity related topics, here is my take on how to achieve a healthy weight.

1.  Some scientists say that to lose a pound you must eat 3500 calories less than you burn, this is based on simple thermodynamics models. But because the human body can adjust its efficiency at using calories, the reality might be higher and the deficit may be over 4000 calories per pound. It’s not going to be easy to avoid weight gain or to lose weight

2. In general, each individual’s body does establish its own equilibrium point between calorie consumption and energy expenditure. Some scientists say that it is very difficult to change this point. Unfortunately, it is easy to adjust it up so that the body requires more food and tries to maintain itself at a higher weight. That’s one reason it’s so hard to lose weight and one reason that your first goal should be to not gain weight.

3. No one knows how many calories are in anything by just looking at it. No one knows what a portion size is.  So you have to drastically overestimate your portion sizes and underestimate calories per portion to be on the safe side.  Better still, check product information when you can.

4. Plan ahead. Check restaurant web sites for menus and calorie information if you can.

5.  Use small plates. They seem to trick the eye into believing you are eating more and the result is that you will eat fewer calories.

6. Avoid processed foods. They tend to have too many calories and too much salt. Sugar too.

7.  Eat as many vegetables and fruits as you can. But fried, salted, sugared, and buttered ones must be avoided.

8. Never finish a meal. Share or save for later. Never join the clean plate club

9. Never eat until you are groggy full. Well on Christmas, Thanksgiving, and your birthday you may. No other times.

10.  Those healthy alternatives at fast food restaurants?  Don’t believe it. They lie.  “Healthy items” often contain fats, processed chemicals, sugars, and who knows what else.

11. Meatless Mondays?  How about going the opposite and only eat meat once a week. Or only on special occasions? Or not at all?

12. Unless you are a woman of childbearing age, eat more fish. Women of childbearing age should also eat fish, but be careful to eat only fish from low on the food chain.

OBECTIVES:

1. Summarize current research and evaluate state of knowledge on the built environment/obesity link.

2.         Outline gaps in current knowledge and suggest additional needed research.

ABSTRACT

A number of studies have been published exploring the relationship between the built environment and obesity.  The vast majority of these studies have been suburban and cross sectional, comparing current outcomes to current conditions.  A very limited number have studied obesity before and after an environmental amenity has been built and none have been longitudinal with obesity as an outcome.  Few have focused on inner city and minority populations.  This is an appropriate time to assess the current state of the evidence.

While the some of the literature suggests that there may be a relationship between the built environment and obesity, there are a number of important research needs including:

Statistical/Epidemiological issues:  Are multilevel studies appropriate models for studying built environment/obesity relationships?  Does the evidence meet conventional standards of causality?

Longitudinal studies.  Do people move to automobile focused neighborhoods because they are already overweigh? Or does weight rise after moving to sprawled communities?

Interventions.  A limited number of neighborhoods might benefit from the installation of sidewalks or other pedestrian amenities.  But many other communities might not be so easily retrofitted.  What can be done to address obesity in the vast majority of already built neighborhoods?

Special Populations.  Most studies to date have focused on predominately suburban neighborhoods.  What can be done to improve the built environment in inner cities and communities of color? How does this research apply to people with disabilities?

Addressing these issues are critical if the current obesity epidemic is to be reduced.

Background

The public health profession has developed theories and methodologies to promote behavior change on both the individual and population level. From reducing tobacco use to encouraging seat belt acceptance, many behavioral change campaigns have been successful.  This paper suggests ways these theories and methodologies could be used to create large-scale, nationwide change to promote active living.

Active living environments is used here to mean communities that foster walking, biking, and public transportation through mixed use, compact and dense development forms, and transportation systems that reduce car use. The alternative is conventional development: large lot zoning, strict separation of land uses, and streets heavily engineered for cars.

Evidence suggests that active environments promote physical activity, reduce obesity, improve mental health, and strengthen social capital.  These may increase health and reduce morbidity and mortality.

Objectives

This analysis aims to provide the beginning of a discussion of what a broad public health campaign to promote the creation and use of active living environments might look like.  Objectives include:

• Identify models of behavioral change that might assist policy makers and advocates to promote active living environments with an emphasis on families with children and communities of color.
• Encourage efforts to change social norms that prioritize active communities.
• Propose strategies for advancing the preference for active living.

Two outcomes were prioritized:

• Increase demand.  How might we encourage individuals and families to choose to live in active environments?
• Increase supply. How might we encourage governments to implement changes to codes and development guidelines that would result in more active communities?

Methods

This analysis included a scan of the public health literature on promoting behavior change.  In addition to broad theoretical models of change, it drew on experiences including reducing tobacco use as models for promoting change at both the individual and community level.

Results

Traditionally, public health has focused on promoting behavioral change on the intrapersonal, interpersonal, and population level.  All these levels must be addressed if we are to increase both the supply of and demand for active environments.  Specific examples include:

Intrapersonal Level. Health belief models of change suggest that public health efforts include working with individuals and families to help them understand that by living in active environments, they can increase physical activity and reduce obesity risk. Thus they should be educated regarding the ways that conventional environments can pose barriers to health, particularly for children, and that health may improve by living in active environments. These campaigns should utilize planned behavior theory and encourage changes in attitudes toward living in active environments, increase perceptions that moving to these environments would mean adopting new social norms that prioritize active living, demonstrate that families with children have the ability to live in these communities in ways that would enhance their health and well being, and identify specific neighborhood attribute choices that would promote health.  Stages of change theory suggest encouraging families to the point where they contemplate moving to an active environment and then help them make that move (a priority target would be people of color most at risk for obesity).  It also suggests that strategies to help those who already live in active environments not to leave (perhaps targeting inner-city residents considering moves to the suburbs).

Intrapersonal Level. Social cognitive theory suggests that campaigns to promote active living environments should aim to change expectations regarding the kinds of neighborhoods people should live in (for example, currently many families believe that conventional neighborhoods are the only appropriate place for children).  It would communicate the idea that individuals and families have the ability to demand and choose healthy neighborhood designs. Social network theory suggests changing norms of behavior so that conventional environments are seen as less desirable.  At the same time, living in active communities would be promoted as more healthy.

Population Level.  Communication theory suggests that information campaigns are necessary so that the public understands the health consequences of conventional development with special outreach to linguistic minorities.  Diffusion of innovation models would imply the targeting of key individuals (particularly in minority communities) as the starting point in changing social norms and behavior.  Community mobilization experience demonstrates the need for planning, coalition building, and action.

Conclusions

If we are to move towards having a sizable portion of the US (and other countries) living in active environments, then there is a need to initiate large scale attitude and behavioral change strategies. These initiatives should include working with individuals to increase the number of people who desire to live in active environments and to develop a constituency that supports changes in zoning and development guidelines. On the community level, these strategies would have the ultimate goal of creating more opportunities for active living.  Together, they may move societies toward better health.