Obesity is becoming a major health issue in the United States across all age groups. It is well known that obesity is a major contributor in the occurrence of type 2 diabetes and heart conditions. Although physicians and other clinicians are often called upon to become the primary players in the prevention and treatment of chronic conditions, it is not possible for them to do so alone when it comes to addressing obesity. The issue is too complex and prevalent for them to solve the problem. Local communities and states must lead or assist healthcare providers in the prevention and treatment of obesity.
In the article “The ABC’s of Beating Obesity” from the Wall Street Journal, the author Betsy McKay stated that obesity is a serious health issue and is best addressed at the local and state level. Currently about 17% of youth ages 12-19 are obese. The percentage of adults who are obese is much higher; about 1/3 of adults under 40 are obese.
What can local groups do to prevent obesity in children and youth? Communities should see to it that its youth exercise about 60 minutes a day and eat healthy, nutritious diets. This is easier said than done, however. How can a community make a significant contribution in addressing obesity? My experience with local prevention coalitions convinces me that coalitions that focus on reducing obesity in youth and adults can make a significant difference.
For several years I have been involved with local coalitions that focus on reducing the use of alcohol, tobacco and other drugs in youth. The groups have utilized a variety of approaches in changing the local environment so that use of drugs and alcohol is reduced. At one high school the use of alcohol has decreased over 20% in the past five years. Changes in the environment have included a messaging campaign that lets youth and adults know that most high school students do not use alcohol or other drugs; survey of local youth support these facts. By publicizing the facts youth are given “permission” to be like the majority (which most want to be) who do not use drugs or alcohol. Another environmental approach is the enactment of “hosting laws” locally; with these ordinances local police are able to fine adults who provide alcohol to youth at their homes. Local governments promote public awareness of the ordinance with the slogan “Those who host lose the most.”
What are effective coalitions and how are they formed? CADCA (Community Anti-Drug Coalitions of America) defines coalitions as a formal arrangement for collaboration among groups or sectors of a community, in which each group retains its identity but all agree to work together toward the common goal of a safe, healthy and drug-free community. The coalitions in which I am a member include the local health department, local schools, medical and mental health groups, representatives from the local or county government, youth and parents, among others. Ms. McKay in her article emphasizes that healthcare providers, employers, schools and health departments should be included in groups that work on the prevention of obesity in youth.
CADCA along with its definition of an effective coalition emphasizes that coalitions should employ a public health model to carry out its work. This model stresses that coalitions should work to change an environment rather than focusing on individuals and families, as has traditionally been done. In order to change an environment CADCA has formed a model for coalitions to employ. The elements of the model are assessment of the problem with data, building of membership of the coalition to include groups that address the issue, creating a plan to change the environment to effect change, implanting its plan and then evaluating the results of the activities of the coalition in the effected population.
This model has worked well for alcohol and drug prevention coalitions in many localities across the United States. It has also worked in reducing childhood obesity. In a May 2007 article in the Wall Street Journal a report indicated that the town of Somerville, Massachusetts had participated in a five-year study led by Tufts University to reduce the BMI of its early elementary children. The study indicated that it was successful in doing so. The community program used inexpensive approaches to change the environment, which lead to healthier weights of its youth. One of the changes involved making it easier for children to walk to school. Crossing guards were added at key intersections and crosswalks were repainted. Schools held programs that taught parents how to cook healthy meals for their children. Local restaurants provided healthy choice meals for youth and adults.
As you can see, healthcare providers alone cannot be expected to effect population level changes in altering lifestyle behavior patterns that lead to unhealthy outcomes such as obesity. Rather, one effective approach is the use of local coalitions involving groups that can together effect changes in the environment that lead to healthier outcomes for the local population. Coalitions that use a public health models employed by their local health departments can produce significant results for their communities.
Donald Tex Bryant is a consultant who helps healthcare providers meet their challenges. He can be reached at Bryant’s Healthcare Solutions.