Obesity is a major public health problem in the United States. Approximately 1 in 3 adults1 and 1 in 6 children2 are classified as obese. Obesity can put individuals at risk for the leading causes of death in the US including: heart disease, certain cancers, and stroke, as well high cholesterol, type 2 diabetes, sleep apnea, and other negative physical and mental health outcomes.3 Annual medical care costs of obesity in the US was about $147 billion in 2008. The development of obesity is complex and influenced by both individual and environmental factors. Individual level behaviors include: genetic predisposition, lack of physical activity, unhealthy diet, medical problems, medications4 and parental feeding practices5-6. Additionally, environmental factors that promote obesity by influencing individuals’ decisions related to physical activity and food consumption include poor access to affordable healthy foods, easy access to an abundance of inexpensive energy dense foods and sugary drinks, and limited opportunities for safe physical activity due to crime and environmental hazards. 7-13
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An individual is considered obese when he or she has excess body fat. In clinical and school settings, body mass indixes (BMI; weight(kg) / height(m)2) and age and sex specific BMI percentiles are commonly used as indirect measures of body fat for adults and children, respectively. Among adults, those age 20 years and older whose BMI is > 30 are considered to be obese14 (man 5’9’’ weight >196lbs, woman 5’4’’ weight >174lbs)15. Children ages 2 through 19 years, with an age and sex specific BMI percentile > 95th percentile are considered to be obese.16 Although obesity is high in the general population, certain demographic groups, particularly racial/ethnic minorities are disproportionately affected by obesity.17 There are also substantial disparities in obesity according to sex, age, social and economic issues17, and where people live.18
Even modest weight loss can improve or prevent health problems associated with obesity. Weight loss is possible through improved diet and nutrition, increased physical activity, and health behavior changes. However, preventing obesity, especially among children is important. Central to decreasing obesity risk for children is promoting healthy individual level behaviors like reducing sugary beverage consumption, screen time and other inactive behaviors, increasing physical activity, 19 and choosing food options low in solid fats, calories, and added sugars.19-20 Environmental supports including promoting breastfeeding, 21-22providing healthy options for eating, and physical activity in school and early childcare settings23may also benefit children.
Obesity is a major public health problem in the US, affecting one-third of the population. The annual medical care costs related to obesity was about $147 billion dollars in 2008. Obesity can lead to a wide array of diseases, including some of the leading causes of death in the US. There is not one sole solution to prevent or reduce obesity. Concerted efforts are required to address this complex public health problem. Examples include healthy diet and physical activity choices among individuals and the promotion of active living and healthy eating opportunities in the communities where they live, work, learn and play.24-25
Martha works as a nutrition counselor in the Crewmanton Clinic. In addition to being at high risk for poor nutrition, she’s noticed that many of the children she serves are overweight or obese. For the past three years, Martha has worked with Angela, a single mother of two boys, one 5 years old and the other 3 years old. Angela’s oldest son is overweight. Martha consistently provides Angela with nutrition and physical activity strategies such as increasing consumption of fruits and vegetables, increasing opportunities for outside play, and limiting fast food, sugary drinks and screen time, to help improve his weight status. Angela has never been concerned about her son being overweight; in fact in her community having a child that is slightly heavy is considered an indicator of prosperity and good parenting. Still, she’s very grateful for Martha’s suggestions and tries to implement them.
One day, Angela shares with Martha the difficulty she has in following through with the recommended strategies. Angela doesn’t own a car and there’s no public transportation near her apartment. She lives in a food desert with no grocery stores or farmers markets in walking distance. There are many fast food restaurants near her home, but she needs a ride from her neighbor to get to the nearest grocery store, which is 10 miles away. Most of the time she visits the local corner store to purchase foods, where fresh, high quality and affordable fruits and vegetables are rarely available. Many of the food options that are within her budget are also unhealthy. Plus, her son is a picky eater and refuses to eat vegetables. Angela tends to buy the foods that she knows he’ll eat in order to avoid wasting money.
Physical activity is a difficult because she lives in a high crime neighborhood that lacks safe play areas like parks and playgrounds. She’s also a fulltime student and works part-time, and often too exhausted or lacks the time for physical activity with the kids. It’s easier for her to turn on the TV to keep her sons out of trouble while she completes her schoolwork.
Dr. Robinson, the pediatrician for Angela’s sons, also realizes that strategies like eating healthy foods and being physically active can be difficult for people who may not have the environmental supports to make these decisions. Both Martha and Dr. Robinson work with Angela to use culturally tailored approaches to address her son’s weight. Angela begins attending free healthy cooking classes at the clinic with her sons. The class instructors use foods purchased at local stores that she can easily access. Angela also gets involved with a local community garden. She and her sons get physical activity as they help tend the garden, plus they’re able to get fresh produce there. Dr. Robinson also takes steps to promote a healthy clinic environment for patients by adding a water dispenser and removing vending machines in the lobby area of his practice.
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