Preventing Childhood Obesity Health in the Balance (2005) / Chapter Skim
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6 Local Communities
6 Local Communities
Pages 193-236
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From page 193... ...
But intrinsic tO any definition of a community is that it seeks to protect for its members what is shared and valued. In the case of obesity prevention in children and youth, what is "shared and valued" is the ability of children 193
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From page 194... ...
The intent of this chapter's recommendations is not only to make a case for raising the priority of childhood obesity prevention in our communities, but also to identify common interests that can spark collaborative community initiatives for addressing that goal. Many communities and organizations across the United States are actively working to address physical activity and nutrition-related issues; examples are highlighted throughout the chapter (Boxes 6-1 through 6-5)
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From page 195... ...
Mass Media, Et tenait ment, Recreatiot, and Leisure it dustries Television, radio, movies, print, and electronic media; journalists; commercial sponsors and advertisers; Internet websites and advertisers; computer and video-entertainment industry representatives PuhEc Health Professionals Recreatiot Ad Sports Et terprises Local, collegiate, and professional sports organizations; recreation facilities; recreation and sport equipment manufacturers, advertisers, marketers, and retailers Researchers Biomedical, public health, and social scientists; universities; private industry Schools, Child-Care Programs Educators and school administrators, food service personnel, after-school program providers, coaches, school boards, school designers (siting and construction) , child-care providers
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From page 196... ...
, Pawtucket Heart Health Program, and North Karelia Project (in Finland) have demonstrated the feasibility of community-based approaches in promoting physical activity and changes in dietary intake (Farquhar et al., 1977, 1990; Maccoby et al., 1977; Luepker et al., 1994; Young et al., 1996; Puska et al., 2002)
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From page 197... ...
Interventions included a schoolbased curriculum and a number of other community-based approaches that were not designed specifically for children (including labeling of hearthealthful restaurant and grocery store items; media campaigns; and screening for heart disease risk factors)
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From page 198... ...
. it has been pointed out, however, that while the strength of TABLE 6-2 Unique Characteristics of Effective Community Coalitions Characteristic Holistic and comprehensive Flexible and responsive Build a sense of community Build and enhance resident engagement in community life Provide a vehicle for community empowerment Allow diversity to be valued and celebrated Incubators for innovative solutions to large problems SOURCE: Adapted train Wolff, 2001 Description Allows the coalition to address issues that it deems as priorities; well illustrated in the Ottawa Charter for Health Promotion Coalitions address emerging issues and modify their strategies to fit new community needs Members frequently report that they value and receive professional and personal support for their participation in the social network of the coalition A structure is provided for renewed civic engagement; the coalition becomes a forum where multiple sectors can engage with each other As community coalitions solve local problems, they develop social capital, allowing residents to have an impact on multiple issues As communities become increasingly diverse, coalitions provide a vehicle for bringing together diverse groups to solve common problems Problem solving occurs not only at local levels, but at regional and national levels; local leaders can become national leaders
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From page 199... ...
Moreover, as discussed in Chapter 3, perceptions about body image and healthy weight can vary between cultures and ethnic groups, and these groups can manifest differing levels of comfort with having an elevated weight. Furthermore, there may be a "communication gap" in making information about the health concerns of childhood obesity widely available.
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From page 200... ...
. However, much remains to be learned about interventions that can reduce or alleviate the risk factors for childhood obesity in high-risk populations.
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Infommation on the risks of childhood obesity · Tools to assist their children in achieving normal growth and healthy development · Hanson demonstrations on how to prepare healthful and tasty foods that families will eat and enjoy . instruction on how to engage their families in physical activity.
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From page 202... ...
In particular, there is a need to galvanize action and expand opportunities for healthful eating and physical activity at the community level. Community youth organizations can have an impact not only by adapting their own programs to include emphasis on healthful eating and physical activity, but also by joining with other organizations to form coalitions to promote community-wide efforts.
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From page 203... ...
Communities should establish and promote coalitions of key public and private stakeholders (including community youth organizations, local government, state and local public health agencies, civic and community groups, businesses, faith-based groups) to address the problem of childhood obesity by increasing the opportunities for physical activity and a balanced diet.
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From page 204... ...
These projects would be run by community organizations linked with public health departments and in partnership with academic institutions to provide support, trarning, and evaluation. Seed fundrng for the projects could come from an expansion of federal programs, particularly CDC's state-based Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases (see Chapter 4)
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From page 205... ...
Because changes to the built environment can enhance opportunities for children and youth to safely play outside and be more physically active, such changes are a critical component of any action plan to prevent childhood obesity. Interest in the role of the built environment in determining levels of physical activity has grown over the past decade, and renewed efforts are currently under way to reconnect the goals of urban planning and public health and to identify the factors that influence physical activity and travel behavior (Handy et al., 2002; HoeEner et al., 2003; Corburn, 2004)
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From page 206... ...
On these walks, the staff train groups of up to 40 neighbors to see their streets as an untapped resource with potential for physical activity. At the end of the one-mile, two-hour inspections, participants receive notes with photos and maps documenting assets, possible improvements, and needed policy changes.
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document a higher level of physical inactivity among persons who perceive their neighborhoods to be unsafe (CDC, 1999)
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Research that directly examines the impact of changes made in the built environment on physical activity has been limited simply because increasing physical activity is often not the primary goal of these interventions and "pre-/post-" studies are difficult to conduct. Instead, changes to the built environment are often made because of safety concerns and the need to reduce the likelihood of traffic-related injuries.
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91) as an approach to promote physical activity, though the focus of this review was on adults (Kahn et al., 2002)
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Citizens themselves have a responsibility to advocate for changes in policy so that the built environment may ultimately offer increased opportunities for physical activity among children and youth The public may bring significant influence to bear over policy, particularly if a large and vor al constituency urges change and if prominent community groups, nonprofit organizations, and business organizations lend their support. In many communities, neighborhood associations play a formal rote in the planning process and have successfully advocated for new or improved parks, additionai side walks, traffic-calming programs, and other changes in the built
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LOCAL COMMUNITIES 211 environment. In addition, legal approaches may be useful (Perdue et al., 2003; Mensah et al., 2004)
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From page 212... ...
found, in a study of 114 British children aged 9 to 11 years, that the boys who walked to school were generally more active than those who were transported by car (although similar results were not seen for girls) While the committee acknowledges that there is no direct evidence that walking or bicycling to school will reduce the prevalence of obesity in children, clear evidence does exist that increases in physical activity can have positive impacts on weight loss or on maintaining a healthy weight.
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. These data suggest that Safe Routes to School programs show promise in promoting physically active means for children traveling to and from school.
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214 PREVENTING CHILDHOOD OBESITY BOX 6-5 Safe Routes to School Safe Routes to Schools was initiated in Western Europe and the United Kingdom. As its name implies, the program promotes walking and bicycling to school, and it does so through education and incentivesthat show how much fun it can be.
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Because so much remains to be learned about the various approaches to increasing walking and bicycling to school, thorough evaluations of such initiatives are critical. Commumtv Food Fnuironmen~ All members in a community need access3 to affordable and healthful food on a regular basis.
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. Community food-security assessment toolkits and other methods, such as community mapping, have been used to assist communities throughout the United States in undertaking community assessments and inventories to identify the type and range of locally available food resources, including supermarkets, corner grocery stores, full-service and fast food restaurants, food banks, food pantries, farmers' markets, and community gardens (Perry, 2001; Cohen, 2002; Pothukuchi et al., 2002; Sloane et al., 2003)
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From page 217... ...
Such efforts will expand healthful food choices at local grocery stores, supermarkets, and fast food restaurants, and they will encourage a broad range of community food-security initiatives that improve access to highly nutritional foods. Health impact Assessments and Community Health Evaluations Evaluation of community-wide efforts can be a challenge, given the typically wide age range among members of the population; their ethnic, racial, and social diversities; the differences in settings of various community interventions; and the numerous barriers involved.
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From page 218... ...
To assist in obesity prevention efforts, community health report cards should use measures that assess the community's progress toward encouraging good nutrition and physical activity. These measures could rate the built and social environments, local school policies and practices (Chapter 7)
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Recommendation 6: Community Programs Local governments, public health agencies, schools, and commumty organizations should collaboratively develop and promote programs that encourage healthful eating behaviors and regulau- physical activity, particularly for populations at high risk of childhood obesity. Community coalitions should be formed to facilitate and promote cross-cuttiog programs and community-wide efforts.
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From page 220... ...
Recommendation 7: Bv.ilt Environment Local governments, private developers, and community groups should expand opportunities for physical activity including recreational facilities, parks, playgrounds, sidewalks, bike paths, routes for walking or bicycling to school, and safe streets and neighborhoods, especially for populations at high risk of childhood obesity. To implement this recommendation: Local governments, working with private developers and community groups, should: · Revise comprehensive plans, zoning and subdivision ordinances, and other planning practices to increase availability and accessibility of opportunities for physical activity m new developments · Pliolitize capital improvement projects to increase opportunities for physical activity in existing areas · improve the street, sidewalk, mud street-crossing safety of routes to school, develop programs to encourage walking and bicyclmg to school, and build schools within walking and bicycling distmce of the neighborhoods they serve Community groups should: · Work with local governments to change their planning and capital improvement practices to give higher priority to opportumties for physical activity DHHS and the Department of Transportation should: · Fund communit -based research to examine the impact of
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From page 221... ...
Health-care professionals have frequent opportunities to encourage children and youth to engage in healthful lifestyles. Unfortunately, treatment of obesity per se is rarely considered a reimbursable interaction between patient and doctor, and our current health-care system is not yet focused on preventive measures for childhood obesity.
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. Studies of such counseling on obesity-related issues have shown positive results.
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From page 223... ...
. They should also serve as role models for healthful eating and regular physical activity and take leadership roles in advocating for childhood obesity prevention in local schools and communities.
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Health- and medical-care professional organizations should make childhood obesity prevention a high-priority goal for their organizations. This includes creating and disseminating evidence-based clinical guidance and other materials on obesity prevention; establishing programs to encourage members to be role models for proper nutrition and physical activity; advocating for childhood obesity prevention initiatives; and coordinating their efforts, wherever possible, with other health-care professional organizations.
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, have raised awareness that childhood obesity might be best addressed from a prevention perspective. Furthermore, the high economic costs of obesity (Chapter 2)
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From page 226... ...
Health insurers, health plans, and quality-improvement and accrediting organizations should designate childhood obesity prevention as a priority health promotion issue. Furthermore, health plans and health-care insurers should provide incentives to individuals and families to maintain healthy body weight and engage in routine physical activity.
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Further research is needed on effective counseling or other types of obesity prevention interventions that could be provided in health-care settings. Improved professional education regarding obesity prevention is an important next step, as is the active involvement of health professional organizations, insurers, and accrediting organizations, in making childhood obesity prevention efforts a priority.
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2004. Neighbothood play~toonds, fast food testamants, and ctime: Relationships to ovetweight in low-income pteschoolchild en.
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1999. Fruit and vegetable consumption and prevention of cancer The Black Churches United for Better Health project.
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230 PREVENTING CHILDHOOD OBESITY Collen KW, Battholomew LL, Patcel GS.
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J Am Diet Assoc 104(2)
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1993. Community-wide youth exercise ptomonon: Longtetm outcomes of the Minnesota Heart Health Pt og am and the Class of 1989 Study.
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Preventing Chronic Diseese [On inej. Available: http://www.cdc.gov/ped/issoes/2004/apt/04 0009.htm [accessed Aptil 20, 2004j.
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2000b. Intetvennons in health cate tettings to ptomote healthful eating and physical achvity in childten and adolescents.
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2003. Childhood obesity: A societal ptoblem to solve.
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236 PREVENTING CHILDHOOD OBESITY Utban and Envi onmental Policy Insutote.
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