Changing patterns in infectious diseases typically attract attention and significant mobilization of funding and action. Chronic disease has often been less of a priority for public health and health care organizations, but the evidence of escalating obesity in the United States is alarming and should motivate widespread action to contain and reverse the effects of this silent epidemic. Such concerted action cannot be undertaken successfully by governmental public health agencies alone; it requires the resources and efforts of other partners within the public health system. Taking action to address the problem of obesity also requires that all entities in the public health system engage in partnerships; demonstrate accountability to their patients, communities, clients, employers, and each other; make program and policy decisions based on the evidence (e.g., community assessments and effectiveness data); and communicate effectively with other partners and the public. For example, communities and community-based organizations can assess the extent of overweight and obesity in the community and engage in a range of activities, from traditional, modestly successful methods that involve the provision of education and information to more innovative and powerful efforts to change the community conditions that make sedentary living and unhealthy eating "the path of least resistance." They can encourage the adoption of active lifestyles by working with community development and planning agencies to make parks and playing fields safe and accessible. As discussed in Chapter 4, communities can also make changes in their physical surroundings, by engaging in a variety of activities to improve neighborhood safety and livability, and by increasing the amount of green space and the recreational options available to children. Schools can become sites for community recreation centers that are affordable and easy to access. Communities could also facilitate the formation of community walk groups that meet on a regular basis to exercise together and share knowledge and success stories. The recently launched Hearts N'Parks program sponsored by the National Heart, Lung, and Blood Institute and the National Recreation and Park Association is getting communities interested and mobilized to become physically active by planning a variety of community and educational activities (NIH, 2002).
In the area of nutrition, school cafeterias can also modify their offerings to support better food choices by students. Through partnerships with schools, communities can work to change children's eating and physical activity habits by providing support and information to help teachers and school staff modify curricula and change cafeteria menus, and by not permitting vending machines with sugar- and fat-laden products in the school setting. For example, the Los Angeles Unified School District discontinued soda vending on all school premises in the district, thus removing an element that has been linked to childhood obesity (Wood, 2002). Communities could also develop relationships with farmers to make fresh fruits and vegetables more readily available and affordable through weekly markets. Neighborhood restaurants and grocery stores could offer and advertise healthier foods. In partnership with local media, health officials, large and small businesses, and others, community groups can spearhead public awareness campaigns and emphasize the importance of physical activity and the opportunities available, as well as the need to make healthy food choices, within a context of enhanced access, affordability, and cultural appropriateness.
The health care delivery system can provide training and resources to all health care providers and professionals to recognize and monitor individuals who are overweight or obese and to inform and educate patients about the risks and the changes that they can make and the benefits that they will receive. Health care plans should base administrative policy decisions on the evidence (e.g., the association between eating, exercise, and chronic disease and the three times greater likelihood that patients who are counseled about weight loss by their health care providers will actually try to lose weight). The health care sector should also work to adopt the National Institutes of Health's (NIH's) 1998 Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults and partner with researchers to establish treatment protocols (e.g., pharmacotherapy and surgery) that are safe, effective, and tailored to individual needs and circumstances. Health care systems and providers should also communicate and work collaboratively with health departments and community-based and national associations and advocacy groups focused on educating the public about the link between obesity and chronic disease.
Businesses and employers can play a major role in carrying out some essential public health services. The contributions of employers may range from providing health insurance plans that offer comprehensive preventive services to supporting research about and implementation of workplace promotion of weight management (e.g., by providing healthy cafeteria and vending machine alternatives and the space, equipment, and time for physical activity). Food industry businesses may also provide point-of-sale nutritional information and healthier menu options.
The news and entertainment media can play a unique part in addressing the problem of obesity. The media can serve primarily as a source of information about the associations between physical activity and nutrition, weight, and chronic disease. Through reporting and entertainment, the media creates a forum for discussing Americans' increasing girth, its implications for overall health, the social and cultural correlates, and related issues that may increase awareness. Local media may collaborate with local health officials to communicate locally relevant information and to highlight opportunities for community-based physical activity. By taking part in tackling this major population health concern, the media can better fulfill its accountability to the public to provide accurate and timely information.
The academic setting can make many contributions to addressing obesity and its impact on overall population health, especially to the evidence base. For example, research has demonstrated that educational approaches aimed at improving individual knowledge and action about food choices and exercise have been largely ineffective at preventing weight gain (Nestle and Jacobson, 2000; Jeffery, 2001). Academic research is necessary to enhance current monitoring and surveillance tools to more accurately track obesity, eating habits, and physical activity among all adults, children, specific populations, and states. Also needed is the development of more precise and consistent assessment tools for measuring obesity and overweight among children. It is also important for academia to continue to support, evaluate, and implement projects related to environmental conditions and policies for their impact on decreasing obesity and increasing healthy eating habits and physical activity. Academia can also disseminate data more broadly to interested parties on initiatives, programs, and policies that are effective and document and analyze how obesity affects mental health, development, and socialization; continue to research the relationship between obesity and various medical conditions; and develop prevention and treatment protocols to address them. Academic researchers can continue to evaluate treatment strategies made available by advances in technology, pharmacokinetics, and genetic research.
The role of the governmental public health infrastructure in responding to the obesity epidemic is multifaceted. Such efforts may include supporting the activities of other partners, funding NIH and academic research on obesity, helping to develop the Dietary Guide for Americans (a collaboration between DHHS and the Department of Agriculture), and spearheading a variety of initiatives such as food labeling. The role of the federal government in addressing obesity is essential, as it sets the pace for the nation and underscores this as a critical issue in assuring population health. In June 2002, in the wake of the 2001 Surgeon General's report on obesity, President George W. Bush launched a new initiative, HealthierUS, that encourages Americans to pursue physical activity, healthy eating, and other healthy choices and to get preventive screenings (White House, 2002). In July 2002, CDC launched a multicultural Youth Media Campaign (entitled "VERB: It's what you do.") targeting youth across the nation (DHHS, 2002). The campaign encourages children between ages 9 and 13 to choose a "verb" (e.g., swim, run, or bowl) that fits their personality and interests and to start applying that verb in their daily lives. The campaign aims to engage children in a type of physical activity that they enjoy and, ultimately, to help them reap the related benefits of enhanced self-esteem, social connectedness, confidence, and discipline. At the local level of governmental public health agencies, health departments may administer or collaborate with the Department of Agriculture's Women, Infants and Children (WIC) food supplementation program that provides nutritious foods and education to mothers and children up to age 5. They may also collaborate with local school programs and engage in many other community-based efforts that target overweight and obesity through a wide range of activities.
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