Obesity: Community-based Approaches to Combat a National Epidemic

Introduction

The United States is facing a growing epidemic. This epidemic comes from a chronic disease

that is one of the country's greatest sources of mortality, disability, and healthcare-related costs.

This epidemic is obesity. While obesity affects all populations, it is most prevalent in minorities,

Hispanics and non-Hispanic Blacks. Although obesity is preventable, it has steadily increased.

Effective community-based nutrition can help to prevent this disease. To effectively combat

obesity, intervention must be multi-pronged and must impact local communities.

Background

Obesity can make an individual at risk of developing dozens of severe health problems.1,2 Many

communities where obesity rates are highest share similar characteristics. Namely, these

communities share an abundance of high caloric food, sugary drinks, and they lack access to

areas for physical activity and healthy foods.1,2 Social class does appear to be connected to

childhood obesity. Obesity affects 1 out of every 7 children from low-income families.3

Recently, obesity rates have nearly stagnated or even slightly ebbed in some cases. Still, rates are

alarmingly high. As of 2014, 37.9% of all adults over the age of 20, almost double the rates from

20 years previous, are obese in the United States.4 Moreover, 20.5% of all adolescents, ages 12

to 19, in America are obese, as of 2014.3

The Office of Disease Prevention and Health Promotion enacted national goals to combat health

issues, including obesity, through the Healthy People 2020 framework. One way leaders hope to

achieve these nutritional goals is through objective NWS-4, "Increase the proportion of

Americans who have access to a food retail outlet that sells a variety of foods that are

encouraged by the Dietary Guidelines for Americans".5 The targets established by the Healthy
People 2020 provide community nutrition leaders excellent resources to develop programs to

fight obesity.

Screening and Treatment

Obesity is defined in two ways, based on age. For children, obesity is characterized by a Body

Mass Index (BMI) measurement at the 95th percentile.6 This means the child has a higher BMI

than 95% of all other children with the same age and gender. For adults, obesity is characterized

by a BMI measurement of at least 30 kilogram per square meter.7 Based on these definitions, the

Centers for Disease Control and Prevention (CDC) growth charts are the most straightforward

means of identifying obesity. Primary health care providers provide much of the screening for

obesity. Yet, another important source of obesity screening is through centers of education, in

areas lacking access to routine health care. Currently only 29 states require weight screening in

schools.8

Obesity can stem from multiple risk factors. Two uncontrollable risk factors for obesity are

genetics, and diseases.1,2 In contrast, there are several controllable risk factors. Food choices and

physical activity are two principle contributive factors.1,2 Other controllable risk factors are food

industry advertising, peer influences, and medications.1,2

The Academy of Nutrition and Dietetics (AND) has developed guidelines to treat obesity using

evidence-based research. The AND first recommends reducing caloric intake and increasing

physical activity to achieve weight management.9 Treatment should also include education in

nutrition, and establishing support from family and friends.9,10 For adults and some severely

obese youths confronting difficulties losing weight through diet and exercise, weight-loss

medications and surgery might be recommended.9,10

Diet

The causes of obesity are complex, nevertheless one strong factor is diet. Individuals can make

dietary changes to prevent improper weight gain and later obesity. Exercising portion control can

lead to a decrease in total daily food calories.10 Individuals can make further dietary changes by

limiting sugary drinks.10 Other nutritional changes can be helpful in weight management, such as

following structured meals, performing food diaries.10

Several eating patterns are protective against obesity. Any diet following the Dietary Guidelines

for Americans, personally tailored to each persons preferences, incorporating an energy balance

will be protective against obesity.10 If there is a weight surplus, a diet that incorporates a caloric

deficit of 500 to 1000 kilocalories should produce a gradual weight loss.10 Two specific dietary

patterns, the DASH diet and Mediterranean diet when combined with daily calorie limitations

can protect against obesity.10 Moreover, these diets promote the majority of calories to come

from fruits, vegetables, grains, nuts, and seeds. This eating pattern provides fiber, which can help

with hunger and lower the energy density of the food. Finally, as long as the dietary pattern does

not create a large energy imbalance, there are no dietary patterns that are more or less effective.10

There is one significant eating pattern that increases the risk for obesity. Consuming high caloric

sugary drinks can lead to an energy imbalance and weight gain.10 The at-risk population is

drinking more high caloric sugary drinks, and eating more high caloric foods.1,2 These two

patterns, combined with larger portion sizes, are contributing to obesity.1,2

Lifestyle

Individuals can maintain a healthy weight through at least 60 minutes of daily moderate

exercise.2 By decreasing consumed calories, and increasing burned calories through physical
activity, individuals can prevent an energy imbalance that leads to weight gain. Moreover, social

support, such as engaging in physical activity and nutrition education with family members has

shown some positive changes in weight management.8,9 Other lifestyle changes can help prevent

obesity. These changes include getting adequate sleep, managing stress effectively, monitoring

ones diet through food diaries, and regular weight checks.11 Finally, research suggests

breastfeeding can prevent infants from developing obesity during childhood.2

Educational programs

Local and national leaders have developed numerous programs aimed to fight obesity. Two

successful programs are We Can! and Farm to Preschool. Farm to Preschool, part of the National

Farm to School Network, provides locally sourced healthy foods, offers education and nutrition,

and start school gardens.12 Although this program aims to promote healthy behaviors in the

rising generation it also reaches out to communities, teachers, providers of childcare, and

families. Community nutritionists can help connect schools with the Farm to Preschool network.

By doing so, community nutritionists can help youths without proper nutrition education, and

lacking access to fresh, healthy food.

We Can! (Ways to Enhance Childrens Activity & Nutrition) is an educational program

developed by the National Institutes of Health. National and international leaders have

implemented this program to instill healthy lifestyles in children between 8 and 13 years old.13

We Can! focuses on educating youths to make healthy food choices, increase physical activity,

and minimize screen time.13 This organization publishes teaching materials, conducts trainings,

and organizes events dedicated to its mission goals. Community nutritionists can effectively use

this organization by distributing its teaching materials to patients and families. Another way is by

recommending to families and patients, or even participating in the We Can! events. Through
these efforts, community nutritionists can help local disadvantaged individual develop healthier

lifestyles.

Recommendations

Obesity costs the nation hundreds of billions of dollars in healthcare and productivity costs each

year.4 The nation is not winning the fight against obesity. It is a wise decision to invest money

now to stop the tide of obesity. Organizations can effectively use greater amounts of funding to

teach the nations youth, from a very early age, proper food choices and physical activity.

Additionally, schools should continue moving toward offering older youths healthier food

choices and providing physical activity opportunities. Furthermore, more states nationwide

should mandate weight screenings to spot obesity early on. Moreover, restaurants can adopt a

similar practice of providing nutritious, healthy meals for children and adolescents. Finally,

businesses can offer their employees, during working hours, opportunities for physical activity.

This multivariable solution can address the current gaps in the fight obesity and further bring

down national obesity rates.

Conclusion

Obesity is one of the nations greatest health problems. Choosing proper nutritional foods and

focusing on regular exercise can protect against obesity. Family involvement can positively

impact an individuals nutrition status. Connecting schools, families, businesses, and community

nutritionists can employ a community of change and lifelong motivation for obesity prevention.

Moreover, by expanding participation in nutrition education programs, and promoting positive

body image, communities can promote healthy living.

Reference List

1. Adult Obesity Causes & Consequences. Centers for Disease Control and Prevention Web site.
http://www.cdc.gov/obesity/adult/causes.html. Published June 16, 2015. Accessed June 10, 2016.

2. Childhood Obesity Causes & Consequences. Centers for Disease Control and Prevention Web
site.
http://www.cdc.gov/obesity/childhood/causes.html. Published June 19, 2015. Accessed June 10,
2016.

3. Childhood Obesity Facts. Centers for Disease Control and Prevention Web site.
http://www.cdc.gov/obesity/data/childhood.html. Published June 19, 2015. Accessed June 10,
2016.

4. Adult Obesity Facts. Centers for Disease Control and Prevention Web site.
http://www.cdc.gov/obesity/adult/causes.html. Published September 21, 2015. Accessed June 10,
2016.

5. Healthy People 2020 Topics and Objectives. Office of Disease Prevention and Health
Promotion. http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx. Updated June
28, 2016. Accessed June 28, 2016.

6. Defining Childhood Obesity. Centers for Disease Control and Prevention Web site.
http://www.cdc.gov/obesity/childhood/defining.html. Published June 19, 2015. Accessed June
10, 2016.

7. Defining Adult Overweight and Obesity. Centers for Disease Control and Prevention Web
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http://www.cdc.gov/obesity/adult/causes.html. Published June 16, 2015. Accessed June 10, 2016.

8. Linchey J, Madsen KA. State requirements and recommendations for school-based screenings
for body mass index or body composition, 2010. Prev Chronic Dis 2011;8(5):A101.
http://www.cdc.gov/pcd/issues/2011/sep/11_0035.htm. Accessed June 21, 2016.

9. Hoelscher D, Kirk S, Ritchie L, Cunningham-Sabo L. Position of the Academy of Nutrition

and Dietetics: Interventions for the prevention and treatment of pediatric overweight and obesity.
J Acad Nutr Diet. 2013;113:1375-1394. doi:10.1016/j.jand.2013.08.004.

10. Raynor H, Champagne C. Position of the Academy of Nutrition and

Dietetics: Interventions for the treatment of overweight and obesity in adults. J Acad Nutr Diet.
2016;116:129-147. doi: 10.1016/j.jand.2015.10.031.

11. Mahan L, Escott-Stump S, Raymond J. Krauses Food and the Nutrition Care Process. Saint
Louis, MO: Elsevier Saunders; 2012.
12. Farm to Preschool. National Farm to School Network Web site.
http://www.farmtopreschool.org/. Accessed June 19, 2016.

13. We Can! Ways to Enhance Childrens Activity & Nutrition. National Heart, Lung, and Blood
Institute Web site. http://www.nhlbi.nih.gov/health/educational/wecan/. Published December 9,
2013. Accessed June 19, 2016.