Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 34
segments of the population remains uncertain.
Furthermore, efforts to contain medical costs, as well
as the increase in medical costs borne by consumers
may drive changes in behavior and create a demand
for environmental change.
Grass - r oots m obilization
The history of social movements is characterized by
grass - roots groups that mobilize in response to a
common threat and are committed to change. 1 An
important element of tobacco control was the development
of a variety of groups with shared or overlapping
agendas, which worked separately on some issues
but together on others to limit tobacco use at the
local and state level. 2 These efforts often began locally,
but as a result of the communication that developed
between the groups and the networks, these strategies
spread to other venues. For example, regulations
to require smoking and non - smoking areas in
public buildings were implemented in Minnesota in
1975 2 and spread from there to other locales and
states.
Although obesity has been recognized as a significant
problem by a variety of elites, such as medical
providers, public health authorities, philanthropies,
and some business and government leaders, the public
has not mobilized broadly around common strategies
to improve nutrition and physical activity in children
and adolescents. One potential explanation is that
obesity is still widely perceived as an issue of personal
or parental responsibility rather than one for which
broad changes in policy are required. Nonetheless, as
indicated above, a number of schools and communities
have committed to change. Because many of these
efforts have been supported by local organizations
including philanthropic trusts, it remains uncertain
whether these efforts are imposed on the community
with only limited community mobilization, or are
community based or community driven. Only the
latter two scenarios are likely to mobilize substantial
numbers of individuals with a sustained commitment
to change. Furthermore, the efforts in communities to
control obesity are not yet connected or coordinated.
An important challenge is how to connect these local
efforts to broaden the base of support necessary for
the prevention and control of obesity.
Conclusion
Tobacco control has progressed because of a successful
social movement that has been coupled with policy
and environmental change. Surveillance led to an
awareness of the adverse health effects of tobacco
use and a broad appreciation of the human costs
associated with tobacco use. Reports from the federal
government regarding the hazards of tobacco use
reinforced local initiatives. Cigarettes and the companies
that produce them became a common enemy,
galvanizing local communities and states to act to
control access to tobacco and sales to minors.
Successful control occurred because of the implementation
of policy and environmental initiatives in a
variety of venues, which were made possible because
of shifts in social norms related to smoking.
If we are to successfully control obesity, it may be
useful to conceptualize our approach to obesity prevention
and control as a social movement. Although
some data would suggest that we have successfully
established obesity as a medical and public health
concern, a number of key elements that characterize
social movements are not yet in place. Obesity is not
perceived as a common threat, and it is not clear that
obesity is the appropriate frame to mobilize broad
segments of the population. A variety of other frames
may engage a broader segment of the population, and
may improve nutrition and physical activity without
specifically targeting obesity. To build the social
movement necessary to address obesity, our efforts
should be channeled to identifying strategies that
resonate with a broad group of supporters, to remain
flexible with respect to they way we promote and
frame our objectives, and to link efforts in diverse
settings to form a more comprehensive approach
across settings and constituencies.
References
1 Davis GF , McAdam D , Scott WR , Zald MN eds: Social
Movements and Organization Theory . Cambridge :
Cambridge University Press , 2005 .
2 Wolfson M : The Fight Against Big Tobacco . Hawthorne NY :
Aldine de Gruyter , 2001 .
3 Morbidity and Mortality Weekly Report . Tobacco use —
United States, 1900 – 1999 . 1999 ; 48 :986 –993 . www.cdc.gov/
mmwr/preview/mmwrhtml/mm4843a2.htm (accessed 15
May 2008).
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