Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 7
at the state level to apply regulatory and fiscal authority,
and at the local level to implement change; mass
communication that includes consistent positive messages
supported by scientific consensus and repeated
in a variety of venues; policy and environmental
changes that promote healthy lifestyle behaviors; and
a plan that includes many components which work
synergistically. Applying these social change strategies
to the community environment to encourage healthy
eating, increased levels of physical activity, and a
decrease in sedentary behaviors is emerging as a practical
way to address obesity on a large scale. 2,3
Community a pproaches to
o besity p revention
Communities have their own societal subsystems
within a particular geographic area and the way in
which an individual often identifies within a community
is defined by race, ethnicity, socio - economic
status ( SES ), and group memberships. 4 To conduct
research within communities, one must take into
account the varied nature of relationships, networks,
and how they may all work together synergistically. 5
Community approaches can target components
within the population (referred to as community -
based interventions or strategies), or they can be
implemented on a community - wide basis. Previous
community - based approaches to change behavior
and prevent disease give promise for the future
of community intervention work. 6 – 13 Furthermore,
community - wide strategies directed at all ages and
groups offer a comprehensive, equitable and intergenerational
response to the problem, and potentially a
means of treatment and prevention. The discussion
that follows reviews these approaches in the context
of social change and their application to obesity
prevention.
Evidence in support of health improvement and
disease reduction by way of community involvement
began gaining ground by the 1970s. The North Karelia
Project 14 and the Stanford Three Community Study 11,15
were among the first to break ground in this area. Each
proved effective in translating educational messages to
significant positive changes and cardiovascular disease
risk reduction in the populations that received
the interventions, as compared to control populations.
The intervention strategies of these projects
used mass media, low - cost lifestyle modifications
and the involvement of community members.
Subsequently, the National Institutes of Health ( NIH )
financed three major community - based intervention
projects: the Stanford Five - City Project, 10 the
Minnesota Heart Health Program, 16 and the Pawtucket
Heart Health Program. 7
These trials essentially provided community - wide
health education over several years. The Stanford
Project provided a comprehensive program using
social learning theory, a communication - behavior
change model, community organization principles,
and social marketing methods. 10 Minnesota ’ s multiple
strategy approach provided systematic population
screening for hypertension, mass media campaigns,
adult and youth education programs, physician and
health professional programs and community organization
efforts. 17 Pawtucket provided multi-level education,
screening and counseling programs throughout
the community. 7
Community - based programs focused on youth
have been carried out to increase contraception use, 18
and physical activity. 19 There are very few examples of
community - based interventions focused on obesity,
owing to the complex nature of both the etiology and
the solutions, and we review several of these below.
Community - b ased o besity
p revention i nterventions
in c hildren
The Pathways intervention was a randomized controlled
trial conducted within the Native American communities.
It was the first of its kind to take into account
cultural, theoretical and operational viability in the
study population and to operate on a large scale
( n = 1704) in 41 schools over six years (three years of
development and testing and three years of intervention).
The aim of the project was to reduce body fat
by promoting behavioral change and a holistic view
of health among Native American school children in
Grades 3 –5. 20 Although the intervention was largely
carried out within the schools, care was taken to enlist
the support of community and tribal leaders, as
well as parents. The intervention was developed
through a collaboration of universities and American
Indian nations, schools and families with a focus on
individual, behavioral and environmental factors.
58