Strategies to Address Obesity Prevention and Control
Various strategies are needed in combination to yield desired impact. These strategies based on the social ecological model include policy and environmental supports, social marketing, and evaluation.
Policy and Environmental Strategies - Making the Healthy Choice the Easiest Choice!
Although many people are aware of the choices they can make to improve and protect their health, their environment may prohibit following through with healthy behaviors. For example, if someone wants to begin a walking program, but the community does not provide access to safe walking areas, this is a barrier to behavior change.
Here are some examples of “Best Practices” and Promising Practices of Policy and Environmental Strategies for Obesity Prevention:
Community/Faith Based Setting
- Change zoning and land use requirements to an environment that encourages physical activity.
- Create walking trails.
- Encourage restaurants to offer and label healthy foods on menus.
- Adopt policies on serving healthy foods at faith-based programs.
Schools
- Create a healthy school nutrition environment.
- Provide before- and after-school physical activity opportunities.
- Set a specific time requirement for physical education in schools.
- Provide adequate time for physical activity throughout the school day.
- Assess BMI for each student.
Worksites
- Allow and encourage physical activity (PA) breaks during the day and offer flexible work schedules to allow time for PA.
- Provide incentives for PA and/or weight management activities.
- Provide, as part of the benefits package, discounted memberships at local health clubs, recreation centers, or YMCA’s.
- Promote stair usage through point of decision prompts.
- Implement incentive-based PA programs.
- Offer appealing healthy food options in the vending machines, snack bars, etc.
- Implement healthy food policies for catering and/or cafeteria.
- Offer healthy food choices at meetings, company functions, and health education events.
- Provide adequate breaks, flexible hours, job sharing and part-time for breastfeeding mothers.
- Provide access to hospital-grade, autocycling breast pumps, small refrigerators, and private “Mother’s Rooms”.
Health Care Settings
- Implement BMI screening and waist circumference screening for all patients.
- Follow guidelines from WHO/UNICEF's International Code on the Marketing of Breast Milk Substitues to eliminate practices that discourage breastfeeding, such as visible signs of formula promotion and infant formula dicharge packs.
- Display health promotion posters and educational materials with PA & nutrition tips.
- Avoid displaying magazines and materials suggesting super thin as the ideal.
- Adopt a written breastfeeding policy for staff.
- Promote the use of national guidelines and standard protocols by health care providers for the management of obesity.
Socio-Ecological Model of Behavior Change
The Socio-Ecological Model (SEM) could be thought of as an onion, with one level wrapping around another. At the center of the model is the individual. At this level, we consider the internal determinants of behavior, such as knowledge, attitudes, beliefs, and skills. This is the foundational level, but the model recognizes that many external forces (interpersonal, organizational, community, and society) influence these individual determinants. In order to facilitate behavior change it is important to address these external forces.
Additional definitions and examples of the Socio-Ecological Model reflect the importance and interaction between each of these different layers.
Society
Developing and enforcing state policies and laws that can increase beneficial health behaviors. Developing media campaigns that promote public awareness of the health need and advocacy for change.
Examples: Partnering with the Department of Agriculture to increase facilities (Farmer's Market programs) for increasing the availability of fruits and vegetables; improving the quality of all foods and beverages sold in schools; increasing incentives for the planning and development of healthier menus in communities; developing statewide media campaigns promoting the need for environments that encourage physical activity.
Community
Coordinating the efforts of all members of a community (organizations, community leaders, and citizens) to bring about change. Developing and enforcing local policies that support beneficial health behaviors.
Examples: Collaboration among community leaders to influence social norms and policies about nutrition; forming a community coalition to assess availability of high quality, nutritious foods in neighborhoods and local food establishments; local physical activity and nutrition coalitions develop educational presentations for other groups; developing a media advocacy strategy promoting the need for environments that support healthy eating; working with local community groups to establish neighborhood walking trails.
Organizational
Changing the policies, practices, and physical environment of an organization (e.g., a workplace, health care setting, a school/child care, a faith organization, or another type of community organization) to support behavior change.
Examples: Setting policy about healthy foods to be included in all menus planned for events; sponsoring school, faith organization, and worksite nutrition events, including healthy eating messages in newsletters and websites; adoption of worksite policies that provide time off or flex time during work hours for physical activity; establishing a policy allowing community members access to indoor and outdoor school facilities before and after regular school hours.
Interpersonal
Recognizing that groups provide social identity and support, interpersonal interventions target groups, such as family members or peers.
Examples: Written information given to parents; training lay health advisors; developing buddy systems and support groups like weight management clubs.
Individual
Motivating change in individual behavior by increasing knowledge, or influencing attitudes or challenging beliefs.
Examples: Offering cooking classes; developing booths and displays for county fairs and community events; offering one-on-one counseling; targeting behavior change through media campaigns (posters, billboards, newspaper stories, and radio/television/newspaper advertisements.)
Social marketing
Over the past several years, social marketing has become well known as an effective health promotion strategy. Social marketing campaigns apply commercial marketing strategies to influence the voluntary behavior of target audiences to improve personal and social welfare. As the DOPC, along with partners, develops the state plan for obesity prevention, social marketing campaigns will be incorporated into the comprehensive strategies for obesity prevention. For an example of a successful physical activity social marketing campaign targeting youth, see CDC’s VERB Campaign.
Evaluation
Evaluation is the systematic collection of information about the activities, characteristics and outcomes of programs to make judgments about the program, improve program effectiveness, and/or inform decisions about future program development. Therefore, evaluation is a crucial component of any successful health promotion program. Currently, SC DOPC receives funding for capacity building and is not yet funded to implement obesity prevention and control interventions. Upon the award of basic implementation funding from CDC, the opportunities for program evaluation will be increased.
Currently, DOPC is integrating evaluation strategies in its planning and capacity building process. Efforts to this point include steps to developing an obesity surveillance system to monitor obesity, physical activity, nutrition, TV time, and breastfeeding rates in SC. Limited data sources presently include BRFSS, YRBS, NHANES, PRAMS, WIC data, and PedNSS. Rates from these sources will be used as baseline measures and as tools for monitoring progress in the fight against obesity. Limited data exist on children kindergarten through eighth grade.The system that will be developed will incorporate evaluation mechanisms for this population.