Originally published in NJ Spotlight
While there are signs that the decades-long rise in childhood obesity is turning a corner, a national obesity expert said community-based public-health efforts in New Jersey and other states could be key to continuing to decrease obesity among both children and adults.
It will take a sustained effort with a consistent message, as well as outreach tailored to target different social groups, according to Dr. William H. Dietz, the former nutrition, physical activity and obesity director for the Centers for Disease Control and Prevention.
Dietz noted that national surveys are beginning to show declines in obesity in young children, with one study showing a drop in the percentage of obese 2- to 5-year-olds from 12.4 percent in 2005-2006 to 8.4 percent in 2011-2012.
“I think we may be at the corner — I don’t think we’ve turned the corner,” he said.
He compared it with the effort to reduce smoking, which reached a 15-year-long plateau in the 1960s and 1970s before beginning a steady decline.
But there’s a major difference between the two public-health issues, Dietz noted, and it may make anti-obesity efforts more difficult: While opposition to smoking grew at a grassroots level, concern about obesity began with the federal government and has not sparked the same kind of community-level concern.
“People don’t feel immediately threatened,” said Dietz, adding who that many people have the attitude that, “ ‘It’s not me, it’s not my family.’ I think that’s the challenge — how do we build that kind of grassroots investment.”
It might help anti-obesity efforts to use terms like “health” or “wellness” to draw broader public support, Dietz said.
With federal funding for anti-obesity efforts unlikely in the near future, state and municipal-level public-health efforts will be important, Dietz said at a conference titled “Building Healthy, Equitable Communities” held yesterday in Edison.
He noted that the roots of obesity are complex and require a multi-pronged response.
Community groups can be more effective when they band together to promote ways to improve children’s health, Dietz said. He noted that existing efforts to promote activities that lower obesity are often not coordinated.
“The people who support breastfeeding are not the same people who support reduced screen time or increased physical activity,” Dietz said. “Building a coalition of diverse groups is really a significant challenge.”
There are persistent differences in obesity levels among different racial and ethnic groups. And the social factors that affect these obesity levels also differ among these groups, Dietz said.
For example, while obesity levels are higher among white people with lower incomes, obesity and income levels aren’t linked for African Americans. Such differences illustrate why public-health efforts will be more effective if they are geared toward different communities, he said.
A potential model is a former federal program, the VERB campaign, which ran from 2002 and 2006. It encouraged children aged 9 to 13 to engage in more physical activity. The campaign, which federal data suggests was effective, used separate marketing efforts targeting children from different racial and ethnic backgrounds.
“The messages were handcrafted by groups that represent those communities,” Dietz said.
Laurie Shanderson, assistant dean of the Richard Stockton College School of Health Sciences in Galloway, added that students preparing for healthcare careers need to understand these disparities. However, they often don’t, in part because they don’t study the historical roots of these differences, she said.
“They don’t have the same historical perspective or background to know how much things have changed, and to even identify certain problems,” she said. “The students we’re training right now don’t really identify health disparities as being an issue.”
Diana Autin, executive co-director of the Statewide Parent Advocacy Network, said parents are key in building community coalitions to improve children’s health.
“If we provide parents with information and assistance and the skills and knowledge that they need to make good decisions, not only for their own children, but also in their community and also in advocating for policies, then we will have a very significant impact on making the changes we need to make,” she said.
Autin added that that it’s important that families become aware of opportunities that are already available to improve their health, including the free preventive care, such as annual physicals, offered under the Affordable Care Act.
Dietz said the ACA could also directly contribute toward anti-obesity efforts in the long term. Since the law encourages linking healthcare spending to improving people’s health, it could lead to federal funding for anti-obesity efforts.
Daniel F. Oscar, president and CEO of the Princeton-based Center for Supportive Schools, said that schools can play an important part in community-based efforts to improve children’s health. But he said public-health efforts suffer from continued racial, ethnic and economic segregation in schools, which remains a barrier in working effectively across different groups.
Autin said that integrating physical exercise with lessons about healthy behavior has been linked to improved test scores, but schools are often so focused on increasing class time for math and other areas measured by standardized tests that that they find it difficult to focus on health.
One area where schools could make a difference is in reducing the stigma attached to obesity. Dietz said this remains an obstacle to efforts to get the public to help combat the problem.
He said efforts to decrease this stigma could start with changing terminology. Rather than saying “obese people,” Dietz said it’s better to say “people with obesity,” which emphasizes that it’s a medical condition rather than an identity. Using “obese people” is similar to saying “cancer people” instead of “people with cancer,” Dietz said.
The New Jersey Partnership for Healthy Kids, New Jersey YMCA State Alliance, the state Department of Health, the Rutgers Cooperative Extension, the American Academy of Pediatrics New Jersey chapter and the New Jersey Hospital Association hosted the conference.
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