Comments on CDC’s “Recommended Strategies and Measurements to Prevent Obesity in the United States” publication in MMWR
I just received a copy of tomorrow’s Morbidity and Mortality Weekly Report (CDC) in my inbox. The special publication this week is particularly relevant to my research and to the INDIAbetes film: “Recommended Strategies and Measurements to Prevent Obesity in the United States” There is so much to say about it, but I’ve only got a few minutes, so please excuse my less than comprehensive review. I suggest you read it for yourself, of course:
Recommended Strategies and Measurements to Prevent Obesity in the United States
The paper reports 24 recommended strategies, all of which are evidence-based or concepts supported by leading researchers and policymakers. I’ll list them all at the end, but I’ve only got time to comment briefly, therefore you will be spared a 10 page essay on the finer points of bicycling in Atlanta’s rush hour traffic.
What I found to be most immediately striking was how demonstrative the strategies are, when considered as a cohesive approach, of the many layers of politics, logistics/infrastructure, behavioral theory, medical and epidemiological evidence, and socioeconomic and environmental issues surrounding the response to the rising prevalence of nutrition-related chronic diseases in the US.
For example, consider Recommendations 3&4 versus 5&6:
->Recommendations 3 and 4 are in support of increasing access to and availability of healthy foods in “underserved areas” (low socioeconomic areas, rural and urban) by providing monetary and political incentives to stores that carry these foods.
->Recommendations 5 and 6 support facilitating the community’s ability to buy food directly from local farms (i.e. supporting farmer’s markets and other similar mechanisms) as well as providing incentives to the farmers along the same vein as the “incentives for food retailers”.
Recommendations 3 and 4 are straight out of the field of Environmental (in)Justice—responding to the fact that environmental burdens are disproportionately borne by residents of low socioeconomic areas. Not only does this include the obvious burdens like environmental contamination and immediate health hazards, but also the perhaps more subtle inequities like lack of access to healthy foods, safe locations for physical activity, as well as the aggressive advertising of “junk food” and alcohol. There is strong evidence to support such a recommendation: increased access to healthy foods tends to correlate with healthier eating behaviors, provided the food is affordable and culturally-appropriate.
It seems to me that a major difference between Recommendations 3&4 versus 5&6 is that the former offers a potentially more immediate, short-term solution, whereas the latter is a long-term solution. Bringing in supermarkets that promise to ship in potatoes from Idaho, oranges from California, 12-grain bread containing ingredients from 8 states and three countries, and fat-free milk from any one of x-thousands of cows without functioning immune systems is, I hope, obviously a short-term solution to the lack of access to healthy foods.
I described Recommendations 5&6 as “long-term” to represent both the challenges to and vital advantages of promoting a direct relationship between communities and local farms. In short, an obvious challenge is behavior change (large supermarkets are familiar) and an obvious advantage is the relevance of reducing the community’s dependence on the massive, centralized food production industry to supporting the local economy, making the community less vulnerable to outbreaks and disruptions in the food supply, and perhaps tugging a little on the reigns of climate change. While still challenging, there exists a wealth of knowledge on effective approaches to behavior change based on well-established predictive models of health behavior, such as the Health Belief Model, the Transtheoretical Model, and the Theory of Reasoned Action. Community-based education and programs are invaluable to public health– school field trips to pick-your-own farms, “senior days” at the farmer’s market, event collaborations between social and religious groups with local markets, etc.
To return to my original statement that the list, as a whole, gives the reader a sense of the multi-disciplinary complexity of the issue of overnutrition:
Isn’t it a little disquieting to see the simultaneous promotion of such a harmful food production and distribution system alongside its necessary, “green” alternative? What does this say about CDC’s confidence in the latter to overcome all the external forces pushing against it?
Before I crawl back into the lab, I must make one more comment on #4. I wonder how this proposed support (ex: zoning variances) and funding (ex: loans, tax benefits) might be used by and benefit small, local businesses and markets versus major supermarkets? Food seems to be 99% politics and 1% sustenance in the United States these days. I wonder if these incentives would be exploited by major supermarkets and end up doing more harm than good for local businesses and markets.
There is so much more to be said about this publication (particularly about #21), but I really must get back to work. I’ll leave you with a few quotes from the publication:
On local food:
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“Providing incentives to encourage the production, distribution, and procurement of food from local farms aims might increase the availability and consumption of locally produced foods by community residents, enhance the ability of the food system to provide sufficient quantities of healthier foods, and increase the viability of local farms and food security for communities.”
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“Evidence suggests that dispersing agricultural production in local areas around the country (e.g., through local farms and urban agriculture) would increase the amount of produce that could be grown and made available to local consumers, improve economic development at the local level (51,52), and contribute to environmental sustainability (53).”
On the potential benefits of local governments collecting data from farmer’s markets:
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“The process of gathering information for this measurement might encourage more interaction between local governments and farmers’ markets and individual farmers, which could spur more local initiatives to support local food production and purchasing food from local farms.”
The Recommendations:
1. Communities Should Increase Availability of Healthier Food and Beverage Choices in Public Service Venues
2. Communities Should Improve Availability of Affordable Healthier Food and Beverage Choices in Public Service Venues
3. Communities Should Improve Geographic Availability of Supermarkets in Underserved Areas
4. Communities Should Provide Incentives to Food Retailers to Locate in and/or Offer Healthier Food and Beverage Choices in Underserved Areas
5. Communities Should Improve Availability of Mechanisms for Purchasing Foods from Farms
6. Communities Should Provide Incentives for the Production, Distribution, and Procurement of Foods from Local Farms
7. Communities Should Restrict Availability of Less Healthy Foods and Beverages in Public Service Venues
8. Communities Should Institute Smaller Portion Size Options in Public Service Venues
9. Communities Should Limit Advertisements of Less Healthy Foods and Beverages
10. Communities Should Discourage Consumption of Sugar-Sweetened Beverages
11. Communities Should Increase Support for Breastfeeding
12. Communities Should Require Physical Education in Schools
13. Communities Should Increase the Amount of Physical Activity in PE Programs in Schools
14. Communities Should Increase Opportunities for Extracurricular Physical Activity
15. Communities Should Reduce Screen Time in Public Service Venues
16. Communities Should Improve Access to Outdoor Recreational Facilities
17. Communities Should Enhance Infrastructure Supporting Bicycling
18. Communities Should Enhance Infrastructure Supporting Walking
19. Communities Should Support Locating Schools within Easy Walking Distance of Residential Areas
20. Communities Should Improve Access to Public Transportation
21. Communities Should Zone for Mixed-Use Development
22. Communities Should Enhance Personal Safety in Areas Where Persons Are or Could Be Physically Active
23. Communities Should Enhance Traffic Safety in Areas Where Persons Are or Could Be Physically Active
24. Communities Should Participate in Community Coalitions or Partnerships to Address Obesity
From: Recommended Strategies and Measurements to Prevent Obesity in the United States
-Catherine Armbruster
