Category Archives: Obesity policy
Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Erin Yastrow, a Bachelor of Science in Public Health candidate at the Tulane University School of Public Health and Tropical Medicine, about what helped lead her to the field, her work as a leader in Tulane’s undergraduate student government and where she hopes to go from here.
NewPublicHealth: What encouraged you to pursue a degree and career in public health?
Erin Yastrow: I’ve always been interested in the field of health. I was actually thinking about going into nutrition when I first started looking at undergraduate schools and I had a family friend at one school who had worked in nutrition, but then ended up working at the School of Public Health. When I met with her, she encouraged me to pursue public health with an emphasis on nutrition because it would give me more opportunities. From there, I started my exploration into what public health was and I realized how interesting and fascinating it was and how it was applicable to so many more areas besides just nutrition.
In the meantime, I had also applied to Tulane. I wasn’t really considering it that much because I didn’t know that much about it. My mom was looking through their brochure and told me that they have a great public health program. So, I started looking and I realized how established the Bachelor’s and graduate programs were. They also had an option where you could pursue a combined degree and it was really appealing to me.
NPH: Are you pursuing a Master’s as well?
Yastrow: Not currently, but I’m actually attending Johns Hopkins next year for a Master’s in Public Health. Tulane does have a really great program where you can do a combined degree with your Bachelor’s and Master’s. Part of my undergraduate core, which has now changed, included taking five graduate classes, so I took some classes at that School of Public Health here.
NPH: Within the field of public health, what are your primary interests and why?
Yastrow: That has also sort of shifted as I’ve learned more about public health. As I mentioned, I started out really interested in nutrition and obesity prevention. As I took more electives and did some internships, I became more interested in the similar patterns of risk factors that exist in obesity and other epidemics that aren’t always considered to be health problems, such as violence. That has developed into an interest about addressing inequalities in health and the social determinants, such as socioeconomic status, education and race and how those, to me, are unjust reasons that people are more likely to develop further health conditions.
Earlier this week a new Roundtable on Obesity Solutions, established by the Institute of Medicine (IOM), convened its first meeting in Washington, D.C.
The goal of the Roundtable, which plans to meet over the next several years, is to engage leadership from multiple sectors to help solve the U.S. obesity crisis. According to the IOM, more than one third of adults and 17 percent of children and adolescents are obese, and some estimates tag the cost of obesity at almost 10 percent of the national health care budget. Obesity also increases rates of chronic disease and their associated costs. The Roundtable will convene meetings, public workshops, background papers and “innovation collaboratives” with a goal of “accelerating and sustaining progress in obesity prevention and care,” according chair Lynn Parker, formerly with the Food Research and Action Center in New York City.
The overarching themes of the Roundtable will include:
- Viewing the problem of obesity from a systems perspective
- Achieving health equity through focused action and research
- Developing and using effective communication strategies
- Identifying innovative financing mechanisms
- Evaluating progress
The opening speaker at this week’s meeting was Bill Dietz, a former Director of the Division of Nutrition and Physical Activity at the U.S. Centers for Disease Control and Prevention, and now a consultant to the Institute of Medicine. Dietz pointed to reports last year that found signs of progress in efforts to reverse the obesity epidemic, with decreases in obesity among preschoolers from low-income families in 18 states.
“Change is beginning and change in a positive direction is taking place,” said Dietz. “The challenge is how we, working together, manage to accelerate this progress. How do we make the decline of obesity the norm and the mainstream of the future?”
Dietz said that research shows that obesity among women has plateaued, which could indicate gains to come if compared with the history of smoking reduction, which showed plateaus in rates of smoking just before major policy changes. Dietz said subsequent initiatives were successful because the public was already aware of the dangers.
Presenters were asked to suggest innovative ideas for preventing obesity and reducing rates overall. Among them were:
- Making physical activity a core component of the school day
- Engaging parents
- Tailoring interventions to culture and audience
- Sustainable approaches, including businesses working on obesity prevention and sharing what works best for them
Several speakers mentioned the need to account for different community needs when addressing obesity.
“Each community faces different challenges so the multifaceted approach will look different in each community,” said speaker Jeff Levi, PhD, executive director of advocacy group Trust for America’s Health.
“We’ll make change by making the healthy choice the easier choice and a health in all policies approach,” said Howard Koh, MD, MPH, assistant secretary for health at the U.S. Department of Health and Human Services.
Jill Birnbaum is an advocate for nutrition policy, tobacco control, and health care reform who has worked at the federal, state, and local levels. Her work began in Minnesota, and she now oversees state advocacy for the American Heart Association. Her grassroots experience, combined with her national role, gives her unique insights into public health policy at all levels of government.
This is the first in a two-part interview conducted by Grassroots Change: Connecting for Better Health, a project of the Robert Wood Johnson Foundation Health Group. In part one, Jill shares her perspective on grassroots movements and the threat of preemption in the obesity prevention arena. Preemption can take away the ability of states and local communities to adopt innovative solutions to their own public health problems in a way that responds to each community’s unique needs.
Grassroots Change: What do you see as the impact of preemption in public health, especially in obesity prevention?
Jill Birnbaum: [Preemption] slows or even ends grassroots movements before they begin. It also drains our resources for future advocacy efforts. We leave it to the next generation of public health advocates to undo policy compromises that we make today. We’re still seeing that in a few states with tobacco, and anticipating the fights both at the federal and state levels that we might have to undo someday [in obesity prevention].
Preemption stifles innovation, and it also makes some assumptions that can be wrong. It assumes that we know everything today and that there’s nothing more that we have to learn tomorrow. That’s especially true in nutrition policy where science continues to evolve and policy needs to evolve along with the science.
Preemption also has the effect of dividing the [public health] community when a small group of people, in some cases even a single individual or organization, negotiates away something that other people really want.
GC: Are the concerns about preemption in obesity prevention mostly about nutrition policy? There doesn’t seem to be a major effort to preempt local physical activity policies.
Over the past few years, many cities and states have considered taxing sodas and other sugary beverages. At the American Public Health Association meeting, Judy Jou, a PhD candidate at the University of Minnesota School of Public Health, discussed a study in which she and her colleagues interviewed stakeholders about their views on a sugary beverage tax. The study was supported by a grant from the Robert Wood Johnson Foundation through its national Healthy Eating Research program.
Most of the eleven interviews were with public health advocates and policy-makers. These stakeholders indicated that the main arguments in favor of the tax revolve around health:
- Sugary beverages contain large amounts of sugar and/or calories.
- Sugary beverages are a major contributor to obesity and related health conditions, especially for children.
- The revenue generated by a sugary beverage tax can be used to fund community health programs.
Some stakeholders said that visual representations of the sugar in these beverages were effective at communicating the first point. Stakeholders learned messaging ideas through personal networking, published documents, other sugary beverage tax efforts and—less frequently—testing from focus groups or surveys.
The most common messages used against sugary beverage taxes included:
- Government is acting as a “nanny state” and is restricting personal choice.
- These taxes would have a negative economic impact on businesses and workers.
- Soda and other sugary beverages are unfairly targeted and are not the only cause of obesity.
Citizens in two California cities, Richmond and El Monte, will vote on sugary beverage taxes on Election Day next Tuesday. In both cities, the campaigns to defeat the taxes have much more funding than the campaigns to pass them. One big challenge identified by the stakeholders Jou and her team interviewed was the vast resources the beverage companies have to fight these tax efforts.
>>The Los Angeles Times recently reported on the effort to pass a sugary beverage tax in El Monte.
>>Learn more about how pricing strategies— both incentives and disincentives—can promote the purchase of healthier foods.
A new report from the Institute of Medicine, Accelerating Progress in Obesity Prevention, released today in conjunction with the Weight of the Nation Conference, finds that progress in stemming the obesity epidemic has been too slow, and that obesity has a negative impact on productivity and is the factor behind millions of people suffering from chronic and often debilitating diseases.
The report focuses on five key goals in order to prevent obesity:
- Integrating physical activity into people's daily lives.
- Making healthy food and beverage options available everywhere.
- Transforming marketing and messages about nutrition and activity.
- Making schools a gateway to healthy weights.
- Galvanizing employers and health care professionals to support healthy lifestyles.
Model practices were the focus of a session, “Building Partnerships for Healthy Places,” on the first day of the Weight of the Nation conference. Bringing diverse groups together to improve community health was a common element of each of the presentations.
Chris Danly of Vitruvian Planning in Boise, Idaho, talked about his firm’s recently completed health impact assessment (HIA) on the Haywood County (North Carolina) Community Bicycle Plan—which aimed to determine what projects, policies and programs were needed to foster a bicycle-friendly community, through a collaborative process with diverse partners such as County officials, the Recreation and Parks Department, the Department of Transportation, bicycle clubs and the local general store. The HIA found the plan would have positive health impacts on community health, including making virtually all members of the community aware of bicycling as an option for recreation and transportation, and also for drivers to be more aware of bikers on the road.
Danly also suggested to conference-goers that they work on both short- and long-term goals with partners when it comes to the built environment: “It’s a great long-term vision to have everyone walk or ride, but in the meantime existing conditions needs to be fixed.”
Danly’s other suggestions:
- Identify places where people are active and build on those small areas to get your long-range vision.
- Get excited about small victories such as kids walking two blocks to the pool, instead of driving.
- Near-term improvements can include sidewalks, pedestrian lighting, landscaping, crosswalks, bike racks, public art and lighting for tracks to make them usable in the evenings.
- Partnership opportunities include citizen’s patrols, site sharing, joint use agreements and organized runs.
Next week from May 7th through 9th, the Centers for Disease Control and Prevention Division of Nutrition, Physical Activity, and Obesity will host the Weight of the Nation™ conference in Washington, DC. Hosted just once before in 2009, this year’s event will highlight key issues in the effort to prevent obesity, and share research showing what’s working to help kids and families be active and eat a healthier diet.
The Robert Wood Johnson Foundation and many researchers, practitioners and advocates it funds will be at the event. If you’re attending, visit RWJF at booths 206 and 208. Foundation staff members will be in attendance to talk with conference participants. If you can’t be in D.C., be sure to follow the RWJF childhood obesity team on Twitter, @RWJF_ChdObesity, for updates throughout the three days. Also check out the event’s website, where you can access a full agenda of sessions, some of which will be webcast live: www.weightofthenation.org. On May 10, visit www.rwjf.org/childhoodobesity to read session highlights and see videos from the conference.
A growing number of facilities are making equipment changes—such as commuter train seats able to withstand up to 400 pounds—to accommodate the needs of overweight and obese Americans, according to a new report from Reuters. Other recent adaptations to accommodate heavier Americans include:
- Widening doors on school buses
- Wider seats at sports arenas
- Performance testing of buses to investigate the impact of heavier passengers on steering and brakes
Weigh In: What accommodations for overweight people has your community introduced?
On May 7-9, 2012, the Centers for Disease Control and Prevention Division of Nutrition, Physical Activity, and Obesity, will host Weight of the Nation, in Washington, DC—a forum to highlight progress in the prevention and control of obesity through policy and environmental strategies. Follow coverage of the meeting on RWJF.org, @RWJF_ChdObesity, www.rwjf.org/childhoodobesity and on NewPublicHealth.
A new report, Assessing the Economics of Obesity and Obesity Interventions, by researchers from the Campaign to End Obesity, looks at the costs of the obesity epidemic and the possible array of interventions that could prevent obesity and save the country money.
When the Congressional Budget Office measures the impact of policies to address chronic diseases, their estimates usually cover a 10-year period. The authors of this new report argue that this timeframe accounts for most of the costs of legislation, but tends to underestimate the benefits. Preventing chronic diseases can have benefits over a long period of time, because many costly complications from such diseases take more than ten years to develop. The authors recommend using a 25-year budget window instead to fully account for the value of disease prevention. The report was supported by the Robert Wood Johnson Foundation.
NewPublicHealth spoke with Michael O’Grady, PhD, a senior fellow at the National Opinion Research Center (NORC) at the University of Chicago, a lead author and a former Assistant Secretary in the Department of Health and Human Services, about the report.
NewPublicHealth: How did the report come about? What research have you been doing that led you to this?
Michael O’Grady: The desire here was to bring in outside researchers to lend a fresh set of eyes who can take a look at the evidence around obesity, and who would have insight into more of the policy discussions that have gone on. My background is on the Hill. So to a certain degree, my co-author and I, Jim Capretta, have expertise in terms of modeling, and in the research, but also very much in terms of how that fits into terms of policy decision-making.
NPH: And what is the gist of what your report found?