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"Nothing so needs reforming as other people's habits."—Mark Twain
When Sylvia Moore, PhD, RD, FADA, began her National Obesity PreventionConference presentation with this quote, the audience laughed. But thespeakers intend to do just that: change the eating and activity habits at thecommunity— even the national—level.
The conference, sponsored by the U.S. Department of Agriculture and held inBethesda, Md., in late October, made clear that the obesity preventionmovement has a long way to go, but provided a glimpse of efforts already inthe works.
Moore discussed the "Wellness IN the Rockies" (WIN the Rockies)program, for which she is co-principal investigator and director. Described onits web site as "a community-based research, intervention, and outreachproject to address obesity," the 4-year program targeted a largecross-generational sample from six rural communities in Idaho, Montana, andWyoming.
WIN the Rockies researchers found that people who eat while doing anotheractivity, such as watching television, are more likely to have high body massindex (BMI), according to baseline data from 1,817 adults (928 men and 889women).1
Eating habits differed by sex. Compared with men, women reported higherintakes of fruits and vegetables—except for potatoes, higher intakes ofhigh-fiber cereals, and lower intakes of milk and sweetened beverages such assoft drinks. Women were less likely to order super-sizedportions.2 Amongparticipants in the study, according to researchers, men had more bad dietaryhabits to change than women.
Energy consumption is half of the weight equation, with physical activitybeing the other. The majority of overweight and obese respondents perceivedthemselves as not having enough physical activity. "The public isn'tdumb," says Moore. "They know they're not getting enoughexercise."
As for the school-age group, Moore says that data analyses are ongoing, butnotes, "These rural children are getting heavier and are not veryfit."
The WIN the Rockies interventions were designed to address both nutritionand physical activity in the family and community settings, with programs suchas:
The USDA-funded project ended in 2004, although WIN Wyoming continues todate. Communities can sustain (or initiate) many of the program components,through Cooperative Extension services, local schools and hospitals, and otherinstitutions and agencies already inplace.
MOTIVATING COMMUNITIES TO MOVE
Laurie M. Anderson, PhD, MPH, an epidemiologist with the Centers forDisease Control and Prevention (CDC), discussed her work with the U.S. TaskForce on Community Prevention Services.
The team looked at successful interventions for improving physicalactivity, synthesizing data from 94 studies. The task force's goal was totranslate information into recommendations for nonacademic people, such aspolicymakers.
These recommendations, compiled in "The Guide to the CommunityPreventive Services," which community leaders can access on theInternet, include thefollowing:3
The task force made a separate analysis of 41 school-based nutritionstudies with varying goals and methodologies. Nine studies involved childrenwho self-reported daily intake of fruit and vegetables. The effect was,Anderson reports, a "positive but small" daily increase of betweenone-fourth and one-half serving of fruits and vegetables. Saturated fatreduction, also self-reported, showed a similarly small change— a 0.71%drop in daily calories.
The task force notes that measures and reporting methods were inconsistentamong the studies, and postintervention follow-up was rare. "We need toimprove the way we measure food intake among children so we know when programsare effective and when they are not," Anderson says.
Another study approaches childhood obesity prevention from a differentangle. Debbe Thompson, PhD, instructor at the Baylor College of Medicine'sChildren's Nutrition Research Center in Houston, describes the ongoing FitnessZone project, which compares designs of computer-based health-educationinterventions. As part of the project, researchers are looking at how childrenin Houston respond to web sites that promote healthier lifestyles and tryingto determine whether comics or fact sheets are more effective, forexample.
CHALLENGING "RESEARCH AS USUAL"
The need to reverse the obesity trend is too urgent to accommodate themethodical pace of systematic research, according to Tim Byers, MD, MPH.
"We shouldn't wait for all the randomized studies to come in beforedoing public health interventions," Byers said in the concludingconference session.
Byers, a professor at the Colorado School of Medicine Department ofPreventive Medicine and Biometrics, pointed to past successful efforts incomplex public health issues, such as lowering the death rate from car crashesin the U.S. Auto design improvements and anti-drunk-driving measures were"proven by common sense and trial and error," he says.
The government needs to make a big commitment to fixing the problemupfront, with funding and personnel, Byers says, before data come in, notafter.
"[The obesity epidemic] will improve," says Byers. "Itjust depends how we're going to get there, and when." 
Interested in Community Health Advocacy?
Physicians concerned with rising obesity can become involved at thecommunity level in a number of ways. For instance, local physicians offices inWIN the Rockies communities implemented the "Healthy Living PrescriptionTool," a set of printed forms to help providers engage in a dialoguewith adult patients about diet and physical activity.
For other suggestions on how to work with state organizations and communitygroups, check the WIN the Rockies web site:www.uwyo.edu/WinTheRockies.
Footnotes
The Guide to Community Preventive Services was developed by the Task Forceon Community Preventive Services, a 15-member nonfederal group of national andregional experts in public health, health care, and health promotion. The taskforce was convened by the U.S. Department of Health and Human Services.
The guide is available online athttp://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat3.chapter.4768
References
2. Liebman M, Propst K, Moore SA, Pelican S, Holmes B, Wardlaw MK,Melcher LM, Harker JC, Dennee PM, Dunnagan T: Gender differences in selecteddietary intakes and eating behaviors in rural communities in Wyoming, Montana,and Idaho. Nutr Res 23:991–1002, 2003.
3. Centers for Disease Control and Prevention: Increasing physicalactivity: a report on recommendations of the task force on communitypreventive services. MMWR Mobr Mortal Wkly Rep 50(RR-18): 1–14, 2001.
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