What Initiatives Actually Help Reduce Obesity?

Obesity has become the focus of a number of initiatives and policies in the U.S. in the last decade. The reason for this focus is clear: obesity is arguably the number one preventable cause of illness and death, leading to conditions such as heart disease and diabetes. The statistics for obesity in the U.S. are alarming.

  • Over one-third of all adults in the U.S. are obese (68% of people in the U.S. are either overweight or obese)
  • In 2008, the annual cost of obesity was more than $147 billion (this includes real medical costs such as treatment for obesity-related disease as well as indirect costs such as lost wages)
  • Low income adults in the U.S. have much higher rates of obesity than do upper or middle income adults in the U.S., and minority groups are more likely to be obese
  • Obesity rates among children are stabilizing but still remain at just under 18% of children ages two to 19

Obesity has been addressed in the past, but which initiatives are actually helping to reduce it? The research on the effectiveness of prevention and reduction often focuses on childhood obesity, but the results from many different studies and analyses seem to indicate that the best approaches to obesity reduction are holistic, combining education, practical application, and convenience.

One of the most crucial parts of an effective obesity reduction strategy is convenience.

It is easy to make poor choices in the U.S. Fast food is on every corner, and our days are often packed with work and family obligations that leave no time for the gym. Drexel University conducted an analysis of 37 studies of obesity reduction programs. They found that the programs that worked the best often had a “no-brainer” component to them. That is, the programs made healthy choices either the only choice or the easiest choice.

This analysis found that changes like banning trans fats and limiting availability of higher-fat and higher-sugar foods resulted in downward trends in obesity. Changes to “active transportation infrastructure,” such as improving bike lanes and walking/jogging paths, also had a strong impact on obesity. Similar environmental changes that were less impactful include building supermarkets in low-income areas and requiring nutritional labels.

The researchers caution that this analysis is not definitive but gives a good idea of which direction reduction programs should take.

Many of these results are echoed in another study of workplace wellness programs. The study, conducted by Diana Fernandez, M.D., M.P.H., Ph.D., an associate professor in the University of Rochester Department of Public Health Sciences, found that workplace wellness programs were particularly effective when they allowed participants to shape the program while making healthier choices easier.

Workers in the U.S. spend over one-third of their lives on the job, so it stands to reason that some of the most impactful changes would happen at work. Fernandez and her colleagues divided ten different worksites in Rochester, New York into two groups, including nearly 3,800 workers in the study.

The workplace intervention group participated in workplace wellness programs that worked towards more healthy eating habits and an increase in physical activity. The control group experienced no interventions, making (or not making) changes on their own.

Programs in the intervention sites included things like free healthy meals in the cafeteria, upgraded gym and workout facilities onsite, and organized exercise groups or activities. At the end of the study, the control group saw an increase in obesity of 4%, while the intervention group saw a decrease of 5%.

Fernandez noted that this study was a good first step towards identifying which workplace wellness programs were actually effective at reducing obesity, saying:

“This study suggests that worksite environmental interventions might be promising strategies for weight control at the population level. These observations lend support to the approaches that might eventually reduce the incidence and prevalence of overweight and obesity on a larger scale.”

Other successful reduction strategies include:

  • Price reduction: Making healthy food more affordable can bring about tremendous change in eating habits, a key factor in obesity reduction. One small study found that cutting the price of fruits and vegetables in half (and increasing variety) tripled consumption of these healthy alternatives. A larger study produced the same results with vending machine snacks.
  • Starting in school: A comprehensive, school-based nutrition policy that involves parent outreach and nutrition education for students and their families seems to be very effective at reducing childhood obesity. A 2008 study found a 50% reduction in the incidence of obesity over the two years that these interventions were in place. Better still, these results were still consistent two years after the study’s completion.
  • Changes close to home: People who live in walkable communities with better access to healthy, fresh food seem to have consistently higher levels of activity and better diets, both of which result in lower levels of obesity. Based on many different studies that demonstrate this outcome, many people are calling for better design in their communities that incorporate wide, safe sidewalks, open markets, and easily accessible recreational facilities.

Just as there are successful interventions in terms of obesity reduction, so, too, are there significant barriers to treatment. Many of the most powerful barriers exist in the physician’s office, where time and money limit the amount of education and programs that are offered to obese or overweight patients.

Some medical professionals also lack the specific relevant training to address the social, emotional, and psychological barriers to treatment, including the stigma associated with obesity in the U.S.

Other barriers include the overall increase in the rate of sedentary behavior in the U.S. This increase is associated with increased screen time (videogames, computer use, etc.) which often leads to increased snacking or poor nutritional choices. Research has found that there is no way to legislate change in this type of behavior. Policy makers cannot enforce rules or limits on how much sitting is too much. Sedentary lifestyles remain one of the most daunting barriers in obesity reduction programs.

In the end, the most effective obesity reduction strategies offer convenient and consistent access to fresh, healthy food and regular, engaging exercise. Coupled with individual support and counseling targeted towards reaching personal goals for individual health improvements, these initiatives may be the best chance for reducing obesity levels in the U.S. in the years to come.

Have you participated in any workplace wellness or obesity reduction programs? What worked best for you?