Using leadership to improve community-based obesity interventions.

Obesity is an enormous health problem facing America in the 21 century. Despite great efforts, health educators have made little progress in meeting the goals laid out in Healthy People 2010. A more contextual, communitybased approach is necessary to change the physical and social environment in which people live, work and play. Studies show that residents of neighborhoods that lack pedestrian-friendly features and have high crime rates are less likely to be physically active, an important point for health educators to take into account when designing interventions. Whereas professional health educators have done little in this area, exemplary grassroots efforts like Safe Routes To School and Walking School Bus demonstrate the efficacy of such approaches. Leadership from health educators is needed, specifically in designing and implementing interventions that target the intersections of the built environment, crime and physical activity. The leadership theories of Daniel Goldman and John P. Kotter are especially useful when using coalition building and the Community Readiness Model as strategies for interventions. Florida Public Health Review, 2009; 6, 8-13. Introduction America is quickly becoming a nation of overweight and the obese persons, much to the dismay of public health professionals, and specifically, public health educators. The causes (sedentariness and poor diet) are clear, and yet attempts to slim America down have met only modest success. Much of the work has been focused on behavior change at the individual level of the socio-ecological model. Recently, both anthropologists and health educators have been moving to interventions at the community and policy levels. It is becoming increasingly clear that food habits and activity levels are best understood in their social context. Neighborhoods and communities are excellent places to stage interventions for this very reason, but they vary in their readiness to embrace change. The Community Readiness Model is a framework for moving communities towards behavior change and clearly explicates the importance of leadership. Another method to create community-based change is to development of coalitions that can provide a direct interface between various community organizations and public health professionals. Both methods underscore the need for leadership both within the profession of public health and within communities themselves to create positive change towards healthier lifestyles. Background and Significance America is facing an obesity epidemic, with a full 34% of adults over age 20 considered to be obese according to statistics from the CDC (Centers for Disease Control and Prevention, 2008a). Among children, 32% are overweight and 16% are obese (Ogden, Carroll, & Flegal, 2008). These numbers are expected to rise; in fact one recent study used the National Health and Nutrition Examination Study data and found that if current trends continue, 100% American adults will be obese by 2048, and that the percentage of overweight children will reach 30% by 2030 and 50% by 2050 (Wang, Beydoun, Liang, Caballero, & Kumanyika, 2008). Being overweight or obese has been linked to hypertension, Type 2 diabetes, stroke, coronary heart disease, osteoporosis, gallbladder diseases, sleep apnea, as well as breast, colon and endometrial cancers. In addition to health problems for the individual, there are societal costs as well, including direct costs like increased health care spending, as well as indirect costs like lost productivity, missed work and potential income never earned because of premature death (Centers for Disease Control and Prevention, 2008b). Health professionals have acknowledged that this is a huge public health problem and have pledged in Healthy People 2010 to reduce adult obesity rates from 32% to 15%, and obesity among children ages 6-17 from 11% to 5% (U.S. Department of Health and Human Services, 2000). The end of this decade is quickly approaching and yet we are nowhere near the goals set by Healthy People 2010. Clearly we, as public health educators, are not reaching our priority population. We have been too focused on individual behavior change programs and have failed to see the big picture.