A social ecological approach to the obesity epidemic.
Abstract: The purpose of this preliminary study was to identify environmental factors that impact weight management in midlife mid·life
See middle age.
Of, relating to, or characteristic of middle age. women. A questionnaire was developed and distributed to women aged 35-65. Forty middle-aged (47.4 [+ or -] 6.6), Caucasian (82.5%) women returned completed questionnaires. Analyses included descriptive statistics descriptive statistics
see statistics. and Spearman spear·man
A man, especially a soldier, armed with a spear. nonparametric correlations. The results suggest that a number of environmental factors affect weight management in these midlife women. Guidance regarding how to apply nutritional information to daily food choices as well as environmental interventions to promote recreational opportunities and healthy nutrition may increase the effectiveness of weight control programs in this segment of the population.
The prevalence of obesity in the United States Obesity has been cited as a major and increasing health issue in the United States in recent decades. While many industrialized countries have experienced similar increases, American obesity rates lead the world with 64% of adults being overweight and almost a quarter being obese. has reached epidemic proportions (Egger and Swinburn, 1997; Mokdad et al., 1999). In the past decade, the percentage of adults categorized cat·e·go·rize
tr.v. cat·e·go·rized, cat·e·go·riz·ing, cat·e·go·riz·es
To put into a category or categories; classify.
cat as obese o·bese
Extremely fat; very overweight.
characterized by obesity.
obese adjective Characterized by obesity, see there; excessively fat has been steadily increasing in all states, in both sexes, and across various age groups, races, and educational levels (Mokdad et al., 1999). Current weight control strategies are not successfully containing this obesity epidemic (Egger and Swinburn, 1997; Hawks and Gast, 1998). A possible explanation for this is that weight control programs have primarily focused their interventions on individual behavior change Behavior change refers to any transformation or modification of human behavior. Such changes can occur intentionally, through behavior modification, without intention, or change rapidly in situations of mental illness. even though experts agree that environmental factors have a substantial impact on weight status (Hawks and Gast, 1998).
Thus, a shift towards an approach that integrates behavior change strategies with environmental-based interventions is necessary. Such an approach has been used in health promotion for more than a decade and has been referred to as the social ecological approach (Richard, Potvin, and Mansi, 1998; Stokols, 1992, 1996).
Although efforts to develop and implement environmental interventions to promote healthy nutrition and physical activity have been attempted (French et al., 2001; Glanz et al., 1995; Glanz and Mullis, 1988; Sallis, Bauman, and Pratt, 1998), a greater depth of initial descriptive research Descriptive research, also known as statistical research, describes data and characteristics about the population or phenomenon being studied. Descriptive research answers the questions who, what, where, when and how. is needed to identify characteristics of settings that influence weight management in various subgroups (Glanz et al., 1995; Sallis et al., 1998). Thus, the purpose of this preliminary study was to identify environmental factors that impact weight management in midlife women.
A cross-sectional design with a single measurement was used for this study.
A focus group was conducted with five middle-aged (mean age = 40 years) women to discuss various weight management strategies. The women were asked to share their opinions and experiences regarding elements in their environment that played a rote rote 1
1. A memorizing process using routine or repetition, often without full attention or comprehension: learn by rote.
2. Mechanical routine. in their weight management. The following themes emerged from these discussions: nutritional knowledge, healthy food availability, and recreational opportunities. These themes were compiled into a questionnaire.
The questionnaire included a total of 69 questions, 13 of which gathered demographic information (age, race, height, weight, education, etc), while the remaining 56 used a Likert scale Likert scale A subjective scoring system that allows a person being surveyed to quantify likes and preferences on a 5-point scale, with 1 being the least important, relevant, interesting, most ho-hum, or other, and 5 being most excellent, yeehah important, etc to address the various themes that emerged from the interviews. Participant were asked to rate statements such as "the environment strongly influences my selection of food choices" or "the community in which I live offers enough recreational opportunities" on a 1-5 scale, from "strongly agree to strongly disagree respectively.
Fifty questionnaires were distributed to women previously recruited for a study on worksite health. These women were aged between 35 and 65 years and lived in the Phoenix metropolitan region. All participants completed the questionnaires anonymously and returned them to the investigators via self-addressed pre-stamped enveloped en·vel·op
tr.v. en·vel·oped, en·vel·op·ing, en·vel·ops
1. To enclose or encase completely with or as if with a covering: "Accompanying the darkness, a stillness envelops the city" provided by the investigators.
Descriptive statistics and Spearman's nonparametric correlations were obtained from the returned questionnaires. Means, standard deviations In statistics, the average amount a number varies from the average number in a series of numbers.
(statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. , and frequency tables were used to describe the sample and to identify the questions for which participants shared a common opinion. Correlations were used to examine associations between different factors.
Forty women (80%) returned the completed questionnaires. Demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. of the sample studied are shown in Table 1. The sample (n=40) consisted primarily of middle-aged, Caucasian, married women with some post-high school education. Ninety-five percent (n=38) of the participants worked full-time (i.e. 30-40 hours per week or more) and worked for others (n=37). About 60% (n=24) of them reported having flexible work hours.
Body mass index (BMI BMI body mass index.
body mass index
Body mass index (BMI)
A measurement that has replaced weight as the preferred determinant of obesity. ) was calculated for 38 participants who self-reported their height and weight. Eleven (29%) participants had a body mass index (BMI) ranging between 25 and 29.9, while 15 (39.5%) of them had BMI of 30 and above. Sixty-three percent (n=25) of the women reported performing at least moderate amounts of recreational activities in the past month, while only 28% (n=11) of them reported doing 20 minutes or more of vigorous aerobic aerobic /aer·o·bic/ (ar-o´bik)
1. having molecular oxygen present.
2. growing, living, or occurring in the presence of molecular oxygen.
3. requiring oxygen for respiration.
4. activity three or more days per week.
Approximately 73% (n=29) of the participants agreed with the statement "the environment strongly influences my selection of food choices". Although 85% (n=34) of the women considered themselves knowledgeable about the food choices they made, nearly two-thirds of them (n=26) felt confused about healthy ways to eat because of the abundance of recommendations circulating cir·cu·late
v. cir·cu·lat·ed, cir·cu·lat·ing, cir·cu·lates
1. To move in or flow through a circle or circuit: blood circulating through the body.
2. . Close to 90% (n=35) of our participants agreed with the statement "what you eat can make a big difference in your chance of getting a disease, like heart disease or cancer".
When asked to report their frequency of eating in fast food restaurants, 50% (n=20) of the women reported going once a week, 23% (n=9) reported going 2-3 times per week, while 7.5% (n=3) reported going 3-5 per week. Close to 58% (n=23) of the participants reported choosing healthy food items in fast food restaurants on most occasions. About half of the subjects (n=21) felt that fast food establishments did not offer enough healthy food items, but 58% (n=23) of them believed that if they asked for healthier alternatives, the fast food establishment was accommodating.
More than two-thirds (n=27) of the women reported they would read through the information before selecting an item if fast food restaurants posted the nutritional contents of its food in an easy location or on every food item.
Sixty percent (n=24) of our participants agreed with the statement "the community in which I live offers enough recreational opportunities (bike paths, walking trails, parks, etc.)". Level of satisfaction with community recreational opportunities was significantly correlated with the amount of recreational activity reported (r=0.363, p=0.025).
The results from this preliminary study suggest that midlife women acknowledge the impact of the environment on dietary habits. Past research has provided evidence of public support for certain environmental strategies related to food consumption (French et al., 2001; Glanz et al., 1995). Together, these findings provide evidence of public readiness for environmental strategies promoting healthy eating.
A majority of out participants felt knowledgeable about their food choices, but were confused regarding which nutritional recommendations to believe. This finding supports conclusions from Glanz and colleagues (1995) that nutrition knowledge has increased in the past decades, but that most people still lack an understanding of how to apply the information.
Our subjects' awareness of the impact of nutrition on their health status is also representative of past surveys, which have shown that public awareness of nutrition's role in the cardiovascular disease Cardiovascular disease
Disease that affects the heart and blood vessels.
Mentioned in: Lipoproteins Test
cardiovascular disease process has improved substantially (Glanz et al., 1995). However, increased awareness has not consistently lead to healthier dietary practices (Glanz et al., 1995). Similarly in this study, although most participants believed unhealthy nutrition could cause disease, many of them reported eating regularly in fast food restaurants.
Many women in our study felt fast food restaurants did not offer enough healthy meals but were accommodating to healthier requests. This is consistent with past evidence that progress has been made in the food industry to supply healthier foods in response to the demand (Glanz et al., 1995). Yet, most of our participants said they would use nutritional information displayed in fast food restaurants, suggesting that point-of-purchase nutrition interventions (POP), which provide consumers with information, reminders, and reinforcement at the point of decision making to influence their choice, may be effective at promoting healthier dietary practices. Controlled studies have shown positive effects of POP on food selection, nutrition knowledge and attitudes (Glanz and Mullis, 1988).
The association between our participant's satisfaction with community recreational opportunities and their reported recreational activity levels parallels findings in children, indicating that children's activity levels are correlated with the number of play spaces dose to their homes (Sallis et al., 1998). Together, these provide evidence of the importance of providing "play spaces" to children and adults.
This study, along with previous investigations, indicates that 1) nutrition education programs should broaden their focus and include guidance on how to apply the information to daily food choices, 2) nutrition education programs alone may not be sufficient to change dietary practices even when they are effective at increasing knowledge, 3) efforts to provide recreational opportunities may promote physical activity, and 4) environmental interventions, such as offering more healthy meals in fast food restaurants or using
POP, may increase the effectiveness weight control programs.
Egger, G., Swinburn, B. (1997). An "ecological" approach to the obesity pandemic pandemic /pan·dem·ic/ (pan-dem´ik)
1. a widespread epidemic of a disease.
2. widely epidemic.
Epidemic over a wide geographic area.
n. . British Medical Journal The British Medical Journal, or BMJ, is one of the most popular and widely-read peer-reviewed general medical journals in the world. It is published by the BMJ Publishing Group Ltd (owned by the British Medical Association), whose other . 315. 477-480.
French, S.A., Jeffrey, R.W., Story, M., Breitlow, K.K., Baxter, J.S., Hannan, P., Snyder, M.P. (2001). Pricing and promotion efforts on low-fat vending snack purchases: the CHIPS study. American Journal of Public Health The American Journal of Public Health (AJPH) is a peer reviewed monthly journal of the American Public Health Association (APHA). The Journal also regularly publishes authoritative editorials and commentaries and serves as a forum for the analysis of health policy. . 91, 112-116.
Glanz, K. and Mullis, R.M. (1988). Environmental interventions to promote healthy eating: a review of models, programs, and evidence. Health Education Quarterly. 15, 395-415.
Glanz, K., Lankenau, B., Foerster, S., Temple, S., Mullis, R., and Schmid, T. (1995). Environmental and policy approaches to cardiovascular disease prevention through nutrition: opportunities for state and local action. Health Education Quarterly. 22, 512-527.
Hawks, S.R. and Gast, J. (1998). Weight loss management: a path lit darkly. Health Education and Behavior. 25, 371-382.
Mokdad, A.H., Serdula, M.K., Dietz, W.H., Bowman, B.A., Marks, J.S., Koplan, J.P. (1999). The spread of the obesity epidemic in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , 1991-1998. Journal of the American Medical Association JAMA: The Journal of the American Medical Association is an international peer-reviewed general medical journal, published 48 times per year by the American Medical Association. JAMA is the most widely circulated medical journal in the world. , 282, 1519-1522.
Richard, L., Potvin, L., and Mansi, O. (1998). The ecological approach in health promotion programmes: the views of health promotion workers in Canada. Health Education Journal. 57, 160-173.
Sallis, J.F., Bauman, A., and Pratt, M. (1998). Environmental and policy interventions to promote physical activity. American Journal of Preventive Medicine preventive medicine, branch of medicine dealing with the prevention of disease and the maintenance of good health practices. Until recently preventive medicine was largely the domain of the U.S. . 15, 379-97.
Stokols, D. (1992). Establishing and maintaining healthy environments. Toward a social-ecology of health promotion. American Pyschology, 47 6-22.
Stokols, D. (1996). Translating social ecological theory into guidelines guidelines,
n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. for community health promotion. American Journal of Health Promotion. 10, 282-298.
Veronique Pepin, Ph.D. is affiliated with the Department of Exercise and Wellness, Arizona State University Arizona State University, at Tempe; coeducational; opened 1886 as a normal school, became 1925 Tempe State Teachers College, renamed 1945 Arizona State College at Tempe. Its present name was adopted in 1958. East. Shari McMahan, Ph.D. is affiliated with the Division of Kinesiology kinesiology
Study of the mechanics and anatomy of human movement and their roles in promoting health and reducing disease. Kinesiology has direct applications to fitness and health, including developing exercise programs for people with and without disabilities, preserving and Health Promotion at California State University Enrollment
Fullerton. Pamela D. Swan, Ph.D. is affiliated with the Department of Exercise and Wellness, Arizona State University East. Address all correspondence to Pamela D. Swan, Ph.D. Department of Exercise and Wellness, Arizona State University East, 7350 E. Unity Ave., Mesa, AZ 85212-0180, PHONE: 480.727.1934, FAX: 480.727.1051, E-MAIL e-mail: see electronic mail.
in full electronic mail
Messages and other data exchanged between individuals using computers in a network. : PSwan@asu.edu
HEALTH EDUCATION RESPONSIBILITY AND COMPETENCY COMPETENCY, evidence. The legal fitness or ability of a witness to be heard on the trial of a cause. This term is also applied to written or other evidence which may be legally given on such trial, as, depositions, letters, account-books, and the like.
Responsibility I: Assessing Individual and Community Needs for Health Education Competency B: Distinguish between behaviors that foster and those that hinder well-being Sub-competency 4: Analyze social, cultural, economic, and political factors that influence health