In the Community
November 3, 2010
New Evidence Supports Kaiser Permanente’s Environmental Approach to Obesity Prevention
By Jon Stewart, Communications Director, Special Projects
A unique partnership between Kaiser Permanente and The California Endowment has produced some of the most compelling evidence to date in support of obesity prevention efforts that galvanize local communities to make key changes in the physical environment that promote greater access to healthy foods and increased physical activity.
Traditionally, obesity prevention strategies have focused on changing individual behavior through public health messages or medical interventions. The California Endowment and Kaiser Permanente have taken a very different, community-based approach aimed at the so-called “upstream” causes of obesity, such as lack of access to retail outlets selling healthy foods in inner-city and rural neighborhoods, and lack of recreational environments, including safe streets and parks.
REPORTS ON JOURNAL’S WEBSITE
- On the Front Lines of Childhood Obesity | pdf
- Community Approaches to Preventing Obesity in California | pdf
- The Kaiser Permanente Community Health Initiative: Overview and Evaluation Design | pdf
- The California Endowment’s Healthy Eating, Active Communities Program: A Midpoint Review | pdf
- The Central California Regional Obesity Prevention Program: Changing Nutrition and Physical Activity Environments in California’s Heartland | pdf
- Approaches to Measuring the Extent and Impact of Environmental Change in Three California Community-Level Obesity Prevention Initiatives | pdf
- Lessons Learned From Evaluations of California’s Statewide School Nutrition Standards | pdf
- Emerging Issues in Improving Food and Physical Activity Environments: Strategies for Addressing Land Use, Transportation, and Safety in Three California-Wide Initiatives | pdf
- Income Disparities in Obesity Trends Among California Adolescents | pdf
- Using Geographic Information Systems and Local Food Store Data in California’s Low-Income Neighborhoods to Inform Community Initiatives and Resources | pdf
While this approach has gained widespread support from the Institute of Medicine and the federal Centers for Disease Control and Prevention, as well as first lady Michelle Obama’s Let’s Move Campaign, there has been little hard evidence to date of the strategy’s effectiveness, given that such efforts are relatively new.
That “evidence gap” is now beginning to be filled, with important implications for other obesity prevention efforts. The entire November issue of the American Journal of Public Health is devoted to a series of rigorous evaluation reports on three separate but similar obesity prevention initiatives sponsored by Kaiser Permanente and The California Endowment in 17 California communities.
The Proof is in the Doing
The evaluations offer strong evidence that residents and leaders of low-income communities can be mobilized to make significant environmental improvements — such as the creation of farmers markets, walking and biking paths, upgraded parks and improvements in public transportation — that result in healthier eating and increased physical activity. These behaviors can prevent obesity, diabetes, heart disease and other chronic illnesses.
The three programs reported on in the Journal emphasize a common core of interventions, each of which are tailored by the local communities themselves to respond to specific needs. Common approaches include working with neighborhood groups and local government agencies to attract fresh food retail outlets to local “food deserts,” and persuading city planning departments to write health criteria into general plans. They also focus on schools that are struggling to implement complex new state regulations limiting junk food and sugar-sweetened beverages on K-12 school campuses, and promoting school district standards for greater time devoted to physical activity.
The programs evaluated include Kaiser Permanente’s Healthy Eating Active Living — Community Health Initiatives, The California Endowment’s Healthy Eating Active Communities program, and Central California Regional Obesity Prevention Program.
Each of the three programs is active in several neighborhoods, cities and counties. Kaiser Permanente’s Community Health Initiative effort, for instance, currently sponsors 37 CHI sites and 40 Convergence sites that partner with low-income communities in five states. The current evaluations however, focused on only three California communities — Santa Rosa, Richmond and Modesto.
In those communities, the CHI evaluations found significant increases in the percentage of people exposed to such changes as improved walkability of neighborhoods, healthier school food policies, development of new parks and bike trails, and/or transportation improvements that increase access to fresh food retail outlets. In all three communities, improved school food policies reach as many as 85 percent of all students, and neighborhood-level changes, such as the establishment of farmers markets, impact up to 35 percent of all residents.
In an editorial accompanying the evaluations, Raymond J. Baxter, PhD, senior vice president for Community Benefit, Research and Health Policy at Kaiser Permanente, and Robert K. Ross, MD, president and CEO of The California Endowment, stated, “The evidence has helped to shift the focus from a relatively narrow set of behavioral and health outcomes (such as obesity rates) to indicators that reflect broader community priorities such as land use, violence and food insecurity.” The communities participating in the programs, they added, “…are at the leading edge of transformative change.”
The special issue of the American Journal of Public Health offers additional information about community-based, environmental approaches to obesity prevention and the special challenges of measuring their impact. Click here to access the entire edition.