Susan Hillman is working on her graduate degree in public health with desire of becoming a wellness coach upon graduation and helping obese people lose weight. She is the ideal person for this role because she has gone from 249 lbs to 130 lbs by educating herself. She is now poised to pay it forward and show others there is a better and more enjoyable way to live life than how so many in this society are.
Susan gracious enough to share this article with me with the hope it will help in some small way. I really enjoyed reading this article! Obesity is such a complicated problem as you have so many factors – big food companies preying on obese and low-income demographic, drug companies, Monsanto and other evil companies running the FDA, GMOs, processed foods, sedentary lifestyle, economy sucks – people have to work 2-3 jobs to make ends meet thus no time for wellness, various fads/etc. marketing of products that make the situation worse, CHILDHOOD OBESITY, ignorance, misconceptions, etc. Great job, Susan, summarizing the problem and highlighting some solutions.
Obesity has become a major public health concern. Communities, state, and federal agencies can help fight this epidemic by using different theoretical elements of human behavior to help fight obesity. People learn the behaviors that can lead to obesity, such as overeating and lack of physical activity through others that they observe. Different organizations can use different theories to help fight obesity.
Public Health and Obesity
In order for public health programs to be successful, they need to be based on human behavior because human behavior has a big part of human health. Therefore, for public health programs to improve, they need to apply human behavioral theories. The people who develop and implement public health programs need to understand why people either practice or do not practice certain health behaviors and what influences these behaviors. One behavior that has become a serious problem for public health is obesity and the different social and behavioral aspects that can lead to obesity.
Obesity and Health
Obesity has become a major public health concern and problem. The average adult female weight has increased by 13.5% since 1999-2000 (Burke & Franklin, 2007). The obesity rates in males, females, and especially children are on the raise and become a problem of epidemic proportion. The obesity rate in children has risen from 4-5% to 17-18 percent from the 1960s to 2004 (Branscum, 2011). There are different reasons for this increase in the obesity rate: change of physical activity, change in eating habits, and economic influences (Burke & Franklin, 2007). Obesity can lead to other diseases that affect people such as high blood pressure, Type 2 diabetes, sleep apnea, and other diseases (“OBESITY-RELATED DISEASE; Seattle Sutton Urges More Focus on Prevention to Tackle Obesity in Healthcare Reform,” 2009). Obesity is not just a problem that affects the individual and his or her family but also affects society.
The costs of obesity and the associated health problems have affected health care costs. According Roche, Conner, Kolodinsky, Buckwalter, Berlin, and Powers (2012), “In 1995, the total costs related to obesity were estimated to be $99.2 billion, 5.7% of healthcare expenditures in the United States. Estimates in 2008 showed an increase to $147 billion” (p. 357, para. 4). Additionally, because of obesity and its co-morbidities, people end on disability or Social Security Insurance. Additionally, obese people generally have to deal with discrimination, stigmatization, and other problems within society. These problems do not only affect them in their personal lives but also can affect them in the school or work environment. There are different theories, such as social learning theory that can help explain the increase in the obesity rates and help public health programs assist with the problem.
Social Learning Theory
The social learning theory was proposed by Albert Bandura and is a very influential theory about development and learning, but added the social aspect of development and learning. Bandura theorized that people learn through observation and intrinsic reinforcement. He also theorized that self-efficacy is important to human behavior, and that positive self-efficacy is produced by positive action. Bandura believed that human behavior is learned through observation, which is known as modeling. For example, many people who are raised in rural communities learn through modeling to eat many fried foods or children are taught to eat junk food through their peers and parents. Additionally, people generally get their physical activity level from their family or peers. If children are in a house where the parents are not active and just sit in front of the television, the children are likely to observe and model this behavior. People also learn to discriminate against people who are obese through modeling or observation. Additionally, obesity can also be treated by public health programs through the social learning theory.
Public Health Using Social Learning
There are different federally funded programs, such as Women, Infants, and Children (WIC). WIC is a program that many families use, and this program issues food vouchers to pregnant women and children under the age of five. With these vouchers, parents and pregnant women can purchase eggs, milk, cereal, fresh fruit and vegetables, rice, bread, or baby formula for an infant. Some of the options on these vouchers are for brown rice, low fat milk, and other healthy food items. However, when qualifying for WIC vouchers, expectant mothers and parents must tend a nutritional class to help them choose better nutritional options. Parents of toddlers and pregnant women generally befriend each other and in this type of social environment it does not take much for eating behaviors to be changed. If one pregnant woman starts eating healthy and her pregnant friends observe her eating healthy, they will also change their eating habits. Louisiana is only of the many states to use the WIC program to help fight obesity (Department of Health and Hospitals, 2013). Additionally, on the state level, many states are starting to get involved with the obesity battle via social learning theory.
Many adults and children look up to sports heroes and model their behavior. Many states have started implementing different programs, such as Fitnessgram, which is a program implemented in between the Cooper Institute and the National Football League (FitnessGram, n.d.). The schools become involved in this program, and the students are given fitness tests and a fitness report card. This program will also help a student’s self-efficacy. Research has shown that self-efficacy is important to weight loss because feeling positive about oneself and motivation is an important key to weight loss and health (Thompson, Cook, Clark, Bardia, & Levine, 2007). Local communities also can use this same concept to promote health and physical fitness. They can develop local programs that include the social aspects of physical fitness, such as community ball teams and nutritional awareness. People can change behaviors by observing healthy behaviors and seeing the outcomes of those healthy behaviors. However, there are other theories, such as the social ecological model that can be applied to this health problem.
Social Ecological Theory
The social ecological model was designed by Urie Bronfenbrenner, and he theorized that different factors affect a person’s development and behavior and that these factors are interwoven. He believed that there were different subsystems that can contribute to a person’s development and behavior (Brown, 2011). He also believed that a person’s social environment has a big influence on a person’s behavior. This model also proposes that it takes more than individual knowledge to change behavior. This model proposes that besides increased knowledge, behavioral change also requires preparation and a supportive situation (Brown, 2011). These different levels in the social ecological model can be applied to helping fight obesity in public health.
Public Health and Social Ecological Theory
The first level is the microsystem, which is the person’s direct environment, such as school, home, or friends. Obesity can be battled on this level by direct intervention from the family, school, or a person’s physician or a person’s health care professional (Brown, 2011). The second tier of these levels is the mesosystem, which is the environment where two microsystems come together, such as a field trip or a family gathering (Victor Valley College, n.d.). This group is generally still an interpersonal level, which as some influence in a person’s life. The next system is the exosystem, which a person does not directly associate with. This subsystem can be on an organizational level and can include policies and established environments (Brown, 2011). This could include community-based programs, such as Weight Watchers because there are rules and people are due-paying members. The next subsystem is the macrosystem, which is the layer that is made up of laws, cultural customs, and customs (Paquette, 2001). This subsystem is where the community can get involved in fighting obesity. The CDC defines a community as “like a large organization, able to make changes to policy and the environment to give residents the best possible access to healthful foods and places to be physically active. Changes to zoning ordinances, improvements to parks and recreation facilities, creating ways to distribute free or inexpensive fruits and vegetables” (Centers for Disease Control and Prevention, n.d.). The last tier is the chronosystem is changes and life events over spans in time; however, society plays a big part in this subsystem. Obesity can be fought on this subsystem through media ads, state-and-federal mandated school policies, and regulation (Brown, 2011). The Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases recommended that the battle against obesity can be fought on the individual, social, organizational, public, and societal levels, which are all in the social ecological model (Hamre, Kuester, Renaud, Williams-Piehota, Franco, Roussel, & Hersey, 2006).
Different Levels of Public Health
There are different levels to the health field that can help fight obesity. One of these fields is the governmental health organizations. Examples of such organizations are the Centers for Disease Control and Prevention and the Food and Drug Administration. The government is also involved in public health by introducing legislation or approving grants for different health programs. On the state level, states are responsible for implementing and overseeing state health programs and services (Novick, Morrow, & Mays, 2008). Different programs overseen by the state are human services, agriculture, housing, and many other programs. There is also the local government level, which oversees health in the community and monitors wellness within the community. However, all levels are reliant on funding and grants. For example, a health unit in a community relies on federal and state funds for operation and has to follow state and federal policy. Many times, organizations are interwoven to help achieve a goal, such as fighting obesity.
Fighting obesity starts on the home front; however, different organizations must reach the family home to address the problem of obesity. Communities can help fight obesity by using the social learning theory by organizing community events and getting people in the community involved in physical activity, such as the Susan Komen 5K for breast cancer or creating a community sports event. Communities can also start a healthy initiative program and allow funding for community parks or bike trails. The state level also can apply the social learning theory to obesity by implementing different programs, such as FitnessGram or educational materials. On the federal level, the social learning theory also can be applied by using programs such as WIC, Head Start, and other federally funded programs to help fight obesity. Additionally, individuals, community, organizations, and society can use the social ecological theory to help fight obesity.
Health care providers can get involved with individuals to help teach them new, healthy habits and get individuals more active. On the interpersonal level, if parents overeat and are not physically active, children follow their habits. Parents can unplug the television and get active with their children. On the organizational level, groups can help educate people about proper nutrition and exercise and how these factors affect an individual’s well-being. On the community level, schools can develop fitness programs and communities can promote health programs and healthy activities for the community to be active in. On the societal level, the government and state can use the media and legislation to promote good health and nutrition. One example of this is Michelle Obama’s “Let’s Move” program, which has four pillars. The “Let’s Move” program encourages parents/adults to learn more about diet and exercise, making the foods offered in schools nutritional, making healthy foods inexpensive, and teaching physical activity (ABC News, 2013). This program is federally funded and encourages everybody to get involved. Getting people involved on every level: individual, community, organizations, and society is what it is going to take to fight the problem of obesity.
Obesity has become a major public health concern over the years, and it has become a problem of epidemic proportion. The public health field can use different theoretical elements of human behavior to help fight obesity. The social learning theory and the social ecological theory are good theories to begin this battle with because people learn from observing other and the different subsystems in their lives. If community, state, and federal government use these theoretical elements to develop programs to help fight obesity, the percentage of morbidly obese people could start to decline.
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