Stakeholders Hope Simple Message Resonates in War on Obesity

As alarming statistics associated with America’s ever-expanding waistline become part of the nation’s collective conscience, everyone from politicians and public health officials to media outlets and moms down the street have begun a dialogue about how to fix the problem. However, it’s become abundantly clear that it will take more than just ‘talking the talk’ to get America moving. With the release of “Eat Well, Play More Tennessee,” a broad array of stakeholders hope to get the state’s 6 million citizens actually ‘walking the walk’ toward better health.

Released in mid-September, the five-year nutrition and physical activity plan developed by the Tennessee Obesity Task Force provides a roadmap to reducing obesity and the burden of chronic disease in the state by 2015. The task is a daunting one.

“Almost 70 percent of our adults are overweight or obese … that’s over two-thirds so being unhealthy is the norm, and I think that’s startling,” said Joan Randall, MPH, administrative director of the Vanderbilt Institute for Obesity & Metabolism and chair of the Tennessee Obesity Task Force. Because being overweight or obese has become commonplace, many Tennesseans don’t even recognize they are outside the range for a healthy weight.

While the comprehensive plan is impressive, it’s certainly not the state’s first stab at addressing the issues of overweight and inactivity. However, stakeholders believe the population-based strategies of the plan offer a real chance to make a difference.

“If you look historically … not just in Tennessee but nationally … oftentimes initiatives to fight overweight and obesity have been program-based,” explained Tennessee Department of Health Commissioner Susan R. Cooper, RN, MSN. She added that while programs are good, they are typically dependent on funding and often have a narrow scope from a population perspective. “There have been some very successful programs in the past, but they’ve only touched a limited number of people,” she continued. “To get that sea change, you need population changes.”

To that end, Eat Well, Play More has changed the intervention mode to a Social Ecological Model that recognizes society is composed of interconnected elements — individual, interpersonal, organizational, community and social — that impact each other. The plan considers how all the various levels of influence should be addressed to support sustainable, healthy lifestyle choices.

Randall stressed, “First of all … it’s not a weight loss plan. It’s mandated by the CDC that it be a plan focused on policy and environmental change. It looks at broader issues that help us create a healthier environment.”

Cooper said the plan’s actions and policy recommendations were set up to really meet people where they are. The strategies focus on five real-world settings — where people live, work, play, learn and heal, plus outreach to the most underserved populations.

Cooper cited regulations that have been implemented around schools, such as the healthier vending machine requirements, as an example of how thoughtful policy could impact larger groups. The commissioner was quick to add, however, that Eat Well, Play More doesn’t mean policy replaces individual choices and accountability.

“Certainly there’s a role for personal responsibility,” she stressed, “but without creating an environment for health where healthy choices are the easy choices and healthy choices are the affordable choices, people will continue to make the best choices within the context of the environment in which they find themselves.”

This conundrum is exacerbated by the country’s current economic climate. “Folks are struggling in our state about how to spend their limited resources,” Cooper noted. She added families tend to gravitate toward the high calorie, highly processed, less nutritious food available at a ‘value’ when trying to stretch $10 to feed a family.

Randall said addressing limited choices for healthful living is where the Tennessee Obesity Task Force could make inroads by tapping into the expertise of a diverse group of stakeholders. When the plan was printed just a few months ago, there were just over 100 organizations across the state involved. That number, however, has continued to grow as those from outside traditional health and wellness groups — including city planners, employers, retailers, faith-based leaders and government officials — recognize the toll obesity takes on a community both in terms of health and economics.

“I see sort of a perfect storm where things are percolating all over the state as people realize the huge costs of the choices we’ve made,” said Randall. “New partners are coming together that you wouldn’t previously have seen at the same table.”

Cooper echoed those sentiments, saying health was not the responsibility of a single department. “We all have a role to play in improving the health of Tennessee, and that’s why it was important to have the broadest representation from the farthest east to the farthest west and from broad constituencies.”

The pieces … and people … are in place to address issues through a variety of work groups and action teams to help drive the plan forward. Randall said the Built Environment group, for example, looks at ways to make communities more conducive to active transportation including sidewalks that actually lead somewhere, bike paths and safe walking routes. The Food Systems group addresses ways to incentivize grocery stores to move into food deserts and to create spaces for farmer’s markets or community gardens in underserved areas.

“There needs to be a culture shift where people are demanding access to food, physical activity, sidewalks, parks,” Randall said. She added that she thinks we’re nearing that tipping point. “There are champions all over Tennessee right now.”

Cooper noted that if overweight and obesity, which affects 70 percent of the state’s population, was an infectious disease, there would be a statewide outcry to ‘do something.’ She continued, “Obesity is an epidemic. We need to create this public outcry that we have a problem, and then we need to do something about it because all problems are fixable … it may take some time, but all problems can be addressed.”

The statewide stakeholders involved in Eat Well, Play More Tennessee believe this population-based model contains the right pieces to solve the nutrition and physical activity puzzle.

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