Adapting Physical Activity Interventions to Prevent Obesity in Culturally Diverse Populations

Abstract

As the United States debates major health reform issues, reversing the obesity epidemic needs to be at the forefront of the discussion. The serious health and economic implications associated with obesity threaten our workforce and burden our health care system. An estimated $117 billion is spent each year to cover the medical and indirect costs of obesity, including lost productivity. The direct health care costs of childhood obesity alone are estimated at $14 billion annually. If we fail to change the policies and environments that contribute to this epidemic, our next generation can expect even higher rates of obesity, greater health care costs, and a health care system less capable of meeting its needs. In the United States, two-thirds of adults and nearly onethird of our youth are overweight or obese. And while the prevalence of obesity has increased in all segments of our population, rates are significantly higher among AfricanAmericans, Native Americans, and Latinos. Research shows that many lower-income, culturally diverse communities have limited access to safe places to walk, bike, and play and that residents have poorer health outcomes. Physical inactivity is a major contributor to the development of obesity, and there is a great need to promote physical activity and support other healthy choices among the populations who are at greatest risk. Thus, efforts to combat obesity must test and implement economically feasible solutions that address the specific needs of these most vulnerable populations. By sharing results about what’s working to promote healthy changes in these populations, we can more rapidly establish the best practices that can inform action in communities across the country. Over the past few decades, we have learned that interventions designed solely to promote positive attitudes and increase health knowledge are insufficient to achieve longterm or sustainable behavior change. The socio-ecological model for behavior change suggests that effective community interventions must include environmental and policy solutions as key components if children and families are going to adopt healthy lifestyles. We cannot expect adults or kids to get regular physical activity or maintain a nutritious diet if they do not have convenient access to safe places to be active and affordable healthy foods. This commentary and the commentary by Kumanyika and Yancey focus on two systematic reviews of physical activity interventions: one conducted in African-American populations by Whitt-Glover and Kumanyika and one conducted in Native American populations by Teufel-Shone et al. These papers were commissioned by the Robert Wood Johnson Foundation (RWJF) to address the lack of published information concerning effective interventions that focus on physical inactivity and obesity among these populations. The literature reviews also examine how physical activity interventions can best be adapted to the cultural needs and values of each population; explore the impact of such interventions on obesity; and offer recommendations for future research. Both reviews show that there have been relatively few highquality studies within each target population. Furthermore, of the interventions that were implemented in either AfricanAmerican or Native American populations, there appeared to be little evidence of systematically adapting the original intervention to the cultural needs, values, and resources of the population studied. Addressing the policy and environmental factors that support sustainable long-term behavior changes was a challenge for all of the interventions, regardless of the specific population that was targeted. Initial findings from the literature reviews were presented at a 2-day meeting, Equal Rights to Health—Moving Forward Together, which was sponsored by RWJF in December 2003. Dr David Satcher, former United States Surgeon General, chaired the meeting, where representatives from research, practice, and media shared ideas and developed recommendations for preventing childhood obesity in the most affected communities. More than 50 experts who had worked with African-American, Latino, Native American, and rural populations participated in discussions about community-based programs, the evidence base regarding culturally diverse interventions, and the role of the media and communications in preventing childhood obesity. During the meeting, discussions revealed that many interventions designed to address obesity had not been widely translated into ‘‘real-world’’ practice, and had not been rigorously applied to culturally diverse populations that are most at risk for obesity. In some cases, the research-based programs were moderately effective, but communities lacked the resources required to implement and sustain the interventions. Many community organizations were unaware Copyright E 2009 by American Journal of Health Promotion, Inc. 0890-1171/09/$5.00 + 0 Terry L. Bazzarre, PhD, recently retired from his position as senior program officer at the Robert Wood Johnson Foundation (RWJF). While at RWJF, he oversaw the Foundation’s support for the literature reviews and Equal Rights to Health meeting described in this commentary.