What strategies should a community effort aimed at impacting obesity implement to effectively reduce morbidity and mortality associated with obesity?

Comprehensive Community Strategies to Combat Obesity in Michigan

A community effort aimed at reducing obesity in Michigan should implement a comprehensive approach that addresses environmental and policy-level changes across six key categories: promoting affordable healthy food access, supporting healthy food choices, encouraging breastfeeding, increasing physical activity for children and youth, creating safe communities for physical activity, and organizing community coalitions for change. 1

Understanding the Obesity Epidemic in Michigan

• Approximately 42% of U.S. adults are obese, and 33% are overweight, with about 75% of the adult population being either overweight or obese 2
• Among children and adolescents, around 17% are obese and 34% are at risk of overweight 2
• Obesity significantly increases the risk of fatal and non-fatal cardiovascular disease, type 2 diabetes, and other chronic conditions 2, 3
• Environmental factors, including lack of access to full-service grocery stores, increasing costs of healthy foods, and limited access to safe places for physical activity, contribute significantly to obesity rates 1, 2

Evidence-Based Community Strategies

1. Strategies to Promote Affordable Healthy Food Access

• Increase availability of healthier food and beverage choices in public service venues through policies and procurement practices 1
• Improve access to retail stores that sell high-quality fruits and vegetables in underserved communities 1, 4
• Provide incentives to food retailers to locate in underserved areas and offer healthier food and beverage choices 1, 4
• Encourage community gardens and farmers' markets that increase access to fresh produce 4

2. Strategies to Support Healthy Food Choices

• Implement nutrition standards for foods and beverages available in public service venues 1
• Restrict availability of less healthy foods and beverages in public service venues 1
• Institute smaller portion size options in public service venues 1
• Implement menu labeling in restaurants and cafeterias 4
• Limit advertisements of less healthy foods and beverages, especially those targeting children 4

3. Strategy to Encourage Breastfeeding

• Implement programs and policies that support breastfeeding, as breastfeeding is associated with reduced risk of childhood obesity 1, 4
• Create supportive environments for breastfeeding in public places and workplaces 4

4. Strategies to Encourage Physical Activity Among Children and Youth

• Require physical education in schools and increase the amount of physical activity in physical education programs 1, 4
• Increase opportunities for extracurricular physical activity 1
• Reduce screen time in public service venues 1
• Include noncompetitive sports and activities to increase participation among all students 4

5. Strategies to Create Safe Communities Supporting Physical Activity

• Improve access to outdoor recreational facilities 1, 4
• Enhance infrastructure supporting walking and cycling 1
• Support locating schools within easy walking distance of residential areas 1
• Improve access to public transportation 1
• Implement Complete Streets policies that make streets safe for all users 1, 4
• Zone for mixed-use development to increase walkability 1
• Enhance personal safety in areas where people are or could be physically active 1

6. Strategy to Encourage Communities to Organize for Change

• Form community coalitions consisting of public and private sector organizations working together to address obesity 1, 4
• Include diverse stakeholders such as health-care professionals, public health agencies, educational institutions, government departments, faith-based organizations, and employers 1
• Focus on environmental and policy-level changes rather than just awareness or individual-level services 1

Implementation Considerations

• Assess and monitor community progress using specific measurements for each strategy 1
• Prioritize multicomponent interventions that combine nutrition education, physical activity, and behavioral techniques 4
• Consider workplace-based interventions that combine nutrition and physical activity components 4
• Implement school-based programs that combine nutrition and physical activity components 4
• Address equity issues to ensure that socially disadvantaged populations benefit from interventions 5

Potential Pitfalls and How to Avoid Them

• Single-component interventions (diet-only or exercise-only) are generally less effective than multicomponent approaches 4
• Short-term weight loss is often followed by weight regain; focus on sustainable changes 4
• Weight-based stigma can create barriers to implementation; provide proper training to address this issue 6
• Focusing solely on individual responsibility rather than environmental factors may limit effectiveness 1, 6
• Some strategies may lack direct evidence of obesity-related health outcomes; monitor and evaluate implementation 1

Measuring Success

• Use specific measurements for each strategy to assess implementation and track progress 1
• Focus on environmental and policy changes rather than just individual-level outcomes 1
• Track changes in obesity prevalence, but also monitor intermediate outcomes such as improved access to healthy foods and increased physical activity 1
• Consider both short-term and long-term outcomes to ensure sustainability 4