Abstract
Policy changes play an important role in shaping the environment to promote healthy choices in physical activity and nutrition. However, additional support is required for these policies to have an increased impact. This article discusses the roles professionals trained in a lifestyle approach can have in promoting policy.
‘. . . professionals are needed to support and guide individuals for the policy changes to have a maximum effect.’
Although overweight and obesity have been described as preventable diseases, 1 the prevalence of obesity in children and adults has reached epidemic proportions. 2 As discussed in this issue by Pronk et al, 3 environments promoting sedentary behaviors and low-nutrient foods largely contribute to the development of unhealthy lifestyles and obesity.4,5 With such high rates of this disease, environmental policies have been adopted to promote lifestyle changes regarding physical activity and nutrition.6-8 Although changes in policy have limited direct evidence as to their effectiveness, these environmental changes are likely to help individuals attempting to be healthier through raising awareness. However, professionals are needed to support and guide individuals for the policy changes to have a maximum effect.
Promotion of Physical Activity
School facilities are positioned to provide communities with a convenient option to increase physical activity. Because many schools have both outdoor and indoor equipment, playing fields, and overall open space to engage in physical activity, they are an excellent resource for communities. However, several factors impact the likelihood that schools will be used for these purposes. For example, youths are less likely to use these resources if adult supervision is not present, and the use of many school facilities is unavailable to adults as they are typically only open during school hours. These and other factors cause school grounds to be underutilized. Advocacy groups within communities have been formed to help address these issues.9,10
The worksite has been demonstrated as another important place to promote physical activity. 11 Relatively short bursts of physical activity (ie, 10 minutes) have been shown to result in significant improvements in activity levels and self-perceived health status. 12 Worksite interventions may also support the adoption of physical activity in individuals who are significantly more sedentary. 12 The feasibility of such programs to be implemented has been clearly shown.11-13 However, these policies are most likely to be followed by individuals when one-to-one counseling is provided around the specified behavior, especially for those individuals who are considered at risk. 11 Additionally, in this study, the worksite that only focused on the provision of fitness facilities demonstrated minimal improvements in physical fitness and did not differ from a control condition in terms of cardiovascular risk reduction. These results demonstrate the need to have individuals supporting the policies being implemented.
Promotion of Healthy Nutrition
The lack of availability of healthy food options is a concern in many neighborhoods. The types of grocery stores in an area may help to identify neighborhoods that have fewer healthy food options. For example, the number of small grocery stores in a neighborhood has been shown to be associated with obesity and body mass index. 14 In a study comparing a low-income neighborhood with a more affluent one, it was found that the low-income neighborhood had twice as many food stores per person. Despite having more food stores, only 18% of these stores had access to a variety of healthy foods compared to 58% of the stores in the more affluent area. Additionally, low-income neighborhoods and rural areas have less access to supermarkets or chain grocery stores that are more likely to provide healthy food options. 15 These issues have led some to propose taxation on high-fat foods and to offer incentives for the provision of healthier foods. 16
In addition to food stores, significant research has been conducted on restaurants. The majority of meals and snacks in the United States are purchased from restaurants. 8 Eating outside the home has been associated with greater intake of fat and sodium and decreased intake of fruits and vegetables. 8 This may be especially true for fast food restaurants. Specifically, proximity to fast foods restaurants is associated with excess weight gain during pregnancy. 14 However, eating at full-service restaurants, which typically have healthier options, is associated with increased fruit and vegetable intake.
Menu Labeling
Central to the issue of eating at restaurants is menu labeling. Many of the food descriptions placed on menus do not provide enough information for the consumer to make an informed choice as to the health of their food choice. Although many restaurants publicized the nutritional information of their choices, it was typically displayed in a way that few customers would notice. The 2010 Healthcare Reform Law required chain restaurants to place nutritional information on their menus. Although the results of placing nutritional information on menus are mixed, several benefits have been identified. For example, menu labeling has been shown to reduce calorie, fat, and sodium choices while in the restaurant. 17 A decreased “intention to purchase” less healthy menu options has been demonstrated,18,19 and parents have been shown to purchase significantly fewer calories for their children when menu labels are present. 20
Although benefits for menu labeling have been found, some evidence suggests that these benefits may be minimal or only seen in certain groups. For example, only lean women may choose meals with lower calories. 21 Additionally, studies examining the implementation of menu labeling in the “real world” found only a minimal 22 or no reduction in calories.23-26 Menu labeling may also only be helping more motivated and health conscious individuals.27,28 As stated, the evidence for menu labeling is currently mixed with some studies showing benefits and others showing none. However, placing calories and other health information on menus should help to raise awareness in individuals, which, in turn, may assist some in making healthier choices. Ultimately, menu labeling permits individuals to make decisions based on health, and its absence make these types of decisions very unlikely.
Menu labeling provides an excellent example of how policy change is in need of professionals to support it. In this case, if individuals are taught how to best use the information on labels, encouraged to do so, and given feedback on their efforts, they should be more likely to have success in their attempts to be healthier. Unfortunately, little research has been conducted to determine the role that additional training and support will have on food selection with menu labeling in place.
Conclusion
The benefit of establishing an environment that supports behavioral change has been clearly demonstrated, and policies that focus on increasing physical activity and healthful nutrition will likely play an important role in the prevention and treatment of obesity. However, limited data are available to determine the impact that these policies have on actual behavior change. As discussed above, policies have been shown to be most effective when health care individuals are present to encourage behavior change, act as advocates, and counsel at-risk individuals. Health care professionals trained in lifestyle approaches are optimally suited to fill these roles. The combination of policy change with individuals in place to support it has the potential to significantly affect population health.