Yanna Lee

A new Yale study has identified community-level factors that may play a role in lowering obesity rates.

The study, which was an outgrowth of a larger initiative by the Robert Wood Johnson Foundation and Blue Cross Blue Shield Massachusetts, aimed to understand how communities and states develop different health outcomes.

According the Centers for Disease Control and Prevention, more than 36 percent of U.S. adults are considered obese, which can lead to conditions such as heart disease, stroke and type 2 diabetes.

Maureen Canavan, associate research scientist at the Yale School of Public Health, said the team felt obesity was a critical issue for this study to address.

“Obesity rates over the last several decades have increased exponentially, and obesity is linked to a lot of other diseases,” Canavan said. “It’s very far-reaching in terms of what’s associated with it.”

A team of Yale researchers, undergraduates and public health students singled out six counties that had unexpectedly low obesity rates despite factors which usually lead to higher rates, such as higher minority populations, lower median household incomes and education levels and higher statewide obesity rates. The team identified common themes and strategies these communities used to promote healthy living.

Senior Scientific Officer of the Yale Global Health Leadership Institute Kristina Talbert-Slagle SPH ’10 explained that by looking at positive deviants — the six counties which had unexpectedly low rates of obesity despite challenging settings or traits — the researchers identified factors which could be copied as a model for other places.

“It was intriguing and inspiring to see how invested community leaders were, especially because these communities are so different from one another,” she said. “There is no silver bullet solution, but it definitely helps to have leaders who really think about their citizens.”

According to the researchers, because obesity is a multi-factor issue with many socioeconomic impacts, it is difficult to find one solution to address the issue. This study provides new insight because of the recurrent themes identified across such diverse communities.

By collecting qualitative data from real-life situations where communities have come together to combat obesity, the study can serve as a model to tackle this problem nationally, according to Elizabeth Bradley, faculty director of the GHLI.

The researchers travelled around the US to visit the six counties and interview over 80 community leaders — such as health care and social service providers, and leaders of educational facilities and public health departments — about the health initiatives they have implemented.

“Obesity is a critical measure of the population’s health, with large variation throughout the US, so this was a perfect opportunity to understand [obesity rates] at a grass roots level,” Bradley said.

The first thing the team noticed was that the communities studied “recognized how complex [obesity] is, that it is driven by social, behavioral, environmental and medical factors,” she added.

Talbert-Slagle said that some of these counties prefer to refrain from labeling the issues “obesity” because they feel it is important to take a holistic approach to health and address the interconnected factors that led to certain health outcomes.

According to the researchers, the community leaders were also very familiar with the challenges facing their county, such as large retiree or student populations, and were working to incorporate these into coordinating health initiatives. For example, students often feel a sense of pride in natural resources, so one of the counties found a way to utilize parks and keep citizens active, she added.

“The level of collaboration was palpable, supported by the social fabric of how people felt about their community,” Bradley said.

Bradley added that the communities also worked across different sectors and with local attractions to establish unique partnership.

“In one county, the local zoo had a lunch menu that wasn’t very healthy, so community leaders worked together with zoo employees to come up with a healthier menu to benefit field trips and other visitors,” Talbert-Slagle said.

Other initiatives the researchers observed were as simple as the establishment of community walking paths or cooking classes that encourage the consumption of more fruits and vegetables.

According to the World Health Organization, 65 percent of the world’s population lives in a country in which obesity and overweight cause more deaths than underweight.