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Tackling Obesity: What Works, What Doesn't and What 'Field of Dreams' Has To Do With It

Tackling Obesity: What Works, What Doesn't and What 'Field of Dreams' Has To Do With It

Picture of Sarah Kliff

The concept of "food deserts" – large swathes of the country where residents lack access to fresh fruits, vegetables and other healthy options-has gotten a serious foothold in the media over recent years. The attention comes with good reason: 2.3 million Americans do not have access to a car and more than a mile away from the closest supermarket.

State and federal programs have attempted to address "food deserts" by increasing the availability of fresh foods. Think of it as a Field of Dreams approach to preventive health: build the produce sections or supermarkets, and they will come. The approach has easily gained traction as one that is both politically palatable – who is going to come out as anti-vegetable? – and commonsensical.

The approach will likely work its way into the Affordable Care Act, too: one of the first preventative grant programs to roll out under the ACA was a fresh round of funding for the Communities Putting Prevention to Work (CPPW) program.

CPPW has interested me as one program to possibly include in my series on health reform and preventative health, largely because of its community-based approach to improving health, that looks to everything from food pricing to public service announcements to reduce obesity and lower smoking rates.

Seattle Times reporter Maureen O'Hagan used her 2010 National Health Journalism Fellowship last year to write about how King County was using its' CPPW grant, to finance "healthy corner stores" to stock fresh foods and vegetables.

But when O'Hagan visited one of the stores in the program, it wasn't exactly the cornucopia that officials had envisioned: an onion here, a few potatoes there, nothing with a shelf life that would be measured in days.

Officials repeatedly pointed O'Hagan to a study of a similar program in Baltimore as evidence for the success of programs that focus on access to fresh produce. When she dug up the study herself, however, the results were less than convincing. From her story:

University researchers who evaluated the program said there was just one statistically significant change in consumption: People were buying more cooking spray. At least, that's what the store owners thought. The study wasn't able to measure actual sales.

Beginning in 2008, the USDA and the Institute of Medicine (IOM) spent a year looking more broadly at the access issue. They each concluded it's unlikely that produce in minimarts, or even new full-service grocery stores, will make much difference in obesity rates.

"The supply of healthy food will not suddenly induce people to buy and eat such food over less-healthy options," the IOM report concluded.

What's going on here? As O'Hagan explained in a Monday presentation, the presence of fresh fruits and vegetables by no means insured they'd be purchased. And if the options in a corner store include both kale and brownies, it's not exactly a shocker which would fly off the shelf. As one owner of a healthy corner store told her, he stopped stocking fresh vegetables because it just wasn't profitable. "We would spend $200 on vegetables and make only $10," he told her.

The outlook is not completely bleak: public health approaches have found successful, wide-ranging approaches that have made statistically significant changes to some of our nation's most vexing health problems. At least two public health issues that have shown big changes in recent decades: smoking rates have dropped by half since the 1950s and teen pregnancy has dropped by a third since 1991.

But even some of the most celebrated successes in prevention still leave much room for improvement: 20 percent of American adults still smoke; our teen pregnancy rate is the highest among developed nations, and even saw a few years of increase as of late.

The big takeaway for me: preventive medicine is hard and the evidence often mixed, with much of the success tied up in the idiosyncrasies of a local community and the leaders in charge. Tackling obesity is an even bigger challenge than smoking or teen pregnancy. While tobacco use and sex are optional, eating isn't.

Unless were ready to declare our national battle with weight a lost cause, prevention must start somewhere. Increasing access to healthy foods, supporters of the program contend, is part of a long term approach to public health, one that lays the foundation for healthy eating and begins to set new norms on what communities consume. In other words, make kale a standard and give it time to stick. The key question I'll be looking at in future blog posts and stories: whether kale can become a best-seller too and, if it can, what policies will get us there.

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