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Tackling Obesity:

Implementing Change Through Action and Public Policy

Obesity is currently America’s greatest public health problem.[footnoteRef:1] Local level nonprofits and community organizations need to take action to make changes towards healthier living. Public policy advocacy has proved to be an effective and efficient way to improve public health. Not long ago, communities and NPOs across the United States launched a series of advocacy campaigns to build a movement against cigarette smoking. They were able to successfully change public opinion and public policy towards the tobacco industry and cigarette smoking.[footnoteRef:2] In this paper, I will show how NPOs can apply successful tactics of the anti-tobacco campaign to the fight against obesity. Just as with tobacco, it will require a multi-faceted effort to influence policy. NPOs will have to impact policy makers, educate consumers, and build up grassroots support. Community and local nonprofit organizations have the power to tackle obesity. Taking the right steps and learning from the successes of the anti-tobacco campaign will enable these groups to have a huge impact on public policy. By starting local initiatives, nonprofit organizations can prove that communities value health, and in turn will generate pressure on policy makers to create change. This change starts by reframing the idea of obesity, taking small steps to improve the environment, and educating the population to ultimately create large-scale change. [1: Scott-Thomas, Caroline. “Obesity Overtakes Smoking as America’s Biggest Health Problem.” Food Navigator. Posted on 01/08/2010. Accessed on March 30, 2013 from http://www.foodnavigator-usa.com/Science/Obesity-overtakes-smoking-as-America-s-biggest-health-problem] [2: Alderman, J & Daynard, R. “Applying Lessons from Tobacco Litigation to Obesity Lawsuits.” American Journal of Preventive Medicine. (2006). 82-88. ]

There are many parallels between the tobacco and food industries. The tobacco industry cost America millions of lives and millions of dollars in medical treatment through their lies and actions. Big tobacco knew they were harming public health and they tried to hide it.[footnoteRef:3] The industry deceived the public and continued marketing and selling a product they knew hurt people and worsened public health. It took decades for the general public to understand the issue and build a campaign against it. [3: Brownell, K & Warner, K. “The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar is Big Food?” The Milbank Quarterly. Vol. 87 (2009). 259-294. ]

A similar pattern is emerging in the food industry. Research has surfaced about the negative effects of fast food and soda and the link between foods with high sugar and fat content with Type 2 Diabetes and a myriad of other health problems.[footnoteRef:4] The food industry is responding to threats in the same way as the tobacco industry did when studies came out linking smoking to cancer.[footnoteRef:5] Large food companies have argued against the emerging scientific evidence, going so far as to hire their own scientists to do counteracting research. Like tobacco, the food industry has claimed to have the best interest of the customers at heart, yet use pressure to prevent policy changes, and target the poorest segments of populations and the most vulnerable: children.[footnoteRef:6] [4: Ibid. ] [5: Ibid. ] [6: Ibid.]

When tobacco came under attack, the leaders of industry joined together to form a common language, and the food industry has taken up a similar model.[footnoteRef:7] Across the board, leadership focuses on personal responsibility of their customers and the freedom to choose. The focus on freedom highlights the core American value of individualism and resonates with the public. By using this “catch phrase” the food industry is able to deflect responsibility and place all blame on the individual consumer. Both food and tobacco industries have also tried to drum up controversy that government action will take away civil liberties. They play into fears of big government and warn against letting the government make decisions for the people. The food industry is working hard to keep the focus on the individual and argues that everyone deserves the right to choose what he or she wants to eat.[footnoteRef:8] [7: Ibid. ] [8: Freudenberg, Bradley, and Serrano. “Public Health Campaigns to Change Industry Practices that Damage Health: An Analysis of 12 Case Studies.” Health Education and Behavior. (2007). 230-249. ]

In order to stop history from repeating itself, we need to confront the food industry with the practices learned from the anti-tobacco campaign. There are numerous ways that local groups can fight back to stop obesity. The anti-tobacco campaign proved that individual people and small organizations can and do make a huge difference. Local nonprofit organizations can start change in their communities, schools, and local institutions.[footnoteRef:9] Action within local organizations starts the dialogue and sets the stage for greater change. Consumer and constituent demands drive the decisions of larger government and industry, and eventually they are forced to take action.[footnoteRef:10] Nonprofit organizations have a lot of potential to create change in the food industry. If they can successfully combine scientific knowledge of public health with what they already know and understand about working with communities and implementing change on a local level, there is an unlimited potential for change.[footnoteRef:11] [9: Popkin, Barry. “What Can We Do?”. The World is Fat. ] [10: Freudenberg, Bradley, and Serrano. ] [11: Badovinac, Kimberly. “Policy Advocacy for Public Health Practitioners: Workshops on Policy Change.” Public Health Nursing. Vol 14 (2006). 280-295. ]

The first step to tackling obesity is reframing the context in which society views it. The food industry has dominated the conversation on obesity and framed it as a personal problem.[footnoteRef:12] As a society, we need to start seeing it as a social issue.[footnoteRef:13] In most communities, obesity is viewed as a matter of personal responsibility.[footnoteRef:14] It is assumed that people with poor health do not take care of themselves because they lack the willpower. It is assumed that unhealthy people do not have the strength of character to make the best decisions for themselves.[footnoteRef:15] Nonprofit organizations spend a lot of time and energy on direct service, working with individuals, trying to convince them to change their eating habits.[footnoteRef:16] Health education is focused primarily on individual behavior. To be successful we need to view obesity as a more comprehensive issue. We need to look at the bigger picture and see obesity as a social issue with many contributing factors. When a nonprofit forms a plan to make their community healthier, they need to realize that people with poor health do not have the economic resources to prevent health problems.[footnoteRef:17] Their approach needs to go beyond the individual and take into consideration corporate and government action.[footnoteRef:18] [12: Dorfman, L & Wallack, L. “Moving Nutrition Upstream: The Case for Reframing Obesity.” Journal of Nutrition Education and Behavior. Vol 39. (2007). S45-S50. ] [13: Ibid. ] [14: Ibid. ] [15: Liebert, Mary Ann. “Obesity, Bariatric Nursing, and the Policy Process: The Connecting Points for Patient Advocacy.” Bariatric Nursing and Surgical Patient Care. Volume 4 (2009). 133-138. ] [16: Dorfman, L & Wallack, L.] [17: Badovinac, Kimberly. ] [18: Freudenberg, Bradley, and Serrano. ]

The anti-tobacco campaign reached success when it shifted the focus from the individual to the environment. The campaign redefined who was responsible and looked into an individual’s relationship with external factors.[footnoteRef:19] Instead of blaming the victim, they looked at how a person’s environment affected their choices and health. The anti-tobacco campaign held the industry responsible for the environment and the product they were creating for the individual. Just as in the fight with tobacco, the anti-obesity campaign needs to shift focus away from the individual. Instead of depending on individual people to decide to make healthier choices (whether it be to quit smoking or stop eating junk food), it is more efficient and successful to focus on the community and the environment that are influencing people to make unhealthy decisions.[footnoteRef:20] Nonprofit organizations have the power to reframe this issue in the way they tackle the problem. By organizing the communities, advocating through media, learning about policy development, and informing the constituency, they can reshape the way their community and society as a whole looks at obesity. [19: Dorfman, L & Wallack, L.] [20: Freudenberg, Bradley, and Serrano. ]

Once a nonprofit begins to change people’s outlook on obesity, they can take small steps to rally support from their community and change the environment they live in. Once a community realizes the impact environmental factors have on health, they will be mobilized for change. The fight against big tobacco proved that the best way to improve the health status of an entire population is to improve the environment in which they live.[footnoteRef:21] Instead of focusing on individual change, time, energy, and resources are more efficiently used in an effort to make policies and spark movements that create a healthier living environment for everyone.[footnoteRef:22] In a workshop on public health to reframe policy advocacy, participants learned, “public health is really about economics, politics, communities, science, and social change, and how all these things collide.”[footnoteRef:23] It is way bigger than individual decisions. The overlapping and intersecting of many different elements cause an epidemic like obesity. [21: Dorfman, L & Wallack, L.] [22: ibid. ] [23: Badovinac, Kimberly. ]

One specific way to make a community healthier is to make better foods and healthier options available for residents. Nonprofits have had great success with small-scale changes to improve the quality of food within a community. Food trucks are a great example. Some cities in New York have brought in “Veggie Mobiles,” stocked with fresh produce at affordable prices, into housing projects and poor neighborhoods.[footnoteRef:24] In other cities, individuals or nonprofits have created community gardens. Ron Finley is on a mission to bring an urban community garden revolution to South Central LA. He works with a group LA Green Grounds, and has given a popular TED talk about the importance of “Gangsta Gardens” in low-income areas. He focuses on empowering communities, especially youth, through access to healthy foods.[footnoteRef:25] In both cases, bringing fresh food into communities has united residents and started the discussion about food and healthy eating. [24: Popkin, Barry. ] [25: “Ron Finley, ‘Gangster Gardener’: Drive-Thrus are Killing More People Than Drive-Bys.” Huffington Post Black Voices. Posted 03/20/2013. Accessed on March 30, 2013 from http://www.huffingtonpost.com/2013/03/19/ron-finley-gangster-gardener-video_n_2910438.html]

Nonprofits should also emphasize the necessity of corporate responsibility to the community to provide healthy choices.[footnoteRef:26] Community groups can approach local restaurants about their food options or local grocery stores about their food displays. The town of Tiburon, California was successfully able to petition to become a “trans fat-free city.”[footnoteRef:27] Eighteen restaurant owners came together and decided to stop using trans fats in their cooking. Other cities have picked up on this model to ban trans fats. A North Carolina nonprofit, spearheaded by Meg Mallow, created the “Winner’s Circle Healthy Dining Program.” The program works with local restaurants to create healthy menu options and encourages hospitals to serve healthier foods in their cafeterias.[footnoteRef:28] By making better food available, the good choices become easier to make. [26: Kreuter, M. “Commentary on Public Health Advocacy to Change Corporate Practices.” Health Education and Behavior. (2005). 355-362. ] [27: Freudenberg, N. “Public Health Advocacy to Change Corporate Practices: Implications for Health Education Practices and Research.” Health Education and Behavior. (2005). 298-319. ] [28: Popkin, Barry. ]

In addition to bringing in fresh and healthy foods, communities can also make physical activity easier for residents. Citizens can work with city planners to ensure their community is walk able and connected through sidewalks.[footnoteRef:29] Some cities have seen success establishing safe walking paths for kids to walk to school to encourage more activity among youth.[footnoteRef:30] In Greensboro, North Carolina, the city and a community group called Action Greensboro joined together to create the Downtown Greenway: a four mile walking and biking trail that connects the center of the city.[footnoteRef:31] It is also important for communities to fund local parks and develop youth sports to encourage and provide platforms for an active lifestyle.[footnoteRef:32] All of these initiatives make it easier for city residents to be active and build a stronger sense of community. [29: Ibid. ] [30: Ibid. ] [31: Interview with Dabney Sanders, Project Manager of Downtown Greenway. January 3, 2013. ] [32: Popkin, Barry. ]

When introducing new healthy programs or ideas into a city, it is important to understand the culture of the community.[footnoteRef:33] There are a variety of programs and ideas that have proven successful, but it is crucial to do background research and understand what project would accurately fit the community’s needs. Overall, the programs need to work for the people who live there. Another key to success in community movements is the involvement of a variety of stakeholders.[footnoteRef:34] Whatever the project, it is important to get the right people invested. Depending on the community, this could include scientists, public health professionals, government officials, community organizers, etc. [33: Kreuter, M. ] [34: Freudenberg, N. ]

Local legislation is an important tool in changing communities. In addition to adding healthier foods and increasing access to physical activity, nonprofits can fight obesity by restricting unhealthy foods in certain places by changing local legislation. The anti-tobacco campaign was very successful in launching local movements to ban smoking in restaurants. Copying that model, nonprofit organizations and small groups can start local initiatives to ban soft drinks from schools. Large soda companies, like Coca Cola and Pepsi, have established “pouring rights” in public schools across the country. They pay school districts (in some cases millions of dollars) in order to have exclusive rights to serve their brand of soda in the vending machines and cafeterias.[footnoteRef:35] Parents in Seattle started a local campaign in 1996 to remove Coke’s pouring rights in their school system. The movement was called “Get Coke Out of Seattle Schools” and it mobilized parents to stand up for the health of their children.[footnoteRef:36] The movement was successful because of the range of strategies it used to attack. “Get Coke Out” used public policy advocacy, media advocacy, community organizing, litigation, letter writing, coalition building, public protest, and public mobilization in their comprehensive attack on Coke’s pouring rights. In the end, they were successful, and in 2004 were able to get Coca Cola out of schools.[footnoteRef:37] [35: Philpott, Tom. “80 Percent of Public Schools Have Contracts With Coke or Pepsi.” MotherJones. Posted on 8/15/2012. Accessed on March 30, 2013 from http://www.motherjones.com/tom-philpott/2012/08/schools-limit-campus-junk-food-have-lower-obesity-rates] [36: Freudenberg, N. ] [37: Freudenberg, N. ]

Another approach to change local legislation is to petition for healthier lunches served in public schools. “Angry Moms,” a group of two women, videotaped school lunch menus and provided alternative healthier options at the same price.[footnoteRef:38] By simply providing the information, they were able to make a change. Nonprofit groups can get certain foods and products banned by their local government by proving it is in the government’s best interest to not have the product on the market.[footnoteRef:39] If they can successfully frame it to be in the government’s best interest, then change will happen. [38: Popkin, Barry. ] [39: Kline, Graff, Zellers, and Ashe. “Beyond Advertising Controls: Influencing Junk Food Marketing and Consumption with Policy Innovations Developed in Tobacco Control.” Loyola of Los Angeles Law Review. Vol 39. (2006). 603-646. ]

Both of these programs were successful in fighting for local legislation partly because they specifically targeted issues involving children.[footnoteRef:40] American ideals of individualism and freedom of choice is slightly altered when it comes to kids. Society accepts children as more vulnerable and has a greater tolerance for legal intervention to protect them.[footnoteRef:41] When attacking food companies, it is important to realize they are the most vulnerable in areas where they are directly targeting and profiting off of children. By using policies and practices surrounding children it is easier to frame the fight against obesity in the context of social justice.[footnoteRef:42] In the eyes of the American people, it is more acceptable to have a group speak up to protect and defend a child because they are unaware of how the choices they make are going to affect them over their lifetime. [40: Mello, Studdert, and Brennan. “Obesity: The New Frontier of Public Health Law.” New England Journal of Medicine, Health Report. (2006) 2601-2610. ] [41: Ibid. ] [42: Freudenberg, N. ]

Childhood obesity is a growing problem with an increasing amount of research connecting it to the food industry. Younger populations are impacted more by obesity, and obesity rates are climbing at much higher rates in children.[footnoteRef:43] Since 1980, the rates of overweight children have more than doubled, and Type 2 diabetes is rapidly rising in America’s youth.[footnoteRef:44] In order to make a community healthier, legislation needs to restrict the way the food industry appeals to children. Local governments have the power to require fast food outlets to follow certain rules.[footnoteRef:45] A group could fight to ban free toys and promotional giveaways with unhealthy meal options, like McDonalds’ Happy Meal.[footnoteRef:46] NPOs can also campaign for local news stations to limit the advertisements for junk foods and fast food restaurants, especially on kids’ networks and family programs. [43: Brownell, K & Warner, K. ] [44: Parloff, Roger. “Is Fat the next tobacco? For Big Food, the supersizing of America is becoming a big headache.” CNNMoney.com. (2003). Retrieved on March 30, 2013 from http://money.cnn.com/magazines/fortune/fortune_archive/2003/02/03/336442/ ] [45: Kline, Graff, Zellers, and Ashe.] [46: Parloff, Roger.]

A huge component to make all the movements and campaigns successful is education. The food industry is very powerful with advertising and PR and currently dominates the conversation about what we eat. Increasing public opinion and awareness about healthy lifestyle choices and the danger of obesity will damage the public image of the food industry.[footnoteRef:47] (For example, the documentary Supersize Me changed audience perception of McDonald’s and consequently the SuperSize option was phased off the menu.)[footnoteRef:48] Health care is a very important part of this discussion. It is important to teach doctors and nurses how to talk about the issue with their patients. Health professionals and their patients should be able to have an open dialogue about diet and physical activity. Pediatric Nurse Practitioners are a perfect resource to provide guidance to families and young children about healthy lifestyle choices.[footnoteRef:49] Since childhood obesity is an increasingly growing problem, educating parents is an important part of the cycle. Most parents do not realize when their child is overweight or obese.[footnoteRef:50] Once the issue is reframed and the blame is taken away from the individual, the conversation should become easier. Once obesity is tackled from the community level, the shame and embarrassment will be lessened, and the problem will become more focused on education and the environment. Education can also come from the schools. NPOs should encourage local schools to create curriculum to help students make healthy choices. The government can use schools as a platform to educate the population and provide counter advertising to the food industry’s message. Active PE classes can also show the value and fun in physical exercise. [47: Alderman, J & Daynard, R. ] [48: “McDonald’s phasing out Supersize fries, drinks.” Food INC on NBCNews.com. Posted on 3/3/2004. Accessed on March 30, 2013 from http://www.nbcnews.com/id/4433307/#.UVnXbs12mPU] [49: Duderstadt, Karen. “Advocacy for Reducing Childhood Obesity.” Legislation and Health Policy. (2004). 103-105. ] [50: Popkin, Barry. ]

Education is such an important component to all of these changes because it will create public concern, which leads to change.[footnoteRef:51] Once people are educated about they food industry and the options for healthy living, they become empowered to take responsibility and make change happen. In his commentary on public health advocacy and corporate practices, Kreuter explains, “When citizens realize how the public’s health and well-being is compromised by the self-serving actions of some corporations and when they fully understand how they bear the negative external social costs for those actions, they are much more likely to become a source of power.”[footnoteRef:52] Once people (the consumers and the voters) understand how their health is being traded for money, the food industry and the government will respond. [51: Ibid. ] [52: Kreuter, M. ]

It is the duty of government to regulate private behavior to promote public health.[footnoteRef:53] There is an obesity epidemic in our country. Millions of Americans are obese, and the obesity rates are rising fastest in our youngest populations. The problem is getting worse. The public has a responsibility to hold the government to their duty and protect public health. It is the public’s duty to speak up and express concern. The food industry is big and complex. It has a lot of strength and nearly unlimited resources, but so did Big Tobacco. The food industry will respond to the power of its customers. It is time for nonprofit organizations and communities across America to spark a movement to incite government and corporate action to address this pressing public health concern. [53: Mello, Studdert, and Brennan.

]

Works Cited:

1. “McDonald’s phasing out Supersize fries, drinks.” Food INC on NBCNews.com. Posted on 3/3/2004. Accessed on March 30, 2013 from http://www.nbcnews.com/id/4433307/#.UVnXbs12mPU

2. “Ron Finley, ‘Gangster Gardener’: Drive-Thrus are Killing More People Than Drive-Bys.” Huffington Post Black Voices. Posted 03/20/2013. Accessed on March 30, 2013 from http://www.huffingtonpost.com/2013/03/19/ron-finley-gangster-gardener-video_n_2910438.html

3. Alderman, J & Daynard, R. “Applying Lessons from Tobacco Litigation to Obesity Lawsuits.” American Journal of Preventive Medicine. (2006). 82-88.

4. Badovinac, Kimberly. “Policy Advocacy for Public Health Practitioners: Workshops on Policy Change.” Public Health Nursing. Vol 14 (2006). 280-295.

5. Brownell, K & Warner, K. “The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar is Big Food?” The Milbank Quarterly. Vol. 87 (2009). 259-294.

6. Dorfman, L & Wallack, L. “Moving Nutrition Upstream: The Case for Reframing Obesity.” Journal of Nutrition Education and Behavior. Vol 39. (2007). S45-S50.

7. Duderstadt, Karen. “Advocacy for Reducing Childhood Obesity.” Legislation and Health Policy. (2004). 103-105.

8. Freudenberg, Bradley, and Serrano. “Public Health Campaigns to Change Industry Practices that Damage Health: An Analysis of 12 Case Studies.” Health Education and Behavior. (2007). 230-249.

9. Freudenberg, N. “Public Health Advocacy to Change Corporate Practices: Implications for Health Education Practices and Research.” Health Education and Behavior. (2005). 298-319.

10. Interview with Dabney Sanders, Project Manager of Downtown Greenway. January 3, 2013.

11. Kline, Graff, Zellers, and Ashe. “Beyond Advertising Controls: Influencing Junk Food Marketing and Consumption with Policy Innovations Developed in Tobacco Control.” Loyola of Los Angeles Law Review. Vol 39. (2006). 603-646.

12. Kreuter, M. “Commentary on Public Health Advocacy to Change Corporate Practices.” Health Education and Behavior. (2005). 355-362.

13. Liebert, Mary Ann. “Obesity, Bariatric Nursing, and the Policy Process: The Connecting Points for Patient Advocacy.” Bariatric Nursing and Surgical Patient Care. Volume 4 (2009). 133-138.

14. Mello, Studdert, and Brennan. “Obesity: The New Frontier of Public Health Law.” New England Journal of Medicine, Health Report. (2006) 2601-2610.

15. Parloff, Roger. “Is Fat the next tobacco? For Big Food, the supersizing of America is becoming a big headache.” CNNMoney.com. (2003). Retrieved on March 30, 2013 from http://money.cnn.com/magazines/fortune/fortune_archive/2003/02/03/336442/

16. Philpott, Tom. “80 Percent of Public Schools Have Contracts With Coke or Pepsi.” MotherJones. Posted on 8/15/2012. Accessed on March 30, 2013 from http://www.motherjones.com/tom-philpott/2012/08/schools-limit-campus-junk-food-have-lower-obesity-rates

17. Popkin, Barry. “What Can We Do?”. The World is Fat.

18. Scott-Thomas, Caroline. “Obesity Overtakes Smoking as America’s Biggest Health Problem.” Food Navigator. Posted on 01/08/2010. Accessed on March 30, 2013 from http://www.foodnavigator-usa.com/Science/Obesity-overtakes-smoking-as-America-s-biggest-health-problem