Community-Based Obesity Prevention and Reduction Programs: Promoting Health Equity and Reducing Gender Disparities through Evidence-Based Policy Changes

Introduction. The US has the highest obesity rate of high-income countries, with a women’s prevalence rate for ages 20-74 of 35.5%. Obesity poses risks to women’s health and well-being such as Type 2 diabetes, hypertension, heart attack, stroke, and renal failure. Obesity increases with age up to about 60 and is common among less educated and lower-income individuals. In the US, 32.6% of non-Hispanic whites are obese; obesity is highest among non-Hispanic blacks (47.8%) then Hispanics (42.5%); and lowest among non-Hispanic Asians (10.8%).  These data speak to the need for culturally competent prevention to reduce disparities.  

The US/HHS Office on Women’s Health, Coalition for a Healthier Community (CHC) Initiative supports ten coalitions’ gender-based, public health systems approaches to improve women and girls’ health. This paper applies a socio-ecological model to data from the coalitions’ obesity interventions. We examined evidence-based policy changes that were initiated to address factors that adversely affect/facilitate women and girls’ health. This model posits that effective health promotion interventions address health at multiple spheres of influence--interpersonal, organizational, community, and policy. Factors within each sphere impact rates of health conditions. The ability to reduce or eliminate gender-based disparities through multi-level interventions depends on the extent to which interventions improve individual behaviors and social and physical environments in which women and girls live. 

Methods. Secondary analyses of grantees’ evidence-based intervention outcomes and policy changes were used. Data were reliably coded and analyzed to determine how grantees addressed health concerns at the interpersonal, organizational, community and public policy levels with populations of African immigrants, African Americans, Asians, Hawaiian/Pacific Islanders, Latinas/Latina immigrants, and Whites.

Results. Grantees formulated policies using prevention science to address community-level barriers to women and girls' health. Grantees focused their attention on school-based, faith-based, workplace, and citywide policies. Examples of gender-based policies in various spheres and sectors are included.

Conclusions. This study highlights communities’ use gender-based approaches to formulate evidence-based policies in every sphere of influence and multiple sectors.  Practitioners should benefit from ways to reduce gender disparities in urban and rural areas through science. Findings also inform community-university research on how to use science to promote health equity through community approaches to women and girls' health. Future research should explore how policies were implemented, enforced, sustained, and resulted in improved outcomes.