Obesity is a serious and costly epidemic in the United States. Recent reports show that 40% of adults and 19% of children in the United States are obese, and both adult and childhood obesity rates have been on the rise. High rates of obesity forecast higher rates of chronic disease, lower educational attainment, poorer psychological health, higher health costs, poorer worker health, and lower productivity, highlighting the urgent need for prevention efforts. Georgia has the 20th highest adult and the 18th highest child obesity rate in the nation.
Obesity is an even greater problem in Georgia, especially in low-income, rural, and minority counties. Troubling inequities exist and require an intensified effort. One possible contributing factor is the high rate of persistent poverty. Adults living in rural areas are less physically active and less likely to have access to healthy food retailers. Several social determinants of health that are risk factors for obesity, such as food insecurity, are more prevalent in rural areas.
While a number of promising individual obesity prevention interventions are being implemented, there is a growing need to identify a set of actions that can accelerate meaningful change on a community level. Solutions to the obesity epidemic must come from multiple sources, involve multiple levels and multiple sectors in the communities, and build on the synergy of multiple strategies. National policy groups have recommended environmental and system-level strategies to improve eating and physical activity.
This grant proposal is in response to CDC-RFA-DP18-1809, High Obesity Program, a funding announcement to support interventions that land grant universities can implement through Extension at the community, county, and regional levels to impact larger system changes. The University of Georgia (UGA) College of Public Health and UGA Extension will lead this project. Additional partners will include local multi-sector community organizations; city and county government; education; faith-based organizations; and the state, county, and district public health departments.
Our work will be focused in the rural Georgia counties of Calhoun, Clay, Dooly, Stewart, and Taliaferro counties (identified by the CDC as having adult obesity rates over 40%). Our specific aims are to:
Aim 1: Using a community participatory model, engage county partners, across multiple sectors, to guide and support obesity prevention efforts tailored to their county
Aim 2: Collaborating with partners, implement strategies to improve the food system to increase access to healthy foods
Aim 3: Collaborating with partners, implement strategies to increase access to places to be physically active
Aim 4: Evaluate the implementation of the nutrition and physical activity strategies
Aim 5: Evaluate the impact of the nutrition and physical activity strategies
Aim 6: Estimate the costs of engaging stakeholders, establishing coalitions, and implementing environmental change strategies
We will (1) implement and evaluate evidence-based strategies to increase access to healthier foods and places for physical activity; (2) provide information on the factors and costs associated with engaging stakeholders and implementing the strategies; (3) identify the influences critical to ensuring the long-term sustainability of such efforts; and (4) suggest how the strategies can be scaled up to other counties in Georgia and the nation. Over time, in the counties, we expect to see sustainable changes that support healthy eating and physical activity; lower rates of adult obesity, childhood obesity and chronic disease; improved well-being for all who live in the counties; and a reduction in health disparities.