Some users of the framework may be tempted to skip this step, thinking they already know why they need to take action on obesity. However, the committee strongly recommends this as a first step in intervention planning. Table 5-1 lists some examples of areas of concern addressed by “Why” questions and the corresponding evidence that might be gathered.

“Why” questions help decision makers assess a public health problem in their particular region and locale. For example, a study characterizing determinants of obesity in an urban area identified individual and neighborhood contexts that were important considerations in formulating obesity-related policies (Black and Macinko, 2010).

To answer “Why” questions about obesity and other public health problems, decision makers require specific, often quantifiable evidence with which to evaluate the scope and severity of the problem, both in an absolute sense and relative to other issues requiring action. The evidence secured may help define characteristics of high-risk populations; it may also help develop benchmarks for setting goals and tracking progress. In cases where decisions have already been made, this kind of information is frequently needed to undergird and justify those decisions.

Studies that generate this type of evidence may include sample surveys or compilations of administrative data for monitoring and surveillance, population trend analysis, or studies of health impact, as well as studies that produce cost estimates and projections of future burden. For example, evidence that provides insight into obesity-related health care costs and lost productivity is helpful for comparing the eco-

TABLE 5-1 Areas of Concerns and Examples of Evidence Needed: “Why” Questions

Area of Concern

Examples of Evidence Needed

Public health situation


• Health burden

Recorded levels of illness, disease, or death related to obesity

• Frequency/incidence of disease or risk factor

Number of people or rate of new cases affected by obesity or obesity-related diseases

• Social or environmental determinants of disease or risk factor

Number of catchment areas that do not have a supermarket or food stores offering healthful foods or suitable options for physical activity and exercise

• Trends

Rates of increase of obesity, obesity-related diseases, or adverse social determinants

• Health disparities

Relative or absolute differences in risk among demographic groups or subgroups

Monetary and social costs


• Health care costs

Estimates of public dollars currently spent on providing health care for obesity or related conditions

• Other societal costs

Estimates of dollars spent by or lost from the public or private sector due to consequences of obesity (e.g., employee absenteeism)

Estimates of other adverse outcomes associated with obesity with implications for social productivity

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