To conclude the workshop, Marion Standish and Loel Solomon returned to the podium to thank the panelists, moderators, and attendees for their participation in the discussions. They also commented on themes and ideas related to community practice, policy, research, and evidence that had resonated with them throughout the day.
DIVERSITY OF EFFORTS
The diversity of obesity prevention efforts is, said Standish, a strength in that it sparks innovation and empowers people to work toward their own better health. However, this diversity is also a drawback in that it complicates efforts to measure impact and build the strongest possible evidence base. Standish urged the field to grapple with this dichotomy to achieve the ultimate outcomes of improved health and a reduction in obesity rates.
A MOVEMENT VERSUS DISCRETE POLICIES AND PROGRAMS
Standish suggested that health policy must occur “in all places.” The development of comprehensive frameworks for community efforts to create healthy environments is under way, but the need persists to educate, convince, and inform actors and decision makers in other sectors that health and health policy are their allies in changing the shape of community environments for the better. Local government is a good resource in which to find allies. Echoing many speakers throughout the day, Standish expressed
hope that as local initiatives to combat obesity continue to emerge, the result will be the building of a movement rather than a series of discrete policies or programs.
COMMUNICATION IS KEY
Communication is key to this work, as speakers illustrated in several ways. Communication is needed to develop a common understanding of obesity prevention, given stakeholders’ many definitions of “prevention.” Another challenge that requires communication is articulation of the shift from individual interventions to environmental change in combating the obesity epidemic.
Solomon observed that a breakdown in communication results from differences in expectations and professional paradigms—even within the research community, for example, between public health researchers and health economists. Communication on such issues as how different sectors view evidence can help bridge these divides.
The importance of communication also relates to how evidence is communicated to policy makers. Workshop presenters demonstrated the impact of maps and other ways of packaging and summarizing research results in the policy process.
Standish voiced a fundamental question raised during the workshop: whether there is a body of data that can be consistently collected across communities to tell the story to policy makers with the necessary impact. More discussion is needed to reach consensus on this question. Standish also urged all those involved in obesity prevention to share data more effectively. Wide dissemination of innovations in data, such as the Supermarket Need Index in New York City, avoids duplication of efforts.
Solomon acknowledged the divergence of opinion among workshop participants on the use of body mass index (BMI) data. He questioned whether assembling the entire chain of evidence—from environmental interventions, to changes in food and physical activity behaviors, to changes in BMI—is necessary for every intervention. He suggested looking at the entire body of work on obesity prevention and not expending time, energy, and community capital on developing this evidence for each intervention. Moreover, as reflected in comments made during the workshop, communities do not want to serve as the subject of research studies that lead to no visible improvement.
Community knowledge is an essential building block that helps form and set policy priorities for communities and different contexts, from soccer fields in Santa Ana to green carts in New York City. Ongoing neighborhood and resident engagement builds leadership and power within communities, said Standish, which can create and sustain change. As Solomon closed the workshop, he reminded the group that community knowledge and experience in obesity prevention are important sources of evidence for creating change now and in the future.