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Operating Outside the Comfort Zone


When researchers first began to see conclusive evidence in the 1940s that tobacco was unhealthy, it was the beginning of a massive, decades long effort to educate people about the dangers of smoking.

“It made very little difference on its own at all,” Scott Kahan, director of the STOP Obesity Alliance at George Washington University, said recently of the initial research. “That, though, combined with a number of structural and environmental and policy changes that began to be initiated in the 1970s and ‘80s, some changes in the taxation and the economics of smoking, changes in marketing acceptability, changes in access and so-forth, combined with that education, made quite a difference.”

Kahan described the arc of the tobacco movement during a TEDMED Great Challenges chat, held this week via a Google+ Hangout. He used the story of tobacco to provide an example of how a combination of education, policy and environmental change could reduce obesity. While Kahan admitted there are obvious differences between anti-smoking efforts and the obesity epidemic, tobacco does provide a real-world example of how a multi-pronged approach can successfully tackle a major public health issue.

The need to work on all fronts was the ongoing theme of Monday’s hangout, which featured a number of obesity experts weighing in on ways to solve the nation’s ongoing obesity epidemic. All seemed to agree that reversing obesity will require changing society so that healthy behaviors are the easy behaviors, but everybody admitted there is no magic bullet for making that happen.

One of the biggest developments in the obesity movement over the past decade is that most in the field no longer are thinking about the epidemic as something that needs to be solved by individuals, said Kahan, a Leader. It is widely agreed upon that while the individuals have a part to play, individuals live in a much broader society, where healthy choices can be limited and unhealthy choices are often easy.

Which leads to the tough question: How do we begin to make healthy choices easier?

Creativity — combined with a willingness for those in the field to work with people they might not be used to working with — could make a major impact, said John Auerback, the former Massachusetts Commissioner of Public Health who now serves as director of the Urban Health Research Institute at Northeastern University. That also means thinking about everything from laws and regulations to community involvement and broad coalitions, including working with education officials, transportation and city planners and zoners.

“We have to think about all the different ways that we can have a positive influence on the conditions of people’s lives so that it’s more likely as they’re getting counseled, and they’re getting information, it’s less work to try to address an issue as significant as obesity,” Auerback said.

Partnerships between the public and private sectors also can prove useful. When cities are seeking to bring healthier choices to underserved communities known as food deserts, for example, they typically work closely with major supermarket chains to open new grocery stores, noted Maya Rockeymoore, director of Leadership for Healthy Communities.

Working across governmental levels also can help achieve lasting, positive change, said Rockeymoore, who also is a Leader. For example, much of the work being done to improve the school environment happens locally, district-by-district or even school-by-school. But state and federal officials can provide financial support and incentives to help local officials execute strategies.

Health care providers also have a role to play, said Rebecca Puhl, director of research and weight stigma initiatives at the Yale Rudd Center for Food Policy & Obesity. Health professionals such as doctors have a powerful voice with their patients, but they aren’t very engaged when it comes to ongoing policy discussions such as nutritional standards in schools or taxation on sugary drinks, Puhl said.

“Many health threats of our time have really required collective action from the health care community,” Puhl said. “We can look at examples such as the control of infectious diseases, and we need to really look at the important role and voice that health care professionals have in these historic examples, and apply that same thinking here with obesity.”

The effort to engage doctors on these issues — and teach them to better communicate with their patients about obesity — could come in medical school. But doing so is easier said than done.

Kahan started the first class on obesity at George Washington University for medical students just two years ago. It is one of the few classes on the topic offered for med students in the entire country, he said. “In many cases, it’s hard to get a single lecture within four years of physician training in medical school, it’s hard to get a single lecture in the curriculum,” Kahan said.

Check out the entire TEDMED Great Challenges Google+ Hangout above.

Connect with Scott Kahan and Maya Rockeymoore.