Talking With Jeffrey Levi of the Trust for America’s Health

This week at The Public's Health we'll be looking back at the election's impact on public health. Today's post by Janet Golden, a professor of history at Rutgers University who specializes in the histories of medicine, childhood and women, as well as American social history, considers the impact of the Affordable Care Act on obesity policies and programs. Golden is a member of an expert panel intended to expand the breadth of The Public's Health.

Since October, 2004 Trust for America's Health has been issuing its report "F as in Fat: How Obesity Threatens America's Future," funded by the Robert Wood Johnson Foundation.  The report gets good media coverage, the media pays attention to the health and economic consequences of obesity, and the topic engages political leaders and drives policy action.

And yet, the future looks pretty grim.

As the most recent "F as in Fat," released in September 2012 explained "The number of obese adults, along with related disease rates and health care costs, are on course to increase dramatically in every state in the country over the next 20 years."

Obesity is linked to type-2 diabetes, coronary heart disease and stroke, hypertension, arthritis and some cancers. So then why are we failing to curb rising obesity rates?

I put these and other public health questions to Jeffrey Levi, Ph.D., Executive Director of the Trust for America's Health.

J.G.: Does obesity pose a new kind of public health challenge?

Dr. Levi: While the obesity epidemic is not new (indeed it has been growing for decades), it is different from other epidemics public health officials have faced because there isn't a "magic bullet" to prevent or reverse obesity.  It takes a series of steps—from improving access to healthy foods in communities and schools to making neighborhoods more walkable and promoting physical activity (not just physical education) in schools—to change the culture around food and activity. And, community needs vary. Some need to focus more on creating physical activities while others might need greater access to healthy food choices. The end goal is clear, but the problem is as complex as the nation is large.

J.G.: Are you hopeful we can succeed in lowering obesity rates in the coming years?

Dr. Levi: Yes.  We know what we need to do to reverse this epidemic.  We just need to invest in approaches that work.  We already have evidence of positive trends—including in Philadelphia where obesity rates among pubic school students declined over a 4-year period.  Moreover, Philadelphia achieved these results while reducing racial and ethnic disparities and it is not alone. There are pockets of success in California, New York City and Mississippi.  However, communities have been battling obesity for a long time and far more will be needed to make a difference on a national scale. That said, through local initiatives and through new federal initiatives such as the Community Transformation grants, we are beginning to put into place the systems and policies—from healthier school nutrition requirements to increased physical activity—that can be replicated everywhere.

J.G.: Finally, how will full implementation of the Affordable Care Act (ACA) help guide obesity policies and programs in the coming years?

Dr. Levi: The ACA is about more than health insurance coverage.  While that is important—having access to counseling about obesity in a clinical setting and treatment for obesity-related conditions such as diabetes are critical to improving the nation's health—when it comes to obesity, what happens outside the doctor's office is important. The ACA creates new programs such as the Community Transformation Grants, which give local communities resources to create coalitions that can affect policy and system changes to make food and physical activity choices easier and healthier. The ACA also creates new funding streams through the Prevention and Public Health Fund to support these non-clinical activities.  By funding, implementing and maintaining these programs the nation is investing directly into communities and providing the resources needed to help neighborhoods get and remain healthy.  In building stronger, fitter, and more productive communities we can curb medical and health care problems and costs.

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