West Virginians come in all shapes and sizes. But health experts say we're becoming larger—and statistics place us on the heavy side of the scale compared to other parts of the country. It's not just an image problem. Being overweight or obese is associated with a long list of health risks, including heart disease, diabetes, and stroke.

It's a problem that affects individuals, but families, physicians, communities, and policy makers all have a role to play in fighting obesity and weight gain. The WVU Center for Healthy Communities (CHC) is conducting research aimed at helping West Virginians and people everywhere make healthier choices when it comes to weight management.

Obesity is reaching epidemic levels in many parts of the United States, and the Centers for Disease Control and Prevention (CDC)—with the encouragement of West Virginia's own Senator Robert C. Byrd—has funded a number of programs at WVU that are working to identify new strategies to combat obesity on a community level.

"The Center for Healthy Communities is part of Senator Byrd's vision to support obesity prevention and develop a comprehensive approach for obesity prevention and weight management research," said Geri Dino, PhD, director of WVU's Prevention Research Center and the CHC.

Research being funded through the CDC includes conducting community-based interventions with preschool children and their families, studying doctor's office interactions to reduce obesity in rural West Virginia, working with high school students to increase physical activity opportunities in communities, and documenting the geographic distribution of obesity.

Managing weight at the family level is the approach taken by Carole Harris, PhD, and Drew Bradlyn, PhD, professors of behavioral medicine and psychiatry. Their research involves children in the Head Start Program in four West Virginia counties.

"This program is trying to prevent the progression of obesity in families with young children," said Harris. "By targeting young children and their parents, we are hoping to slow or prevent weight gain and obesity in the whole family."

Planning for the program included focus groups with parents and community leaders about health beliefs, nutrition patterns, and exercise.

"The preschool classrooms were randomly divided into two groups in each county," Bradlyn said. "One group attended five monthly meetings of the Family Fitness Program, and the other attended meetings of the Child Safety Program."

Those in the Child Safety Program acted as the control group for the Family Fitness Program, and learned about things like preventing illness, dental hygiene, and home and play safety. Participants also received bike helmets, first aid kits, dental kits, and smoke detectors. On average, adults enrolled in the program gained more than three quarters of a pound over the five months of the program.

Each session of the Family Fitness Program consisted of a nutritional component and a physical activity component. "We did a cooking demonstration and an exercise demonstration each month, and we gave away exercise equipment including an exercise step, elastic bands, pedometers, and an exercise video that we made especially for this program," Harris added.

The results from the Family Fitness participants suggest that family-level intervention can help to prevent weight gain. "Adults in the Family Fitness Program lost an average of 2.8 pounds," Harris said. "But the results also showed changes in their habits. Family Fitness participants used lower-fat products, avoided frying foods, and increased their leisure-time physical activity. The Child Safety participants reported no changes in their diets and no change in their physical activity."

"We found that the families were very eager for this information," Harris said. "They knew they should be cooking differently, but they were bound by tradition. Having cooking demonstrations and providing healthy recipes hopefully gave them a basis for making good decisions."

Another CHC project, Office System Intervention or Prevent Obesity, led by Alan Ducatman, MD, and Elizabeth Prendergast, MS, CHES, is assisting health-care professionals help overweight people. Providing weight counseling to overweight or obese patients in a doctor's office or clinic is more difficult than many people would imagine, says Prendergast. The primary aim of this study is to investigate the possibility of integrating an existing computer program into rural medical clinics to remind health-care providers to talk to their overweight patients about increasing their physical activity and improving their diets. A secondary aim is to provide computerized linkage to community resources for dietary counseling and/or exercise.

"Currently, there is no insurance reimbursement for weight management counseling," Prendergast explained. "We hope that will change soon. Medical professionals, especially doctors, have many demands on their time. This kind of counseling is one of the first things to be discarded when a medical professional becomes busy."

Added to these deterrents is the fact that talking about weight loss can be uncomfortable, even for doctors and nurses. "Telling an overweight person that he or she needs to lose weight is uncomfortable for everyone involved. Years ago, doctors were uncomfortable discussing smoking with their patients, but that has changed. Hopefully, frank discussions about weight loss, diets, and exercise will soon become a routine part of the visit."

The computer program—Cardiovascular and Diabetes Electronic Management System—is being introduced to rural West Virginia health clinics by the Office of Health Services Research (OHSR) in the Department of Community Medicine. By collaborating with the OSHR, Ducatman and Prendergast have tailored the program to monitor body mass index, physical activity, and nutrition. "This program allows health professionals to identify which of their patients are in need of weight management counseling," Prendergast said. "These patients may need to lose weight, increase their physical activity, or change their diets."

A survey of clinicians around the state indicated that there is interest in this approach to obesity prevention. A pilot study was started in summer 2004 to determine whether the software is user-friendly for the staff, helps to increase reimbursement, and if it has an effect on weight management.

Increasing opportunities for physical activity in communities is one of the goals of the Health Sciences and Technology Academy (HSTA) Education and Outreach project, led by James Rye, PhD, an associate professor of educational theory and practice. The project will provide professional development and education about weight management for teachers and students of high schools participating in HSTA.

The HSTA Club promoted the completion of an outdoor trail and encourages walking both indoors and outdoors.

The focus of the CHC is community-based prevention, says Geri Dino. "We want to develop research with communities, not to them," she said. "The research we conduct can influence science and policy. We are working to improve public health by increasing the scientific basis of public health policy and practice."

West Virginia is one of the most obese states in the country. According to the West Virginia Department of Health and Human Resources, West Virginia ranked third in obesity prevalence in 2000; statistics from the CDC report that 23 percent of the West Virginia population is obese, compared to 17 percent nationally.

Why?

Obesity in Appalachia: An Atlas of Geographic Disparities is documenting the geographic distribution of obesity in West Virginia and Appalachia, with an eye to linking the distribution of obesity with the characteristics of individual places and the distribution of behavioral risk factors and health outcomes for which obesity is a known risk factor.

"By examining where obesity occurs, we hope to see if it is related to certain behaviors or social environment conditions," said Joel Halverson, director of the Office of Social and Environmental Health Research and a member of the community medicine faculty.

The atlas examines influences on obesity and overweight status, ranging from gender and ethnicity to poverty and educational level to the food that is available to local residents.

"This research is a first step in thinking about why there are geographic differences in obesity frequency. This will enable us to start asking questions, which in turn should enable us to think about solutions.

"Despite the national focus on diet and physical activity, it appears that reasons for variations in obesity prevalence are very localized," Halverson added. "The atlas can suggest allocations of public health resources for reducing obesity, and it can help those who make health policy on local, state, and national levels."

Obesity prevention is a complex issue. There are no universal solutions to obesity that will work for everyone, everywhere. A comprehensive approach to fighting this epidemic is vital. In order to win, we must develop strong partnerships across government, academia, health care, and communities.

"Our projects involve research work with partners," Dino said. "They involve communities, the West Virginia Bureau of Public Health, HSTA, and educational institutions. These projects involve the communities and constituents they are designed to serve. This research is practical. It is grounded in science, but it works in communities."

 Fall 2004 Contents

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