The WSJ Health Blog is running a post on Mississippi's State Health Officer's work to reduce the state's obesity rate, the worst int he country. The blog adopts a kind of cynical, tongue-in-cheek,"check out this Southern simpleton" kind of approach. Too bad Elva Ramirez didn't Google the subject of obesity interventions.
Mississippi has several interventions under way, but the data shows neither clinical nor public health interventions work very well.
Obesity is subject to health disparities by race and by economic status and these effects appear to be independent. The worst off are First Nations and Latinos, whose obesity-related mortality is higher. It also turns out inner city African-American neighborhoods have more fast-food restaurants than wealthy "white" areas and are exposed more heavily to high-fat food advertising. One of the most interesting associations (not a causal relationship, for those of you who are still awake) is the effect of infrastructure. The accessibility of sidewalks and safe areas to walk, stores within walking distance, public transportation and exercise facilities or parks can all impact obesity rates in a any given environment. This is frequently referred to as the built environment.
So the NIH is supporting a program to investigate how the built environment influences obesity. Obesity experts have approached our facility with a proposal to participate in a couple of grants and they tell me that the two areas which will likely yield the best future outcomes are interventions that empower patients and interventions that alter the built environment.
But that's just an opinion.