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Breakout Session VII—Influences
of Family, Schools, and Worksites on Obesity
Discussion Group C: Family Influences on Obesity
Moderators: Tom Baranowski,
Shiriki Kumanyika
Recorders: Frank Buck,
Carole Garner
Purpose: A family has
significant control over the values and behaviors of its members.
This discussion focused on families and the ways they can contribute
to or prevent obesity in family units.
Process: The group opened
with brief presentations from the moderators and selected five areas
as actionable priorities for the next five years. A brief discussion
of the specific recommendations contained within each priority is
included in the discussion that follows each recommendation.
Introduction
The introduction by Tom Baranowski discussed the importance of implementing
interventions in the way that they are designed so as to determine
mediating variables. Shiriki Kumanyika conceptualized the family
factors that contribute to or protect against the development of
obesity. She added that "families" might be thought of or defined
in numerous ways and recommended that we should define them broadly.
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Actionable Priority: Media
Messages to Families
Develop a media campaign with messages that promote healthy family
lifestyles and disseminate this message through a variety of venues.
It would be helpful to examine and use the lessons learned from
other issues (e.g., the "tobacco world").
Ideas and Considerations
- The discussion group believes that a lot is known
about successful interventions and that action needs to occur
now as a followup to the National Nutrition Summit.
- Messages that might be incorporated in a campaign
include the following: awareness that families are influential
and can have a positive impact on eating and activity; promotion
of dietary guidelines; risk identification (e.g.,what does body
mass index [BMI] mean and how is it used?); linkage of obesity
to disease; and being healthy—not focusing on fad diets or
body image. Media are vital to create awareness; however, media
alone may not change behavior. Other intervention activities are
needed to complement their efforts.
- Messages should also address how to help people
restructure their lives. Once funding has been attained, we need
to develop resources such as proven messages and commitment by
organizations, public figures, and media, etc., to speak on and
promote these messages.
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Actionable Priority: Research,
Evaluation, and Theory
Develop research programs to determine the causes of eating and
activity behavior of family members that relate to the family itself,
interventions that alter these behaviors, and culturally sensitive
interventions effective in reducing the prevalence of obesity by
targeting critical variables.
Ideas and Considerations
- Some issues may arise in funding joint research
on nutrition and physical activity. After research is completed,
it may be difficult to find journals that will publish such combined
research. Basic and applied researchers often disagree about which
area has more meaning and impact. Both types of research are needed,
however, to help move efforts forward.
- The strategy will require connecting families to
schools, churches, social service organizations, clubs, health
systems organizations, and physicians to deliver the interventions.
It is important to include populations that vary culturally, economically,
and educationally in the intervention efforts. Evaluation of the
different types of interventions is also crucial.
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Actionable Priority: Family
Empowerment—Skills Building, Personal Responsibility
Families are responsible for the health and behaviors of their members.
Parents need help to assume more of this responsibility. In some
cases, parents need to be taught skills in behavioral management,
meal planning, and parenting. Many parents believe that behaviors
are inherited and thus not their responsibility, and they may need
to learn that genetics does not determine behavior. Theoretical
models may help parents assume their responsibilities.
Ideas and Considerations
- Coach families to identify goals for nutrition
and physical activity.
- Equip families with practical means to meet their
goals for enhancing nutritional health and physical activity.
- Identify healthy conveniences that address the
time constraints faced by many families.
- Share creative ideas for developing an atmosphere
of wellness (e.g., develop a parent guide and encourage parents
to model positive behaviors for their children).
- Is time really the issue or is it just an excuse?
Is there some other factor?
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Actionable Priority: Incentives
and Facilitation—Family Supports (Millennium Family Center)
During the brainstorming session, suggestions were made to develop
and implement family and community centers that are user friendly,
fun, and safe. In some places, they may be referred to as "Millennium
Family Centers."
Ideas and Considerations
- Establish Millennium Family Centers that will build
in opportunities and incentives for healthy eating and physical
activity as a part of family-centered programming within neighborhoods.
- The Millennium Family Center would involve schools
as a possible focal point for many community development activities
and for family and community participation. These centers would
be used to promote healthy eating and physical activity and to
involve families and help them deal with some of the issues that
make it difficult to maintain a healthy lifestyle.
- A lead funding agency, foundation, or corporation
must be identified. Establishment of an advisory board will be
necessary to further develop the concept of the Millennium Family
Centers and to develop potential guidelines for a Request for
Application (RFA) for pilot sites across the United States. RFAs
should include theoretical constructs, implementation, and evaluation
components. The funding agency should fund 3-year projects. The
pilot sites should assemble and make recommendations for Millennium
Family Centers in other neighborhoods.
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Actionable Priority: Increase
the Effectiveness and Relevance of Nutrition Programs
Identify existing nutrition education programs that work with families
and ways to make them more effective in implementing obesity intervention/reduction/management
within the targeted audiences.
Ideas and Considerations
- Resources must be provided for staff training appropriate
to the current population, including training for peer counselors,
developing linkages to other resources, and locating financial
support.
- All stakeholders must be brought to the table (e.g.,
families, organizations, etc.). The level of client involvement
that is implied may not be acceptable to some programmers.
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