Obesity research: Creating healthier families and neighborhoods

Summertime…and healthy living is easy. Summer brings peaches and green beans, swimming and softball. Our surroundings can promote nutritious eating and daily activity, say Group Health Research Institute (GHRI) Senior Investigator Paula Lozano, MD, MPH, and Assistant Investigator Dori Rosenberg, PhD, MPH. They are studying how social and physical environments contribute to lifelong healthy habits.

Our social network and our weight are connected, according to a New England Journal of Medicine report showing an association between obesity and social ties. A Journal of Health Economics study estimates obesity-related illnesses cost more than $190 billion annually. Interventions that introduce healthy behaviors in one family might have a ripple effect, spreading through networks and possibly reducing health care costs.

Dr. Lozano is working toward this kind of impact, one family at a time. She and Group Health pediatrician Sarah Rudnick, MD, recently completed the Group Health Family Wellness pilot program, funded in part by GHRI. In the pilot, behavioral specialists (“health coaches”) helped families of overweight or obese children create a long-term plan to achieve diet and exercise goals. Preliminary analysis showed that parents and children in the program lost weight. Dr. Lozano’s next project enlists the family’s social network to support healthy behaviors, inspired by conversations with parents in the Family Wellness program.

“What we heard was ‘My spouse, my parents, my sister, or my coworkers don’t get it,’” says Dr. Lozano. Healthy efforts by families were undermined by well-meaning grandmothers with cookies. A spouse might sabotage a parent’s attempts to serve healthier dinners by complaining about the new menus. However, parents with a social network whose members were willing to change, for example by scheduling active playtime for the kids, felt much more supported. To figure out how to enlist families’ social network in healthy changes, Dr. Lozano recruited two parents from the Family Wellness program to help design her current study, called CONNECTS, which is funded by the National Heart, Lung, and Blood Institute and runs through April 2013.

The research team identified challenges to maintaining the strategies of the Family Wellness program such as learning how to talk about the family’s goals with relatives, teachers, and coworkers. To help the 28 families recruited to the study meet these challenges, the researchers will create social network diagrams. These show interactions among family members, friends, neighbors, and others and whether or not the interactions are supportive. The researchers will help families develop an action plan to get people in their network on board with their healthy living goals and strengthen connections to supportive network members. Dr. Lozano, who is also assistant medical director, Group Health Department of Preventive Care, hopes that families transfer healthy skills and strategies to others in their network, expanding the project’s effects.

Meanwhile, GHRI's Dr. Rosenberg is focusing on our physical networks—our neighborhoods—particularly those of the growing population of activity-challenged individuals: older adults and people with mobility impairments or chronic conditions such as obesity. She is especially interested in environmental influences, citing research that shows that people who have mobility impairments but live in walkable neighborhoods get as much physical activity as unimpaired people who live in less walkable areas.

“Our current built environment makes it easy for us to be inactive,” says Dr. Rosenberg. We’re encouraged to drive, take the elevator, and sit. To find out what makes walking easier for people with limited mobility, Dr. Rosenberg conducted BEAMS (Built Environment, Accessibility, and Mobility Study), a collaboration with the UW Health Promotion Research Center funded by the Centers for Disease Control and Prevention Research Centers Program. Her collaborator was Basia Belza, PhD, RN, of the UW School of Nursing. The researchers studied 35 people over age 50 who used mobility devices such as a cane or walker. Study participants wore a global positioning system (GPS) unit for three days, then were interviewed about their travels. The research team went on short walks with participants for on-the-spot observations.

BEAMS generated a detailed, prioritized list of physical activity barriers such as inadequate sidewalks, lack of curb cuts, and high-speed traffic. Facilitators included clearly marked crosswalks, places to sit (such as at public transit stops), and flat, paved, interesting walking areas. BEAMS findings are being used to adapt the Neighborhood Environment Walkability Survey for older adults with mobility impairments. The survey is used for multidisciplinary research such as in urban planning and public health to understand environments that encourage activity.

Summer is the time to set healthy habits, from bike-to-work month in May to the Labor Day family outing. GHRI researchers are making it easier to sustain those habits throughout the year. 

For information about enrolling in the family-based CONNECTS study, call 1-877-224-4167.

By Chris Tachibana