|Proceedings of a Workshop—in Brief|
Engaging Communities in Addressing Structural Drivers of Obesity
Proceedings of a Workshop—in Brief
The Roundtable on Obesity Solutions of the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine held a virtual public workshop, Engaging Communities in Addressing Structural Drivers of Obesity, on July 25, 2022. The workshop was the second in a series of three workshops to explore how to bridge evidence gaps within foundational drivers of obesity (with special attention to structural racism, biased mental models and social norms, and health communication) and translate knowledge toward actionable solutions.
This workshop focused on community engagement, giving special attention to the relevance and impact of power within communities for obesity solutions that take into consideration broader structural drivers of obesity. It explored barriers and opportunities for solutions at the community level and highlighted examples of community initiatives that emphasize the intersection of obesity with structural racism, bias and stigma, and health communication to address needs identified by communities, and foster changes with community systems to support health and wellness. Topics covered in the July workshop sessions included power dynamics and communities as complex systems in relation to obesity, the role of community dynamics in power and engagement, and promising initiatives to build community power and improve health.
Ihuoma Eneli, professor of pediatrics at The Ohio State University and director, Nationwide Children’s Hospital Center for Healthy Weight and Nutrition, explained that the workshop series builds on a strategic planning process that the Roundtable initiated in 2020. It took a systems-oriented approach to identify foundational areas for obesity solutions, she said, which culminated in a causal systems map that depicts both the drivers of and the evidence-based solutions to obesity. The map was used to prioritize three cross-cutting foundational areas that the roundtable has since pursued, including through a three-part workshop series in 2021—structural racism, biased mental models and social norms, and effective health communication—which Eneli said were considered to be deep leverage points in the system that could bring about lasting, systems-wide change.
This Proceedings of a Workshop—in Brief highlights the presentations and discussions that occurred at the July 2022 workshop and is not intended to provide a comprehensive summary of information shared during
the workshop.1 The information summarized here reflects the knowledge and opinions of individual workshop participants and should not be seen as a consensus of the workshop participants, the Roundtable on Obesity Solutions, or the National Academies of Sciences, Engineering, and Medicine.
DISTINGUISHING CAUSES OF AND CONTRIBUTORS TO OBESITY AND EFFECTING SOLUTIONS THROUGH COMMUNITY SYSTEMS CHANGE
The workshop began with an introductory session featuring two speakers who set the stage for the workshop. The first speaker, Nikhil Dhurandhar, professor, Helen Devitt Jones Endowed Chair, and chairperson of the Department of Nutritional Sciences at Texas Tech University, discussed the distinction between causes of and contributors to obesity and the importance of addressing both at the systems level.
Dhurandhar’s first key point was to define “obesities,” which he used intentionally in the plural to underscore that obesity is a collection of diseases with multiple causes, contributors, and clinical expressions. This definition of obesity is in contrast to the common belief that obesity is typically caused by eating too much and moving too little, a view that he submitted needs to be updated to reflect that obesity is retention of excess energy in the body due to physiologic impairment in energy balance regulation.
Dhurandhar explained that this alternate view has its own set of causes and contributors to obesity (Dhurandhar et al., 2021). The causes in this case are intrinsic—within one’s body—and can induce obesity in the absence of contributors but while treatable, are also not preventable. Examples include dysregulation of hormones involved in thyroid function, hunger, and appetite satiety. The contributors to obesity in this alternate view are extrinsic—outside of a person—and can lead to obesity in the presence of causes but are preventable, modifiable, and treatable. Examples include poor sleep quality, food insecurity, and exposure to energy-dense foods. These contributors appear to exert effects on body weight when the energy balance mechanism within a person is impaired, he indicated, which means that a key implication of this view of obesity is that if the contributors did not exist, future expression of obesity would be reduced.
Dhurandhar’s second key point was that treatment is imperative for the hundreds of millions of U.S. adults with overweight or obesity and requires efforts to achieve substantial, sustained negative energy balance. Unstructured weight loss interventions that provide general suggestions for doing so typically fail to produce meaningful weight loss, Dhurandhar stated, because individuals are unfamiliar with calorie values of both food and physical activity, and physiologic and metabolic adaptations to weight loss often challenge individuals’ attempts to lose weight.
Dhurandhar’s third and final point was that individualized, structured, wide-scale treatment is warranted to meaningfully address existing obesity and to minimize or prevent its further expression. Approaches that aim to modify only one contributor to obesity are ineffective on their own, he pronounced, because many other simultaneously operating contributors will continue to perpetuate the problem. Supporting both individuals and systems-wide changes can synergize, he maintained, to address obesity more effectively and on a wider scale.
Shiriki Kumanyika, emeritus professor of epidemiology at the University of Pennsylvania Perelman School of Medicine and research professor in the Department of Community Health and Prevention at the Dornsife School of Public Health at Drexel University, discussed effecting obesity solutions through community systems change. In her view, Dhurandhar’s framing of issues as causes and contributors helps clarify that solutions are not “either/or” but “both/and.” There is no competition between prevention and treatment strategies nor between individual- and population-level solutions, she affirmed, because both are needed. “Both/and” framing also emphasizes the importance of obesity solutions that mitigate factors outside of individuals’ direct control, she added, and underscores the potential power of collective actions to effect population-level solutions.
1 The workshop agenda, presentations, and other materials are available at https://www.nationalacademies.org/event/07-25-2022/engaging-communities-in-addressing-structural-drivers-of-obesity-a-second-workshop-in-the-series (accessed October 27, 2022).
Kumanyika referred back to the Roundtable on Obesity Solutions’ systems map of obesity’s drivers and solutions and contended that an exquisite understanding of obesity systems is effective only when translated into action. Engaging communities to address structural drivers of obesity involves discussion about the relevance and impact of power within communities, approaches to community engagement, and barriers and opportunities for solutions at the community level.
Kumanyika offered four caveats for thinking about community power and community-level obesity solutions. First, she posited that communities should be approached as complex systems in which contributors to obesity are interrelated and dynamic. Second, she suggested that while community-level solutions are most proximal to individuals and families, contributors at this level may be driven by upstream factors such as state or national policies. Third, it is important for community-level solutions to be current and future-oriented, while also proactive to address historical factors that contributed to problematic structural pathways. These pathways need to be strategically destabilized without disrupting societal function. Fourth, just as individuals are affected differently by obesity causes, communities are affected differently by obesity’s contributors.
POWER DYNAMICS AND COMMUNITY AS COMPLEX SYSTEMS
The second session of the workshop explored power dynamics and communities as complex systems in relation to obesity.
Angela Odoms-Young, associate professor and director of the Food and Nutrition Education in Communities Program in the Division of Nutritional Sciences at Cornell University, highlighted the importance of understanding and addressing structural racism as a pathway to obesity solutions. She began by explaining that communities encompass many complex adaptive systems, including small- to large-scale systems (e.g., families, neighborhoods) and a variety of domain-specific systems (e.g., housing, employment, schools), and submitted that it is important to understand the complex interaction of community systems and their relationships to influences on obesity (Auspos and Cabaj, 2014).
Odoms-Young discussed racism as a root cause of disparities in obesity and health and urged a deeper understanding of the relationships through which racism and power exert these effects (The Aspen Institute, 2016; Guess, 2006; Krieger, 2003; Williams and Mohammed, 2013). Racism occurs at several levels within the fabric of society, she posited, from internalized racism (one’s private beliefs and biases about race and racism) and interpersonal racism (occurring within interactions between individuals) to institutional racism (occurring within institutions and systems of power) and structural racism (racial bias among institutions and across society) (Jones, 2000). As an organized system, Odoms-Young explained that racism is based on the premise of categorization and ranking of social groups into races, which she said devalues, disempowers, and differentially allocates desirable societal opportunities and resources by race. One pathway by which racial discrimination affects health outcomes is disparate treatment, she said, that occurs on the basis of race that disadvantages a racial group. A second pathway is disparate impact, which she relayed as treatment on the basis of inadequately justified factors other than race that disadvantages a racial group (NASEM, 2017).
Odoms-Young also discussed the concept of power and appealed for embedding power within health equity. Power can be defined broadly as the ability to act or produce an effect, she said, and social power is defined as access to resources that enhance one’s chances of getting what one needs in order to lead a comfortable, productive, and safe life. Community power has been defined as “the ability of communities most impacted by structural inequality to develop, sustain, and grow an organized base of people who act together through democratic structures to set agendas, shift public discourse, influence who makes decisions, and cultivate ongoing relationships of mutual accountability with decision makers that change systems and advance health equity” (Pastor et al., 2020). Multiple definitions of health equity exist and tend to be comparative, she observed, in that they centralize whiteness and focus on a group versus their privilege, which she said can lead to perception of certain groups as behaviorally inferior and lacking agency. There is therefore a need to embed the
definition of power when talking about equity (Pastor et al., 2020).
Curtis Archer, president of the Harlem Community Development Corporation, discussed efforts to empower Harlem’s community members to choose healthy lifestyle behaviors. The opening of Harlem’s first large chain supermarket in the early 1990s did not guarantee that residents would stop their patterns of frequenting the community’s numerous fast food restaurants, Archer pointed out, because of the convenience of fast food as well as a lack of education about how to correct unhealthy patterns of behavior.
He said that such efforts have not been a focus of many of the area’s elected officials or community-based organizations, but observed growing recognition of the need for change. Community-based organizations such as the Harlem Children’s Zone and Harlem Congregations for Community Improvement have developed learning opportunities and resources, he pointed out, to empower youth and entire households to adopt lifelong healthy eating and activity habits by changing the community culture. Archer noted that although a Whole Foods Market recently opened in Harlem, many community residents “did not feel that Whole Foods was built for them.” After the store worked to raise awareness of its 365 brand’s more reasonable price point and began offering educational classes about healthy eating, Archer said that more community residents have visited the store.
Notwithstanding these positive developments to address the role of diet in chronic disease development, Archer said that it is still an “uphill battle.” He observed a lack of coordinated effort on the part of food and beverage companies to provide meaningful support to promote healthy eating and active living, noting that the companies tend to have philanthropic divisions but have not committed to stop marketing unhealthy foods in the community. Harlem is inundated with advertisements for fast food restaurants, he observed, whereas advertisements for fruits and vegetables are scarce.
Archer said that a significant change in Harlem’s demographic has occurred during his tenure in the community, whereby more residents with greater disposable incomes have moved into the area. These folks tend to want more choices and different choices than what have been historically offered in the community, he observed, and suggested that this offers hope for changing lifestyle patterns. He reiterated that even with the introduction of healthier choices, it is also necessary to provide education and shift the culture in order to realize meaningful shifts in dietary risk factors for obesity and other chronic diseases.
Tony Iton, senior vice president for programs and partnerships at the California Endowment (TCE), discussed the organization’s Building Healthy Communities (BHC) initiative. He shared a framework that he said has helped guide TCE’s shift from a technocratic to a democratic understanding of health. The framework’s right half representing a medical model illustrates downstream drivers of health—genetics, individual risk factors and behaviors, and health care access. The healthcare delivery system spends an enormous amount of time, he pointed out, managing these downstream consequences of upstream conditions. The framework’s left half representing a socio-ecological model illustrates three categories of upstream drivers of health—discriminatory beliefs, institutional power, and social inequities. Iton suggested that the two halves of the framework could be thought of as inequities and disparities, conditions and consequences, or democratic and technocratic strategies. TCE organized its upstream strategies into three categories that align with each component in the left half of the framework: narrative (discriminatory beliefs), policy (institutional power), and place (social inequities). The goal of TCE’s work, Iton continued, is to build a critical mass of social, political, and economic power in people who are “closest to the pain” (i.e., on the front lines of experiencing health inequities) in order to reshape narratives and lead to more equitable policy.
Iton expounded on the BHC program, which he described as an ecological approach to improve population health in California. BHC chose 14 communities throughout California, Iton recounted, and facilitated formation of human relationships around a hub that created the
opportunity for community residents to exercise power and influence directly over systems leaders to help them understand the lived experiences of community residents. To guide targets for community change, TCE gave the hubs a basic framework with a menu of options or allowed them to create their own priorities. BHC also invested in youth leadership and youth organizing, leveraged partnerships, and worked to change a predominant community narrative that some people were valuable and others were less valuable. The “basic recipe” for the BHC work, Iton said in summary, is that it’s about power, policy, and narrative.
Iton shared a BHC case study from Fresno, California, about building community power to participate in political decision-making. The community had prioritized access to parks, noting disparities in park condition and accessibility between the northern (mostly white) and southern/eastern (mostly black, Latino, and immigrant populations) parts of the city. Community members overcame powerful local political resistance as they ran a campaign to highlight the city’s wide geographic disparity in per capita park space, collected enough signatures to place a parks measure on the ballot, and garnered 52 percent of the vote. Estimates suggest that nearly $2.2 billion will be allocated for parks and park infrastructure in Fresno by the end of the measure’s 30-year duration.
MOVING TOWARD SOLUTIONS: UNDERSTANDING COMMUNITY DYNAMICS AS KEY TO POWER AND ENGAGEMENT
The third session of the workshop featured two presentations that continued the focus on community power dynamics as a key component of systems that drive obesity.
Michelle Cardel, senior director of global clinical research and nutrition at WW International, discussed her experience using a community-engaged approach to develop a healthy lifestyle intervention for adolescents with overweight and obesity. She began by emphasizing the complexity of the disease of obesity, describing it as a multifactorial disease that cannot be attributed to environment, behavior, or physiology alone.
Current approaches to obesity management in youth center on family-based behavioral treatment programs, Cardel said, and best practices in this approach tend to occur among children younger than age 12. Data are lacking for adolescents but suggest that current interventions are minimally effective in this age group, she reported, because adolescents are more autonomous than younger children, may or may not benefit from parental involvement, and are developing self-regulation skills. This research gap led Cardel and her team to explore how to create interventions tailored for adolescents’ needs and preferences.
The team undertook an adolescent-engaged approach to develop, tailor, and implement a weight loss intervention for adolescents based on acceptance-based therapy (ABT). ABT is characterized by the acceptance of uncomfortable states and emotions, mindfulness, values-based living, and self-regulation skills, she explained, and has shown promising results in adult weight loss studies (Forman et al., 2016). Focus groups confirmed the need for sex- or gender-stratified interventions, Cardel relayed, because they revealed that boys and girls experienced weight status differently and exhibited strikingly different perceptions about both weight status and perceived barriers and facilitators to weight loss and healthy lifestyles (Cardel et al., 2020). Participants also shared that they wanted a program focused on multiple domains of health (e.g., physical, mental, social, emotional), instead of just weight loss. Participants also provided feedback on whether they wanted parental involvement in the intervention, and identified incentives, engaging activities, and electronic communication as core components for program engagement and retention (Lee et al., 2021).
Program development focused on adolescent girls (ages 14 to 19), Cardel said, and involved hiring adolescent citizen scientists with lived experiences in overweight and obesity to collaborate with researchers as equal partners in every aspect of the development (Lee et al., 2022). Results from a feasibility cohort indicated that 84.6 percent completed the six-month intervention and assessments, 90.9 percent completed all 15 sessions, and there was high participant satisfaction (Cardel et
al., 2021). The next step is to assess the program’s effectiveness in a fully powered trial. The bottom line, Cardel said in summary, is that given impressive weight loss results observed in adults treated with ABT, combined with pilot data demonstrating feasibility and acceptability, ABT could represent a highly effective obesity intervention for adolescents.
Rafael Pérez-Escamilla, professor of public health in the Department of Social and Behavioral Sciences at the Yale University School of Public Health, presented a case study to illustrate how community engagement led to the successful development, implementation, and sustainability of the Connecticut Hispanic Health Council Supplemental Nutrition Assistance Program (SNAP)–Ed Program. The program’s mission is to improve food and nutrition security and nutrition knowledge, attitudes, and behaviors among Hispanics in Connecticut, through a community-engaged life course approach.
Pérez-Escamilla explained that “community-engaged” means that the program’s structure, strategy, and end-to-end operations are informed by relationships of trust and respect with the community. Since day one, he explained, the program has aimed to implement evidence-based practice models; multi-disciplinary, culturally tailored approaches; thorough evaluation of process, satisfaction, and impact outcomes; and strong partnerships built from a social justice perspective.
Pérez-Escamilla reported that according to a childhood obesity prevention life course framework, it is not enough to address excess weight starting with younger school-age children because fundamental drivers of childhood obesity are established prior to gestation (e.g., pre-pregnancy body mass index and excess gestational weight gain) (Pérez-Escamilla and Bermúdez, 2012). The program conducted a series of innovative social marketing campaigns accompanied by culturally appropriate ancillary materials, he recounted, that addressed preconceptional nutrition issues among young adults, nutrition during pregnancy, and breastfeeding. A campaign evaluation indicated that more frequent exposure to the marketing materials and greater diversity in types of media viewed was associated with higher intake of fruits and vegetables.
Community-engaged implementation research is a powerful approach to advancing evidence-based childhood obesity prevention efforts, Pérez-Escamilla declared, and he shared several strategies for effective, equitable person/family-centered approaches. Engaging community stakeholders in every stage of the process is critical, he reiterated, as is considering community structures, needs, and wants in all decisions. Next, he urged community-engaged programs to follow social justice, health equity, and antiracism systems, frameworks, and principles. Finally, Pérez-Escamilla emphasized that community-engaged programs must be systematically planned, implemented, and evaluated.
PROMISING INITIATIVES TO BUILD COMMUNITY POWER AND IMPROVE HEALTH
The fourth and final session of the workshop highlighted examples of promising initiatives to build community power and improve health, and their application to obesity prevention and treatment efforts.
May Okihiro, associate professor and community researcher at the University of Hawaii John A. Burns School of Medicine and senior pediatrician and director of research at the Wai’anae Coast Comprehensive Health Center (WCCHC), discussed WCCHC’s integration of social service programs and its produce prescription program. Okihiro explained that the intersection of Hawaii’s high cost of living, low wages, and the COVID-19 crisis’ disruptions to the state’s highly imported food supply have elevated the need to strengthen community food systems and address health and wellness.
Communities along Oahu’s Wai’anae Coast, where Okihiro’s team works, have some of the state’s highest rates of poverty and chronic diet-related diseases. The community is also home to the largest concentration of native Hawaiians in the world, Okihiro highlighted, and observed that among the community’s strong cultural values is a growing desire to return to traditions.
WCCHC is the largest of the state’s 13 federally qualified health centers and is also the only safety net provider along the 15-mile western coast of Oahu. WCCHC’s integration of social services and prioritization of food systems are important supports for patient health and
well-being, Okihiro maintained, and provided as an example a community farmer’s market that was the island’s first farmer’s market to accept SNAP electronic benefit transfer (EBT) card payments. WCCHC’s social service team distributed thousands of pounds of food to community residents during the COVID-19 pandemic, she recollected, which she said strengthened trust and relationships between community members and the health care system.
Okihiro shifted to discuss the Wai’anae Ohana Produce Prescription (WOPRx) project, which she said is recruiting WCCHC patients who are Medicaid or SNAP participants and have a diet-related chronic disease(s). The program seeks to improve health and wellness and decrease food insecurity while strengthening community food systems. WOPRx program participants receive a $50/month voucher to purchase fresh produce at WCCHC’s farmer’s market for up to 18 months, Okihiro said, and the WOPRx team created EMR templates to record each encounter with program participants and facilitate communication between health care providers and program staff. She reported that the program is collecting baseline and quarterly measurements including BMI, blood pressure, and hemoglobin A1C to help evaluate its outcomes. The program is undergoing continuous tailoring to better meet community member needs, she added, such as launching a free delivery service to serve participants without transportation or who are homebound.
Michelle Moskowitz Brown, executive director of Local Matters in Columbus, Ohio, discussed her organization’s work in food education, access, and advocacy. Local Matters works with health care institutions, schools, community centers, and housing organizations to help children and adults grow, cook, and access affordable food that meets their cultural needs and preferences. People of all ages, experiences, and abilities participate in the organization’s programs, which she explained pair in-depth education and access points to help participants build positive relationships with food and cooking.
Brown highlighted Local Matters’ efforts to equitably increase availability and affordability of fresh, healthy foods. The veggie van is an access initiative to provide convenient, consistent availability of fruits and vegetables while supporting local small businesses and small-scale farmers. The van stops at the same locations each week and also provides delivery services, Brown explained, for $10 meal kits that come with recipes and can be purchased using SNAP, WIC, and TANF benefits. It’s not free food, she clarified, but it provides equitable access to people who have food dollars and cannot easily obtain fruits and vegetables. The veggie van also provides dollar-for-dollar matching up to $25 per day, and will soon begin participating in a produce prescription program with a local hospital. These and other access programs are designed to complement each other, Brown said, and to foster participation from multiple generations while addressing residents’ priorities. With respect to Local Matters’ efforts to advocate for policies that support community food access and education, Brown highlighted a new Community Advocates group that provides ongoing feedback about Local Matters programs, discusses neighborhood needs, and builds group members’ advocacy skills.
In her closing thoughts, Brown submitted that everyone has power and it is great when community-based organizations find ways to define purpose within communities and build power together, recognizing that collaboration moves at the speed of trust. She shared that as a community organization, Local Matters appreciates when powerful partners such as health care systems commit to long-term collaboration and explore the services that local providers can offer.
Brian Castrucci, president and chief executive officer of the de Beaumont Foundation, asserted that obesity is one of the last diseases that society views almost solely through an individual lens, i.e., as a result of an individual’s poor choices. It is still acceptable to create entertainment at the expense of people with excess weight, he observed, such as televised weight loss competitions. Those shows perpetuate the simplistic narrative that obesity results from failed lifestyle choices, he contended, and promote weight stigma and bias.
Castrucci voiced his concern with the use of body mass index (BMI) as a diagnostic measure for obesity. He
shared his view that BMI does not necessarily work well for characterizing an individual’s position relative to a broad population group, nor does it account for muscle mass or frame size. BMI is sometimes used singularly to characterize health, he observed, without considering other relevant indicators. Weight is a complex and fluid number, he said in summary, and suggested that obesity be diagnosed with more dynamic, sophisticated measures.
A narrow focus on individual behavior as the cause of obesity is problematic not just because it medicalizes obesity and perpetuates weight bias and stigma, Castrucci maintained, but also because it fails to consider the role of social determinants of health or equity, namely, environments and policies. He called for community conditions that enable residents to make healthy lifestyle choices, recognizing that such conditions are often determined on a policy level. He suggested that upstream solutions might involve stiffer penalties for propagating medical misinformation (e.g., “miracle cures” for obesity), or promotion of easily accessible, culturally relevant food retail options in communities that will meet residents’ needs.
CLOSING REFLECTIONS AND REMARKS
Leah Whigham, founding director of the Center for Community Health Impact and associate professor at The University of Texas Health Science Center at Houston, summarized key takeaways from the workshop. She began by stating that obesity is a complex disease with multiple causes and contributors that should be targeted in interventions. Power, she added, influences the availability of, access to, and uptake of interventions.
Another key takeaway, Whigham continued, is that evidence-based treatment for obesity’s causes and contributors is expected to drive the greatest impact at community and population levels. Several speakers emphasized that when developing strategies to address causes of or contributors to obesity, it is critical to center and uplift the voices of community members whom the strategies are targeting. Whigham emphasized that communication and framing can either perpetuate misconceptions about obesity or reframe and correct false narratives. As an example, she said that conflating contributors and causes of obesity can unintentionally fuel the bias that people with obesity choose to have excess weight because they do not eat healthy or exercise enough.
The bottom line, Whigham proposed, is that two strategies are essential: integration of individual strategies that are scalable and available regardless of a person’s physical location, zip code, income, and race/ethnicity; and systems-wide changes that make those individual strategies available and sustainable. She appealed for advancing the two strategies in tandem, working collectively and focusing on the interaction of both causes of and contributors to obesity.
Bruce Lee, professor of health policy and management at the City University of New York School of Public Health and executive director of the university’s Public Health Informatics, Computational and Operations Research (PHICOR) initiative and Center for Advanced Technology and Communication in Health (CATCH), provided closing remarks and recapped how the workshop fit into the context of the overall 2022 workshop series. He reminded attendees that the workshop series is titled Translating Knowledge of Fundamental Drivers of Obesity into Practice. The three workshops in the series are rooted in the foundational understanding that obesity is a result of complex systems, he said, that in many cases are broken or need to be redesigned. This workshop highlighted that communities are complex systems, Lee reiterated, and that power dynamics in communities are key. Communities need to be empowered to effect change, he urged, instead of being engaged in discussions to listen and provide input but not afforded any decision-making capacity.
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DISCLAIMER This Proceedings of a Workshop—in Brief has been prepared by EMILY A. CALLAHAN as a factual summary of what occurred at the meeting. The statements made are those of the rapporteur or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.
REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by RODNEY LYN, Georgia State University and MAY OKIHIRO, University of Hawaii. LESLIE J. SIM, National Academies of Sciences, Engineering, and Medicine served as the review coordinator.
SPONSORS This workshop was partially supported by the Academy of Nutrition and Dietetics; Alliance for a Healthier Generation; American Academy of Pediatrics; American Cancer Society; American College of Sports Medicine; American Council on Exercise; Blue Shield of California Foundation; General Mills, Inc.; The JPB Foundation; Kresge Foundation; Mars, Inc.; MedTech Coalition for Metabolic Health; National Recreation and Parks Association; Nemours Children’s Health System; Novo Nordisk; Obesity Action Coalition; Partnership for a Healthier America; Reinvestment Fund; Rudd Center for Food Policy and Health; Robert Wood Johnson Foundation; SHAPE America; Society of Behavioral Medicine; Stop & Shop Supermarket Company; The Obesity Society; Wake Forest Baptist Medical Center; and Walmart.
STAFF HEATHER COOK, AMANDA NGUYEN, CYPRESS LYNX, and MARIAH BRUNS, Food and Nutrition Board, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine.
For additional information regarding the workshop, visit https://www.nationalacademies.org/event/07-25-2022/engaging-communities-in-addressing-structural-drivers-of-obesity-a-second-workshop-in-the-series.
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Engaging communities in addressing structural drivers of obesity: Proceedings of a workshop—in brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/26787.
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