Deana Hildebrand Curbing Obesity project wins $4 million CDC grant

Nutrition professor Deana Hildebrand can imagine a world with only healthful choices, where fresh fruits and vegetables are available and neighbors cheerfully march toward their daily 10,000 steps.

It’s a world she is attempting to create in two counties in Oklahoma, with help from the federal government.

Ms. Hildebrand is leading the Curbing Obesity in Adair and Muskogee Counties project, a social experiment focusing on two counties in the state where more than 40 percent of the residents are obese. She and her colleagues at Oklahoma State University were awarded nearly $4 million from the Centers for Disease Control and Prevention to try to build healthful communities.

The challenge cuts across regional, economic and behavioral lines, among other factors, Ms. Hildebrand said.

The goal is “communities where people can live and play and work and learn in environments that support healthy behaviors — but we know that that’s not the social norm,” she said.

According to the CDC, the overall U.S. obesity prevalence for adults was 39.8 percent in 2015 and 2016, the most recent period for which complete data are available. The CDC defines obesity as body weight that is higher than what is considered healthy for a given height. It determines healthy weight using the Body Mass Index (BMI), which is a person’s weight divided by the square of his or her height. A BMI of 30 or higher is categorized as obese. A person who is 5 feet 9 inches tall and weighs 203 pounds or more would be considered obese.

Oklahoma, with an adult obesity prevalence of 32.8 percent, is among the states with the highest rates of obesity, according to the CDC’s most recent data. Other states with high obesity prevalence include West Virginia (37.7 percent), Mississippi (37.3 percent), Arkansas (35.7 percent) and Alabama (35.7 percent).

Obesity is a key driver of high risks of type 2 diabetes, heart disease, stroke and certain types of cancer.

In 2014, the CDC launched a pilot program to tackle obesity on a societal level. The agency surmised that living a healthy lifestyle shouldn’t be the sole responsibility of the individual and that the community should support healthy lifestyles.

“That’s exactly what we want to see happen,” said Terry O’Toole, chief of program development in the CDC’s Division of Nutrition, Physical Activity and Obesity.

Through its High Obesity Program, the CDC made millions of dollars in grants available to university researchers to implement programs in select counties to increase access to healthful foods and to promote physical activity.

Eligibility for funding was narrowed to states with counties where at least 40 percent of the population is obese. No state has an obesity prevalence below 20 percent, and at least seven — mainly in the South and Midwest — have rates above 35 percent.

In the program’s first year, the CDC gave five-year grants to universities for obesity-reduction efforts in select counties in Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, North Carolina, South Dakota, Tennessee, Texas and West Virginia.

The CDC hopes to publish data this year on the early impact of some of these programs. Researchers don’t expect to see meaningful changes until about seven to 10 years into the projects, Mr. O’Toole said.

“There is no one-size-fits-all silver bullet to address obesity,” he said. “It takes community leaders, policymakers, worksites, schools, government agencies, child care, health care. All of these sectors are engaged in how the High Obesity Program works.”

’Making healthy changes’

In Alabama, grantees added more healthful food choices in workplace vending machines such as dried fruits and vegetables, whole-grain products, low-fat dairy goods, and foods low in saturated fat, sugar and sodium. In Texas, state employees were challenged to meet minimum physical fitness requirements by exercising at least 150 minutes a week with activities such as walking, running and bicycling.

Such small changes respond to specific needs in the communities and lay the groundwork for environmental shifts to influence behavior, Mr. O’Toole said.

“Population-level outcomes take a long time to realize impact,” he said. “You know what healthy communities are up against? They’re up against a system that has a lot of other choices out there, or barriers that are out there — barriers to fruits and vegetables — that might be apparent. Or, on the physical activity side — exercise — barriers to safe access to activities in your community.”

In Texas, the work fitness program helped get thousands of people committed to being conscious about their exercise levels. The High Obesity Program team also worked to change the environment, specifically by making one county more bike-friendly. The team helped improve bike lanes and infrastructure and offered businesses free bike racks to place outside their stores. Those shops were included on a map of bike-friendly stops.

One local business owner included discounts on products to people who walked or rode their bikes to the store.

“There are evidence-based approaches that we know work,” Mr. O’Toole said. “Our job is to kind of work with communities to remove those barriers that people face when they’re trying to access nutritious foods, affordable foods, finding places and opportunities to be physically active.”

Last year, the CDC launched its second round of funding to 15 land grant universities — including Oklahoma State University — that had been working on healthy initiatives with federal partners such as the Department of Agriculture. The CDC told the 15 grantees which counties in their states were in most need of intervention.

In Oklahoma, Adair and Muskogee counties were selected.

Adair, which sits on the border with Arkansas, has a population of about 22,000 people. Nearby Muskogee County has a population of about 69,000.

Ms. Hildebrand, leader of the Curbing Obesity in Adair and Muskogee Counties Project, said apathy in the communities is one of the main contributors to the problem.

“I think they don’t feel supported in making healthy changes,” she said, noting that the rural, low-income neighborhoods don’t have resources or easy access to fresh fruits and vegetables, convenient exercise opportunities, or confidence and support to make healthful changes.

Ms. Hildebrand said her team will work with initiatives already underway in the county to prevent cancer and heart disease. The state used funding from the Tobacco Settlement Endowment Trust to make grants available.

The cooperation between the two health programs is “something that’s been in the works for a while, an idea in our head, and this seemed like an opportunity to do that,” she said.