Municipal officials' perspectives on policymaking for addressing obesity and health equity.

Background: Obesity evidence-based policies (EBPs) can make a lasting, positive impact on community health; however, policy development and enactment is complex and dependent on multiple forces. Aims and objectives: This study investigated key factors affecting municipal officials' policymaking for obesity and related health disparities. Methods: Semi-structured interviews were conducted with 20 local officials from a selection of municipalities with high obesity or related health disparities across the United States between December 2020 and April 2021. Findings: Policymakers follow a general decision-making process with limited distinction between health and other policy areas. Factors affecting policymaking included: being informed about other local, state, and federal policy, conducting their own research using trustworthy sources, and seeking constituent and stakeholder perspectives. Key facilitators included the need for timely, relevant local data, and seeing or hearing from those impacted. Key local policymaking barriers included constituent opposition, misinformation, controversial issues with contentious solutions, and limited understanding of the connection between issues and obesity/health. Policymakers had a range of understanding about causes of health disparities, including views of individual choices, environmental influences on behaviors, and structural factors impacting health. To address health disparities, municipal officials described: a variety of roles policymakers can take, limitations based on the scope of government, challenges with intergovernmental collaboration or across government levels, ability of policymakers and government employees to understand the problem, and the challenge of framing health disparities given the social-political context. Discussion and conclusion: Understanding factors affecting the uptake of EBPs can inform local-level interventions that encourage EBP adoption.

Implementation of a Scalable Family-Based Behavioral Treatment for Childhood Obesity Delivered through Primary Care Clinics: Description of the Missouri Childhood Obesity Research Demonstration Study Protocol.

Background: Significant gaps exist in access to evidence-based pediatric weight management interventions, especially for low-income families who are disproportionately affected by obesity. As a part of the Centers for Disease Control and Prevention's Childhood Obesity Research Demonstration project (CORD 3.0), the Missouri team (MO-CORD) aims to increase access to and dissemination of an efficacious pediatric obesity treatment, specifically family-based behavioral treatment (FBT), for low-income families. Methods/Design: The implementation pilot study is a multisite matched-comparison group pilot of packaged FBT in pediatric clinics for low-income children with obesity, of ages 5 to 12 years old. The study is implemented in two Missouri pediatric primary care clinical sites, Freeman Health System Pediatric Clinics (rural Joplin) and Children's Mercy Hospital Pediatric Clinics (urban Kansas City). The design focuses on pragmatism through utilization of PRECIS (Pragmatic Explanatory Continuum Indicator Summary) domains, such as open eligibility criteria, limited follow-up intensity, reliance on medical records for creating a usual care comparison group data, and unobtrusive measurement of participant and provider adherence. The evaluation focuses on effectiveness as well as implementation outcomes and barriers to inform implementation scale up. Conclusions: Findings from this study will advance both science and practice by providing novel and immediately useful information to families, health care providers, health care organizations, payers, and other state Medicaid plans by developing and optimizing evidence-based pediatric weight management treatment for implementation and dissemination in health systems to address health disparities among low-income populations most affected by overweight and obesity.

Translating Family-Based Behavioral Treatment for Childhood Obesity into a User-Friendly Digital Package for Delivery to Low-Income Families through Primary Care Partnerships: The MO-CORD Study.

Background: Significant gaps exist in access to evidence-based pediatric weight management interventions, especially for low-income families. As a part of the Centers for Disease Control and Prevention's Childhood Obesity Research Demonstration project 3.0 (CORD), the Missouri CORD (MO-CORD) team aims to increase access to and dissemination of an efficacious pediatric obesity treatment, family-based behavioral treatment (FBT), among low-income families. This article describes the MO-CORD team's approach to translating FBT into a digital package for delivery to low-income families through primary care practices. Methods: Using digital technology, the primary care setting, and existing reimbursement mechanisms, the MO-CORD team is developing a scalable user-centered design informed treatment package of FBT. This package will be implemented in primary care clinics and delivered to children (5-12 years) with obesity from low-income households in rural and urban communities. The digital platform includes three main components: (1) provider and interventionist training, (2) interventionist-facing materials, and (3) family-facing treatment materials. User-centered design techniques and continuous iterative stakeholder feedback are utilized to emphasize tailoring to a low-income population, along with scalability and sustainability of the digital package. Conclusions: The MO-CORD project addresses the critical need to increase access to obesity treatment for children from low-income households and establishes a platform for future large-scale (i.e., nation-wide) dissemination of evidence-based pediatric weight-management interventions. This study determines whether the digital FBT package can be implemented within real-world settings to create a system by which children with obesity and their families can be effectively treated in primary care settings.

The influence of Western body ideals on Kenyan, Kenyan American, and African Americans' body image.

Studies have shown that there exists a relationship between exposure to idealized media images and increased self-ratings of body dissatisfaction - defined as a person's negative feelings and ratings of their own body weight and shape (e.g. Galioto & Crowther, 2013; Grabe, Ward, & Hyde, 2008). Using two experimental studies, we examined the impact of exposure to Western media-ideal images on Kenyan, Kenyan Americans, and African Americans' self-perception and body satisfaction. Across the two studies, it was hypothesized that individuals who were exposed to the thin body ideal media images would report more body dissatisfaction than those exposed to overweight images. Findings support these hypotheses and suggest that exposure to Western media body ideal images is significantly related to increased body dissatisfaction. Implications regarding the need to educate people to become critical consumers of media and consequences on social justice are discussed.

Public Health Messages and Weight-Related Beliefs: Implications for Well-Being and Stigma.

Across two studies, we examined the double-edged sword hypothesis, which outlines effects of weight-related beliefs and public health messages on physical and mental health. The double-edged sword hypothesis proposes that growth mindsets and messages (weight is changeable) predict reduced well-being and stigma via an increase in blame, but also predict greater well-being via an increase in efficacy and less stigma via a reduction in essentialist thinking. We tested this model in a correlational study (N = 311) and in an experimental study, randomly assigning participants (N = 392) to different weight-based public health messages. In Study 1, growth mindsets predicted greater onset blame and more offset efficacy. Blame did not predict any of the outcomes. However, offset efficacy predicted reduced risk for eating disorders, fewer unhealthy weight control behaviors, and less psychological distress. And, growth mindsets had a negative indirect effect on outcomes. In Study 2, we experimentally demonstrated that a changeable message about the nature of weight, designed to also reduce blame, indirectly decreased eating disorder risk, unhealthy weight control behaviors, body shame, and prejudice through increased offset efficacy and decreased social essentialism. This work contributes to our theoretical understanding of the psychological consequences of weight beliefs and messages on well-being and stigma.