OBESITY PREVENTION POLICY INTERVENTIONS FOR US ADULTS: EXPLORING FACILITATORS AND BARRIERS

ABSTRACT Background The obesity epidemic is one of the most significant public health problems facing the United States (US). Reducing current weight in adults and preventing further weight gain among those already overweight and obese provides a critical opportunity to curb the rising burden of obesity-related morbidity and mortality. As a result, many jurisdictions in the US are considering policy interventions. However, very few policy strategies have been implemented and there is no consensus regarding the most appropriate policies to prevent and control obesity. Therefore, research on the policy process is warranted to understand barriers and facilitators. This study explored framing in the news media during policy consideration; public knowledge, attitudes, and beliefs regarding a policy proposal; and the predictors of enactment of legislation focused on adult obesity prevention and control. Methods The goal of this study is to examine the policy process regarding interventions to reduce obesity and related health outcomes in the US adult population. Each of the three studies explored an internal or external factor that influences policy change – the news media, public opinion, and legislation features. News media coverage of the New York City sugar-sweetened beverage (SSB) portion size cap was explored to assess supportive and opposing frames about the policy. Data from a state public opinion survey were used to examine characteristics of supporters of a proposed SSB tax and pro-SSB tax messages. Adult obesity prevention legislation retrieved from a publically available database, as well as state-level variables were examined to identify patterns and correlates of legislation enactment. Results This dissertation illustrated the challenges faced by policy interventions focused on obesity prevention and control in the US adult population. Although there was a general consensus that the obesity epidemic warranted a response, legislation was not a uniformly popular approach and perceptions of the role of government in protecting the public’s health were varied. When legislation was considered, framing in the news media and the details of the approach, such as the target population, and how the food environment may change as a result of the intervention were particularly important for successful passage. Conclusions This dissertation provides novel evidence on some of the barriers and facilitators to the policy process and offers an important first step in understanding why few adult-focused obesity prevention policy interventions have been successfully enacted and implemented to date. The influence of the news media, public opinion, and legislation characteristics should be considered by advocates, researchers, and policymakers seeking to slow the adult obesity epidemic in the US through policy change