Community-Based Childhood Obesity Prevention: Perspectives, Practices And Potential

Childhood obesity rates in the US have tripled over the past 30 years and dozens of communities have launched prevention initiatives in the last 10. However, little research has been conducted on what stakeholders believe communities should do or on what community initiatives are doing. This dissertation addresses these gaps with three studies. The first study identifies values underlying discourses about "choice" in childhood obesity prevention (COP) and discusses ethical implications. Through analysis of 105 stakeholder interviews it identifies three main "choice" frames: choice as freedom, choice as moral responsibility, and the influence of context on choice. Dominant values revealed were, respectively, autonomy, personal accountability, and social responsibility for enabling autonomy and accountability. COP strategies that respect these values include investing in developing agency through community organizing approaches and evaluating impacts of community prevention efforts beyond anthropometric and behavioral outcomes. The second study identifies four perspectives on what communities should do to prevent childhood obesity using Q methodology with 95 people in an upstate New York community. One stance fits the environmental perspective common in public health and three are variations of individual-responsibility-centered perspectives. Areas of agreement include providing access to free family activities and making fruits and vegetables more affordable. The third study examines community-based COP practice through case studies of three COP projects, including interviews (n=22), participation in meetings/events (n[GREATER-THAN OR EQUAL TO]7 per case), and document analysis (n[ALMOST EQUAL TO]100 per case). It profiles each project and maps its actions to the ANGELO framework. Project actions were concentrated in physical food and activity environments, being weaker in creating policy change and economic incentives for healthy eating and activity. Projects were also weak on involving those most affected by this issue, particularly youth. The study's concludes by proposing regional networking and technical assistance to tackle these weaknesses, leverage strengths, and build advocacy. It also questions the current community COP model, which entangles the solution-focused, values-based strategies of social movements with problem-centered, evidence-based approaches of obesity interventions. Bridging rather than confusing these by investing in related movements such as community food security, paired with technocratic obesity-specific interventions, may unleash more of the potential for effective and inclusive community COP