We can apply the Diabetes Today framework to obesity prevention among youth by examining the context within which we find adolescents. Generally, they are nested in a family unit, a neighborhood, and a community. Public health interventions can occur at many levels, but this framework focuses on the community, and the intended audience is adolescents. Thus, we must consider youth development practice and theory and employ strategies to prevent obesity that provide opportunities, skills, and support in a safe environment.
Health promotion practices aim to empower people so they can gain control over the underlying factors that influence health. Community-based public health interventions have used many health promotion theories and practices, such as empowerment, community participation, social marketing, and community-based participatory research, all based on the premise that the community is an asset in transforming the health system for health protection. The community is also the place where the social determinants of health converge to affect behavior and health. Therefore, the participation of community members is imperative in a process to bring about change in shared outcomes. This participatory process begins with the identification of an issue or concern, continues through the development and evaluation of an intervention, and is a continuous cycle of assessment, planning, action, evaluation, and learning. This process takes time and commitment from both the practitioner and members of the community.
Some communities may be offended by the words "obesity" or "overweight" to describe adolescents because of culture, health beliefs, or community norms. Demonstrating respect by allowing community members to use their own words and share their knowledge and experiences opens opportunities for better communication, trust, creativity, and innovation toward developing appropriate community-specific interventions. For example, the built environment is associated with physical activity (4
), and regular physical activity among adolescents leads to better risk profiles for heart disease, diabetes, bone health, and depression (5
). However, even though parents may be aware that their children should be more physically active, they may be reluctant to allow them to participate in after-school sports because of concerns about the safety of walking home from school (7
). If public health practitioners were aware of parental concerns, they could provide opportunities for adolescents and their families to communicate issues related to safety and inactivity to stakeholders, exchange ideas, and begin to build the community's capacity to solve this problem. Ultimately, community members would be more willing to advocate for change and participate in the decision-making process, become more aware of how to access resources for solving problems, and be better able to solve other problems that might arise (8
Adapting the Diabetes Today framework to obesity prevention among youth requires us to look closely at the physical environment where adolescents live, work, and play. More research on the physical environment's impact on physical activity and nutritional practices in youth is needed. In the meantime, in keeping with the recommendations of the CDC's Guide to Community Preventive Services, we can enhance the environments of adolescents and reduce their risk for injury so they can engage in physical activity in safe environments (7
). We can also change social norms so that eating healthy and nutritious foods becomes normative behavior.
Acknowledging that the health sector alone cannot transform any community is important. The Diabetes Today framework emphasizes intersectoral collaboration and partnerships for achieving shared goals. If we use this framework to focus on obesity prevention among adolescents, we must include youth and representatives from organizations that cross several domains involved with youth, such as schools, local grocery stores and fast-food restaurants, religious organizations, and parks and recreation departments. All stakeholders must also accept that youth representatives must be given the opportunity to make appropriate decisions throughout the planning, implementation, and evaluation process.
Generally, adolescents are cared for and influenced by a family, a social network, and their physical environment. In their discussion of social network approaches to preventing childhood obesity in this issue of Preventing Chronic Disease
, Koehly and colleagues note that "individuals define themselves in terms of their interconnectedness and relationships with their family, friends, neighbors, and community" (9
). Understanding these networks and their effect on the behavior of youth in the community is vital when developing interventions that will affect their lives. Public health professionals must also be aware of the rules and regulations associated with working with minors when collaborating with communities to explore possible strategies to prevent obesity (10
Finally, we must consider the role of parents in interventions involving adolescents, theories about the intergenerational transmission of health risk behaviors from parents to adolescents (11
), and ethical arguments implying that parents cause their child's obesity (12
). Parents influence their children's well-being, but community-driven interventions or participatory research should not focus on blame as a basis for developing evidence or best practices. Rather, the focus should be on exploring how adult family members and networks influence the transmission of health risk behaviors to adolescents.