An ecological approach to investigating the influences of obesity

"Globesity," as defined by the World Health Organization, describes obesity as a pandemic affecting at least 400 million people worldwide. The prevalence of obesity is higher among women than men; and in non-Hispanic black and Hispanic populations. Obesity has been significantly associated with increased all-cause mortality, and mortality from cardiovascular disease, obesity-related cancers, diabetes and kidney disease. Current strategies to curb obesity rates often use an ecological approach, suggesting three main factors: biological, behavioral, and environmental. This approach was used to develop four studies of obesity. The first study assessed dietary quality, using the Healthy Eating Index (HEI)-2005, among premenopausal Hispanic and non-Hispanic white women, and found that Hispanic women had lower total HEI-2005 scores, and lower scores for total vegetables, dark green and orange vegetables and legumes, and sodium. Markers of obesity were negatively correlated with total HEI-2005 scores. The second study examined the relationship between reported screen time and markers of obesity among premenopausal women and found that total screen time, TV, and computer use were positively associated with markers of obesity. Waist/height ratio, fat mass index, and leptin concentrations were significantly lower among those who reported the lowest screen time versus the moderate and high screen time categories. The third study examined the relationship between screen time and dietary intake and found no significant differences in absolute dietary intake by screen time category. The fourth study was designed to test a brief face-to-face healthy shopping intervention to determine whether food purchases of participants who received the intervention differed from those in the control group; and whether purchases differed by socioeconomic position. Participants in the intervention group purchased more servings of fruit when compared to the control group. High-income participants purchased more servings of dark green/deep yellow vegetables compared to those in the low-income group. Among those who received the intervention, low-income participants purchased foods of lower energy density, and middle-income participants purchased food of higher fat density. The findings of these studies support policy changes to address increasing access and availability of fruits and vegetables, and support guidelines to limit screen time among adults.