Implementation of the HEAL Program to Reduce Obesity among the non-Hispanic Black Population in Louisiana

Abstract
This is a summary of a program manager’s interview with a delegate from the non-Hispanic black community on how he intends to roll out the program given the fact that obesity continues to loom despite intense awareness on the issue. Interventions have been implemented in Mississippi for example, but still the prevalence of obesity, among the non-Hispanic black adults, is alarming. As a result, this program targets this population using a unique approach to community involvement to enhance sustainability, which is lacking. Apparently, the programs developed do not devise strategies of dealing with emerging hurdles. Literature indicates that the best way of ensuring that this sustainability if achieved is through community involvement. Healthy food choices and engagement in physical activity will be the main domains that will lead the program, which will target social, cultural, and environmental factors to create a healthy food environment, and a safe environment that encourages involvement in physical activity.

Introduction
Maintaining a normal body weight through a healthy lifestyle is essential. Otherwise, one is predisposed to adverse health effects that reduce one’s quality of life. Overweight and obese are serious preceding factors to more serious and debilitating health problems, for example, metabolic syndrome, hypertension, cardiovascular diseases, and diabetes. According to statistics from the Centers for Disease Control and Prevention (2015), 78.6 million U.

S. adults are obese. Also, the Annual health costs for obese individuals were $1,429 higher than for normal weight individuals. Obesity tends to affect some populations more than others. The sequence of populations based on the prevalence rates of obesity in relation to race is non-Hispanic blacks (47.8%), Hispanics (42.5%), non-Hispanic whites (32.6%), and non-Hispanic Asian (10.8%). Obesity affects adults in the middle age (40-59 years old) than younger adults (20-39 years old) or older adults (>60 years) (Centers for Disease Control and Prevention, 2015). Disparate obesity rates are obvious from these statistics, and it is apparent that discrete factors are responsible for such variation.
Since obesity is a major public health issue, this paper aims at discussing a ‘HEAL’ program that will help to encourage involvement in physical activity and promote healthy eating. HEAL means healthy eating and an active lifestyle to help in redressing the high prevalence rates of obesity. This program aims at breaking through the inequities and varied access to affordable and healthy food, as well as the unsafe environments that impede engagement in physical activity. This program will adopt a participatory approach with the community to come up with feasible and sustainable solutions. In particular, the program will work with the community leaders. This program will rely on literature to carry out a community assessment in an attempt to identify the prevailing gaps; thereby, act to redress these gaps (Trust for America’s Health, 2014). This program will seek assistance from local groups dealing with similar issues to help avoid duplication of intervention, but instead reinforce the already initiated interventions on the ground. Appropriate marketing and education techniques will be employed to reach out to the non-Hispanic black population.
Background
The disparity in obesity rates among the different racial groups is linked to variation in the food environment. Stein (2015) indicates that the non-Hispanics, which are deemed a racial minority, are predisposed to poverty, lack of education, and life in densely populated metropolitan areas. The concept of ‘block groups’ seems to be a risk factor for obesity among the non-Hispanic blacks due to the interplay of multiple factors evident in a densely populated and impoverished neighborhood.
The non-Hispanic blacks tend to have a higher consumption of potatoes, sweets and sweetened beverages, refined grains, fatty meats, and whole milk due to their low socioeconomic status. The cost of more nutritious foods, for example, those rich in iron, fiber, vitamin C, and vitamin A. Therefore, this population concentrates on the caloric density of a meal, and not the nutritive value of that meal; hence, the high obesity rates among the non-Hispanic blacks (Stein, 2015). The food environment within the non-Hispanic black population is a mix of both food deserts and food swamps. It is a food desert in the sense that the area lacks exposure to a variety of healthy food choices, and it is a food swamp due to the high number of fast-food restaurants and small stores selling energy-dense but lower nutrient-dense foods. According to a study cited in Trust for America’s Health (2014), non-Hispanic blacks have the least access to supermarkets and related markets compared to other racial groups including African Americans. In addition, fewer Black youths (11.3%) compared to White youths (4.5%) consumed fruits. All these are clear indications of a mix of poor decision making, an unhealthy food environment, and limited resources that result in obesity among the non-Hispanic blacks.
The limited access to affordable healthcare due to limited resources is further aggravated by poor advertising in relation to consumption of unhealthy foods. Stein (2015) indicates that non-Hispanic blacks are exposed to fast food commercials twice as much as the Whites. In addition, social marketing, among the non-Hispanic blacks, mainly focuses on the high-calorie and low nutrient-dense foods is 13-fold evident in non-Hispanic black neighborhoods than the White neighborhoods. Therefore, a lack of education that is associated with poor decision making coupled with exposure to the wrong foods leads to the high obesity rates among the non-Hispanic blacks in comparison to other racial groups.
The HEAL program will target non-Hispanic blacks in their middle age living in Louisiana. The non-Hispanic blacks are a minority group that is predisposed to a multiple of factors that make them more susceptible to obesity than any other racial group. Social and environmental factors do not allow the non-Hispanic blacks to engage in physical activity. This minority population lacks social grounds, for example, sidewalks, recreational centers, public parks, and playgrounds, where outdoor activities can take place (Trust for America’s Health, 2014). Then, the high crime in the neighborhoods of these minority groups makes the situation worse. Despite the fact there is literature indicating the high obesity rates among the non-Hispanic blacks, little has been done to help them. Hence, the reason for developing this program.
Literature Review
In an exploratory study conducted by Robert Wood Johnson Foundation and the NACCP: the Greenberg Quinlan Rosner Research, on behalf of Trust for America’s Health, it was revealed that few countries have implemented programs aimed at reducing the high obesity rates among the black population. The limitation of this exploration is that it does not delineate the non-Hispanic blacks from the Hispanic blacks. Nonetheless, it is important to understand the practices that have worked in some states so that they could be implemented in other countries. The success of practices implemented within a community is dependent on community involvement; otherwise the success of such practices is not guaranteed.
According to the exploration, three areas of concern were pointed out by the black community leaders (Trust for America’s Health, 2014). These included:
Unsupportive socioeconomic and environmental factors
Misconception about healthy and unhealthy foods
Establish platforms that can be used as a basis for future programs in the fight for reducing obesity within the black population
Food is a salient determinant of obesity as seen in the earlier discussion. A lower proportion of fast-food restaurants and convenience stores in relation to supermarkets and grocery stores are linked to lower rates of obesity. This is attributed to the fact that supermarkets and grocery stores have a variety of high nutrient-dense and low-energy-dense foods. Since these foods are expensive in comparison to their counterparts, the black population tends to purchase and consume more of the high-calorie foods that result in obesity. Despite the fact that attention is placed on increasing access to healthier foods, counteractive barriers thwart achievement. Initiatives developed are usually short-term, unscalable, and unsustainable. Community involvement helps to identify locally available resources that can be improved to provide long – lasting solutions. Also, the non-Hispanic black neighborhoods are insecure; hence, they are deemed unsuitable for engaging in physical activity. However, involving the community will help to identify appropriate interventions that can nullify the thwarting crime and traffic effects, for example, having workouts in the morning hours as a group before traffic can start building up. The local authority should restructure the physical environment to create space for physical activity and outdoor activities (Truth for America’s Health, 2014).
The program will encourage family meals because this is presumed to promote healthy eating choices (Knight, 2010). When children eat away from home, they tend to be influenced by the choices of their peers, who will mainly prefer energy-dense foods that are low in nutrients. Knight (2010) stresses that childhood overweight and obesity translates into adulthood overweight and obesity. Therefore, the program will aim at engaging children in the HEAL program. Therefore, this program will implement activities that will also involve children and adolescents. The program will utilize community feedback in developing intervention materials, for example, posters and brochures. Stein (2015) indicates the role of color, wording, and gender-specific messages while developing the information, education and communication materials.
Educating the population is deemed essential because the non-Hispanic black population is considered to be less educated due to its impoverished state. Also, the healthcare fraternity and the education sector pay little focus on disseminating information on making healthy choices about obesity. Since the non-Hispanic black social environment has a higher preference for larger body sizes than small ones, education will help to remove this misconception. Even if the community is given funds to combat obesity, lack of education about healthy living will render the resources useless. Also, the manner in which information is presented is very important; it is not all about body image. As a matter of fact indicates that black women are aware of an ideal body image but a large body size is tolerated. This could be attributed to the fact that education on obesity is lacking; hence, the population is not adequately knowledgeable about the detrimental health effects of obesity. Most importantly, the population needs to be taught about making healthy decisions despite limited resources. Also, it is not about developing new strategies; rather, it is about incorporating novel approaches into the current ones. For example, education will enable the families to learn about ideal novel ways of making their current dishes healthier in relation to nutrient and calorie contents.
Social marketing of energy-dense foods will need to be replaced with healthy advertising. Most often, the media are replete with advertisements of delicious chip sticks, chocolate, sweetened beverages and soft drinks, and hardly will there be an advertisement about healthy eating and balanced meals. This will change as the emphasis is made towards healthy and nutritious foods and their associated benefits.
Program Goals
The program manager outlined that the following goals would be used to generate specific program objectives and guide the program’s activities. These goals are in alignment with the predisposing factors to obesity among the non-Hispanic black population. They include:
Educate the non-Hispanic population about obesity in association with a healthy lifestyle
The program will create awareness among the non-Hispanic population about obesity and associated health effects. They will also be educated about possible risk factors as indicated in the background information discussed earlier. The population will be educated about normal and healthy body parameters, precisely on BMI and waist circumference as indicated by Knight (2010, p. 238-239).
Improve the decision-making processes of healthy eating
The program will enable the non-Hispanic black population make healthier choices regarding meal times. The non-Hispanic black community will be taught to improve the family dishes by incorporating missing components that deem a meal as nutritive.
Encourage engagement in Physical Activities
The assistance of community members, including local community institutions and authorities, will be sought to help integrate locally available institutions and structures into the program’s agenda. Schools will be asked to provide playgrounds where the local community can freely indulge in physical activity. During this phase, participants will be informed about recommended amount of physical activity per day.
Social Marketing and Advertising
The program will replace unhealthy advertising with healthier advertising. In addition, the program aims at inventing video games for children that will reinforce the need for striving towards healthy eating. Writing books and stationery will be redesigned in a manner that advocates for the consumption of fruits and vegetables as opposed to junk foods and sweetened beverages and drinks.
Reinforce Accessibility of safe foods and healthcare services
Restaurants and food stores will be supported to provide an array of healthy food options at an affordable price. In addition, healthcare workers will be asked to provide mobile services that aim at mobilizing the community members once in a while on the need to stay and live healthily.
Program Objectives
Educate 80% of the population on obesity and related outcomes
Liaise with at least five schools on how to encourage physical activity
Format least five community clubs aimed at reinforcing the program’s agenda after the program phases out
Initiate redesign processes of the current physical structures to provide sidewalks and exercise trails
Link up at least 30% idle youths with various institutions and organizations on gainful employment and responsible living
Reduce crime rate by at least 50%
Ensure 70% of the non-Hispanic blacks’ households meet the required intakes of fruits and vegetables
Ensure that 80% of the non-Hispanic population consumes healthy balanced meals
Ensure at least 70% of the non-Hispanic black families can access healthy foods
Ensure that at least 85% of the population engages in daily physical activity
Program Description
Name of the program: HEAL
This program will be characterized by a variety of activities. The program will begin by organizing a committee of stakeholders that will oversee the successful implementation of the program. Different stakeholders will be given responsibilities. The most important stakeholders will be the community, members.
Mobilize the general community and available resources
The person in charge of community mobilization will go out to involve the community by creating awareness. This will be followed by recruitment of community members willing to take part in the program. During the community mobilization process, the community members will be briefed on the main activities of the program and the indicators used to measure the successful implementation of each activity. During this process, the community members will identify potential locally available resources that could be incorporated into the program.
Education
The targeted population will be educated on the importance of a healthy lifestyle twice a week to allow a flexible schedule. Each session will last for two hours, but the patients will be required to undergo two sessions per day.
Physical Activity
Each within the population will be required to engage in vigorous physical activity per day. Recommendations for physical activity will be at least one hour for children and adolescents, and at least two hours for the middle age population for at least one hour per day (World Health Organization, 2015).
Social Marketing
Materials will be developed for dissemination throughout the neighborhood. Billboards and posters will be redesigned to focus on balanced, healthy foods. The media will advertise more of the healthy and nutritive foods, and less of the high-calorie foods.
Transforming the Food Environment
Food restaurants and fast-food joints will be supported to provide the option of taking away healthy food. In addition, provision of nutrient-dense foods within the targeted neighborhood will be encouraged by setting up of green space for groceries and market stores.
Program Monitoring and Evaluation
Progress towards intended objectives will be determined using the process indicators while program evaluation will be determined using the outcome indicators.
Program Schedule of Activities
The program will run for three months and during this time, the following table indicates the breakdown of activities.
Activity Time Person Responsible
Needs Assessment and formulation of program’s objectives 1st week Program Manager
Identifying relevant stakeholders to aid in the successful planning and implementation of the program 2nd week Logistics Manager
Mobilization of the community and locally available resources 3rd week Community Mobilization Officer
Development of information, education, and communication materials 4th week Program Education Officer
Education on obesity and associated effects as well as healthy living 5th -12th week Nutrition Officer
Increasing involvement in physical activity 5th -12th week Nutritionist
Social marketing using the right language and media 5th -12th week Communications Officer
Enhancing accessibility to nutrient-dense foods by integrating available food joints and helping in setting up new ones 5th – 12th week Program Manager
Project Monitoring 8th week Program Manager
Project Evaluation 13th week Program Manager
Program Evaluation
Both process and impact evaluation, suggested by Day and Leggat (2015), will be used to determine the effect of the program. Surveys will be used to obtain data on both processes and impact evaluations. Process evaluation will be determined by examining defaulter rates, coverage, attendance rates for cooking classes and training sessions, as well as adherence of food restaurants to the provision of healthy meals. All these indicators will help to determine if the implementation of the program is going on well (monitor progress); hence, make necessary changes in the event that participation and adherence rates are low. Impact evaluation will determine the achievement of the specific objectives (outcomes).
The table below illustrates the indicators, explained by Parsons, Gokey, and Thornton (2013), which will be used to measure the listed objectives.
Objectives Process Indicators Outcomes Indicators
One -Attendance rates
-Defaulter rates -Knowledge level
-Decision-making abilities
-Attitude change
Two -Schools identified
-Number of times contact to the identified schools will be made -Number of schools involved
-Number of playgrounds
Three -Criteria developed for forming groups
-Club composition -Number of clubs
Four -Established plan to redesign the physical structure of the neighborhood
-Identified and mobilized resources
– -Number of sidewalks
-Number of exercise trails
Five -identified some employment opportunities
-Identified number of youths willing to take up gainful employment -Crime reduction rates
-Percentage of employed youths
Six -Percentage of employed youths -Reduced crime rates
Seven
-Amount of fruits and vegetables purchased from the market
-Amount of fruits and vegetable servings consumed by household members per day -Number of non-Hispanic black households that consume the required intakes of fruits and vegetables per day
Eight -Number of family meals
-Number of balanced meals consumed
-Number of healthy balanced meals purchased from the restaurants, food stores, and supermarkets -Percentage of non-Hispanic black families that eat healthy balanced meals
Nine -Number of stores providing healthy foods
-Number of healthy meals each family consumes
-Number of new food stores and groceries -Number of families that can access healthy foods
Ten -Number of students using the sidewalks to school
-Number of individuals using the exercise trails -Percentage of individuals engaging in daily physical activity

References
Centers for Disease Control and Prevention. (2015). Adult Obesity Facts. Retrieved October 6, 2015, from http://www.cdc.gov/obesity/data/adult.html.
Day, G., & Leggat, S. (Eds.). (2015). Leading and Managing Health Services: An Australian Perspective. Melbourne: Cambridge University Press.
Knight, J. (2010). Human Longevity: The Major Determining Factors. Bloomington: AuthorHouse.
Parsons, J., Gokey, C., & Thornton, M. (2013). Indicators of Inputs, Activities, Outputs, Outcomes and Impacts in Security and Justice Programming. London: Vera Institute of Justice.
Stein, N. (Ed.). (2015). Public Health Nutrition: Principles and Practice of Community and Global Health. Burlington: Jones & Bartlett Learning.
Trust for America’s Health. (2014). The State of Obesity: Better Policies for a Healthier America. Retrieved October 7, 2015, from http://www.stateofobesity.org/disparities/blacks/#footnote-14.
World Health Organization. (2015). Global Strategy on Diet, Physical Activity, and Health. Retrieved October 7, 2015, from http://www.who.int/dietphysicalactivity/factsheet_young_people/en/.