Why the Fight against Diet-Related Diseases Requires Attention to Social as Well as Individual Causes

The U.S. healthcare system spends over $210 billion per year on health care to deal with problems of obesity. Americans who are overweight or obese are more likely to suffer from type 2 diabetes, heart disease, and a range of other chronic diseases. Obesity has become the second leading cause of preventable deaths in the United States.

Unfortunately, there is no straightforward or easy way to explain what causes diet-related chronic diseases. Respected models that emphasize social and ecological contributors to health acknowledge that people’s health behaviors are very complex and outcomes can be influenced by many factors. Most models of this kind categorize various factors that can affect people’s health – including individual factors such as genetics and personal health beliefs; inter-personal factors such as social networks and supports; organizational factors including rules, regulations, and programs; community environments; and policies including public benefits and measures that influence the distribution of power and resources. My research and expertise focus on how each of these factors interacts with one other to influence diet-related chronic disease.

Individual Influences on Health

Individual health behaviors both shape and are shaped by the environment. At the individual level, risk factors for diet-related chronic disease can include age, gender, dietary intake, and physical activity levels.  In addition, diet and food consumption can be affected by individual characteristics that influence behavior, such as knowledge, attitudes, beliefs, and personality traits. At North Carolina State University, I oversee the university’s Supplemental Nutrition Assistance Program-Education – that is, nutrition education for low-income individuals. This program is federally funded by the U.S. Department of Agriculture and provides nutrition classes to give families and individuals the knowledge and skills needed to make healthy food choices within a limited budget. The program also works with organizations and communities to change the environment and policies, so healthy choices become easier for people to make.

Social Factors that Matter

People’s diets and physical activity levels are influenced by their social environment, including home and family life, social networks and supports, and social norms. Social norms that matter include those that affect eating out, eating as a social activity, and weekend eating. Currently, more than 50% of the money Americans spend on food is for foods consumed outside the home. In general, eating has become a social activity; individuals eat out with friends after work, school, birthdays and other special occasions. Unfortunately, multiple studies have shown that people consume more calories when they eat in groups at restaurants. And people tend to consume more calories during the weekends. On average, American adults consume an extra 115 calories per day during the weekend – Friday, Saturday, and Sunday night, compared to Monday through Thursday.

Organizational Influences

People engage in much of their activities and interactions and learning at schools and worksites, whose rules, regulations, programs and practices affect diet and health in many ways. Organizational structures and processes can affect individual weight either positively or negatively, and the availability of certain foods at a school, worksites, or health care settings can influence what people eat. Having nearby vending machines with sodas and other high-calorie beverages, as well as high-fat and high-calorie-content food, can lead to unhealthy weight gains. Or, by contrast, having regular access to a weekly farmer’s market or sources of healthy food snacks can make a positive difference for diets and weight. 

Community Environments

In simplest terms, community refers to where people live, work, play, and pray. The Centers for Disease Control and Prevention states that “communities, like large organizations, can create circumstances and policies that give residents the best possible access to healthful foods.” Much of my research to date has focused on the community level, and my work deals not with issues of geographic proximity but also considers the access residents have to affordable, high-quality, healthy foods.  How easy is it for residents to walk or get transportation to places where they can purchase healthy foods or be physically active in safe places?  

Policies to Promote Healthy Diets and Activities

Of course, people’s lives are also influenced by public policies and systems affecting the distribution of power and resources. Local, state, and federal governments can regulate environments and enact laws influencing food prices, access to healthy food, and incentives for healthy behaviors. Governments can finance initiatives to increase the sale of fresh produce in underserved communities and allow farmers’ markets to accept Food Stamps through electronic benefits transfers.  They can also take steps to integrate locally grown produce into the marketplace. And governments can make it easier and safe for people to be active, by improving parks, sidewalks, and outdoor lighting and ensuring access to free drinking water.

The Importance of a Broad Focus

Understanding the many reasons people suffer from diet-related chronic disease is important for researchers and policymakers. Some public health professionals argue that individual behaviors amount to only half of the factors that influence individual health. Recognition that chronic diseases are not entirely due to individual choices has enlarged the focus of public health research and policymaking, shifting concerns solely with individual responsibility to more realistic understandings of the community, organizational, and public policy factors that can help all people and communities avoid becoming overweight and suffering from all the life problems that come with obesity.