A Literature Review on Nutritional Change

Janine Milazzo
HLTH 634
Liberty University
April 6, 2014



Introduction
The purpose of this literature review is to provide justification for my health
communication program, ECNC: Engaging Communities in Nutritional Change, by using peer-
reviewed sources in order to provide that justification. ECNC hopes to reduce and prevent
obesity within communities in Missouri by providing nutrition education classes to make better
food choices, physical activity opportunities, and providing better access to healthier foods
through policy change. ECNC hopes to reduce low food insecure homes by providing training in
job acquisition, such as resume creating classes and interview training. According to Americas
health rankings, Missouri ranks number 33 in the area of obesity with a rate of 29.6%.
1

According to the CDC, obesity is common, serious and costly. Obesity is a problem that spans
all demographics with 35.7% of adults being obese and more than 1/3 of children and
adolescents being obese. In fact, in the past 30 years, childhood obesity has more than doubled
and adolescent obesity has quadrupled.
2
Obviously, this is a major problem facing our nation
today. Also, in 2011, 14.9% of households were food insecure, 33.9% of single parent families
had household low food security and 13.9% of families with married parents, Hispanic and
Latino communities had the highest percentage with 26.9%, and those with lower incomes had
higher percentages.
3
When speaking of nutritional change, the program seeks to better the
quality of life for communities by not only helping to reduce obesity, but also providing better
and healthier food choices.
This review will be divided into three parts: introduction, body of evidence, and
summary and conclusions. This division will help to provide structure and help in better
understanding the literature and how it applies to the program. The references were selected
through a specific criterion. At least six of the sources were to be found from peer-reviewed
journal articles, in actuality, seven were used. The other sources were to be found through the
Internet, but from reputable sources like government websites. The data obtained was published
within the last 8 years, even more current in some circumstances.
Body of Evidence
ECNC seeks to make changes in three areas: obesity, food access, and making healthier
food choices. The research included in this literature review focuses on these three areas. As
mentioned early, obesity is a serious problem that affects all demographics, woman, men,
children, old, and young. According to an article in Abdominal Imaging, the prevalence of
obesity has risen steadily over the last few decades across every age, sex, race, and smoking
status.
4
This dramatic increase has not only occurred in the United States, but all across the
globe. Obesity is most commonly caused by excess energy consumption or in other words our
dietary intake, relative to energy expenditure or the energy that is lost through metabolic and
physical activity.
4
Although this is the most common cause, the causes of obesity are more
complex and involve genetic, physiologic, environmental, psychological, social, economic, and
even political factors.
4
Higher caloric and fat-laden foods are more affordable and easily
accessible, foods are generally available in large portions, and physical activity levels have
drastically decreased because of less environmental access and the appeal of sedentary
behaviors.
4
All these factors interact with one another and drive the increase in obesity rates.
4
Another article in Clinics in Colon and Rectal Surgery,

identifies that the epidemic of obesity on
a global level reflects substantial changes in behavioral patterns because more and more people
are adopting Western lifestyles, which involve many of the factors mentioned in the previous
article cited.
5
This article also poses that the main cause or etiology of obesity is the dietary
intake and energy expenditure balance.
5
This article also posits that rising incomes, increasing
urban populations, diets high in fats and simple sugars, and a shift toward less physically
demanding jobs are some societal changes that are contributing to the obesity epidemic. The
difference between the two articles is the way in which they use economic factors as the cause of
obesity.
According to a recent article in Medicine, obesity presents a number of medical
consequences, which is why it is a top public health issue. Major health complications from
obesity include stroke, poor self-esteem, hypertension, coronary heart disease,
thromboembolism, heart failure, infertility, pregnancy problems, uterine cancer, menorrhagia,
gout, osteoarthritis, gallstones, colon cancer, breast cancer, sleep apnea, hirsutism, pancreatic
cancer, kidney disease, and diabetes mellitus.
6
The most common and most harmful effects of
obesity are on the heart. Obesity increases the chances of hypertension, heart failure, coronary
heart disease, and stroke.
6
Obesity can also have psychosocial effects as it is considered a social
stigma.
6

The American Journal of Lifestyle Medicine produced an article that focused on lifestyle
interventions in order to help prevent and reduce obesity. One intervention mentioned is dietary
prescriptions written by medical professionals that outline calorie and fat gram goals to achieve a
2 lb per week weight loss.
7
The article also discusses physical activity interventions. Although
physical activity usually doesnt produce high weight loss, it does help to maintain weight and
prevent regain.
7
Physical activity recommendations will differ depending on the goals of the
individual, but the article does cite that 30 minutes of physical activity, 5 days per week is the
current standard.
7
The article also states that behavioral strategies, such as goal setting, self-
monitoring, and stimulus control are also ways to help prevent and reduce obesity.
7
Reducing food insecurity is another goal of ECNC. Food insecurity, as defined by the
USDA, means that consistent access to an adequate food supply is limited by lack of money or
other resources.
8
As mentioned early, 14.9% of households were food insecure, 33.9% of single
parent families had household low food security and 13.9% of families with married parents,
Hispanic and Latino communities had the highest percentage with 26.9%, and those with lower
incomes had higher percentages.
3
An article in Revista de Nutrio, says that the existence of
food insecurity in the U.S. and other countries with per capita energy supplies well over
biological needs is due, in part, to an unequal distribution of resources.
9
The article also cites
some interventions to help decrease food insecurity. Agricultural production can help to make
more food available for populations. Employment and income generation are great ways to help
reduce food insecurity in an economic way.
9
Human capital development is also another strategy
to reduce food insecurity. This would involve programs that develop skills, education, and health
of individuals.

Lastly, food-based assistance like food stamps and voucher programs can also be
used to help reduce food insecurity.
9

Finally, helping communities learn how to make better and healthier food choices is
central to ECNC. According to an article in the American Journal of Preventive Medicine, the
food environment plays a significant role on food choices. The availability and price of healthier
food items is a significant factor that limits the ability to eat a healthier diet.
10
The study done in
the article showed that lack of availability in small grocery stores located in low-income
neighborhoods and higher costs of healthier foods were a deterrent to eating healthy among low-
income consumers.
10
Policy change can make a major impact on getting people and communities
to make better food choices, as well as providing them with access to better food choices. A
recent article in Health Affairs, lists a number of ways to promote healthier food choices through
policy changes. Changes to social and physical environments that would make communities
default food choices healthy ones have the greatest potential for long lasting impacts.
11
One of
the policy changes mentioned in the article is targeted toward helping to reduce sugar sweetened
beverages by making water peoples default beverage choice.
11
Policy change could also aim at
increasing the prices of unhealthy foods and decreasing the prices of healthy foods. Increasing
taxes is another policy change method.
11
Local governments can partner with supermarket chains
to help expand grocery stores in low income neighborhoods. Governments can also expand and
subsidize farmers markets, as well.
11
Zoning restrictions can be enforced to limit the density of
fast-food restaurants. Policy change can also involve improving the image of healthier foods and
making unhealthy foods look more unattractive.
11
All these methods can be used to promote
healthier food choices, make healthier foods more accessible and decrease the accessibility and
appeal of healthy foods.
Summary and Conclusions
The review of the literature substantiated the necessity for a program like ECNC. The
literature regarding obesity provided evidence that obesity is in fact a major health concern and
can cause major health consequences and by making an impact in reducing and preventing
obesity in communities, people will live longer and healthier lives. Reducing and preventing
obesity is the first step in creating nutritional change in communities. The articles presented the
leading cause of obesity as an imbalance between dietary intake and energy expenditure, but one
article suggests that the causes of obesity are more than that. The causes of obesity are very
complex and involve a number of factors. Change should be targeted towards all of those factors
realizing that every person is different and every community may need a different approach to
change.
The literature also helps to understand the necessity of making changes to help reduce
and prevent food insecurity. As seen in the data, food insecurity effects various populations
differently and its important to understand that. It is also important to understand that even
though the U.S. is not a poor nation, food insecurity still exists because of inconsistencies in
resource distribution. The article mentioned previously on the subject recognized human capital
development as a way to help reduce food insecurity. ECNCs goal is to use human capital
development by providing skill and education development to community members to help make
a difference in their economic well-being and therefore helping them reduce their food insecurity
issues. ECNC strives to keep development as a center of their program. The article did mention
food assistance programs, but we believe relief produces dependency and doesnt create an
environment that fosters change. More research should be done on how food insecurity affects
families and studies should be done on what effectively works to help reduce it.
The literature also provided evidence that healthier food access is a means to healthier
communities and that policy change is a great way to achieve that. In order for the program to
help reduce obesity, healthier food options and better access to it needs to happen. A farmers
market or government partnerships with local grocery stores are two first steps in helping to
make Missouri communities make nutritional change. Future research should be done on
communities who have implemented farmers markets or policy change in this area and if it
actually made a difference on the health of the community members.