Discretionary calorie intake a priority for obesity prevention:
results of rapid participatory approaches in low-income US
Deborah A. Cohen1, Roland Sturm1, Marielena Lara1, Marylou Gilbert1, Scott Gee2
1RAND Corporation, Santa Monica, 1776 Main St, Santa Monica, CA 90407, USA
2Kaiser Permanente, 1950 Franklin Street, 13th floor, Northern California, Oakland, CA 94612, USA
Address correspondence to Deborah A. Cohen, E-mail: firstname.lastname@example.org
Background Since resources are limited, selecting the most promising targets for obesity interventions is critical. We examined the relative
associations of physical activity, fruit and vegetable consumption and ‘junk food’ consumption with BMI and the prevalence of relevant policies
in school, work, food outlets and health-care settings.
Methods We conducted intercept surveys in three low-income, high-minority California communities to assess fruit, vegetable, candy, cookie,
salty snacks and sugar-sweetened beverage consumption and self-reported height, weight and physical activity. We also assessed relevant
policies in selected worksites, schools and health-care settings through key informant interviews.
Results Data were collected from 1826 respondents, 21 schools, 40 worksites, 14 health-care settings and 29 food outlets. The average
intake of salty snacks, candy, cookies and sugar-sweetened beverages was estimated at 2226 kJ (532 kcal) daily, 88% higher than the US
Department of Agriculture/Department of Health and Human Services guidelines recommend. Energy from these sources was more strongly
related to BMI than reported physical activity, fruit or vegetable consumption. Policies to promote healthy eating and physical activity were
limited in worksites. Fruits and vegetables were less salient than junk food in community food outlets.
Conclusion Targeting consumption of salty snacks, candy cookies and sugar-sweetened beverages appeared more promising than alternative
Keywords community interventions, discretionary food, nutrition, obesity
Many communities are eager to take steps to halt the
obesity epidemic. The causes of population weight gain are
multi-factorial and reversing the obesity epidemic calls for
changes in individual behavior, social norms, physical
environments, public policy and organizational practice.
There are countless potential interventions, for example: fix
sidewalks, make streets safer, increase physical activity
opportunities, add more sports clubs and after school pro-
grams, build walking trails, increase the availability of fruits
and vegetables, have merchants place fruits and vegetables
in the front of the store, and change the options in vending
machines. The scope can be overwhelming for communities.
Diluted efforts and messages may contribute to the limited
effect of recent community-level interventions.1How could
community-based organizations prioritize among all possible
Deborah A. Cohen, Senior Natural Scientist
Roland Sturm, Senior Economist
Marielena Lara, Natural Scientist
Marylou Gilbert, Project Manager
Scott Gee, Medical Director of Prevention and Health Information, KP Northern
# The Author 2010, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.
Journal of Public Health | Vol. 32, No. 3, pp. 379–386 | doi:10.1093/pubmed/fdp117 | Advance Access Publication 7 January 2010
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