For two years running, the Bronx has attained an unwelcome distinction: the unhealthiest of all 62 counties in New York. High rates of adult and childhood obesity, especially in the South Bronx, have helped plunge the borough to the bottom of the and the University of Wisconsin Population Health Institute. A few miles west, across the Harlem River, the proportion of overweight and obese residents in Central and East Harlem is similarly high--about 6 in 10 adults and more than 4 in 10 children.
As a result, these low-income neighborhoods, largely African American and Latino, show disproportionately high rates of hypertension, heart disease, stroke, diabetes, and a host of other chronic health conditions related to poor diets and sedentary lifestyles. Perhaps most distressing, however, are the environmental, cultural, and economic influences that promote obesity in these neighborhoods: a surplus of fast food restaurants and a shortage of fresh produce and other healthy options; limited access to parks and affordable recreation; and unusual work, family, and social strains.
"The odds are truly stacked against a lot of people," said Erica Phillips-Caesar, M.D., M.S., assistant professor of medicine at Weill Cornell Medical College (WCMC). "It's no surprise that obesity is an epidemic and a huge public health concern in these places."
Through a novel alliance with local churches and health clinics, a multidisciplinary team of Human Ecology and Weill Cornell investigators are striving to reverse the odds and reduce obesity and obesity-related deaths in black and Latino adults in Harlem and the South Bronx. The Small Changes and Lasting Effects (SCALE) project, funded by a $6 million grant for Obesity Related Behavioral Intervention Trials from the National Heart, Lung, and Blood Institute, seeks to nudge residents toward healthier diets and increased physical activity through minor lifestyle changes. The study, led by Dr. Mary Charlson, the William T. Foley Distinguished Professor of Medicine at WCMC, includes a broad group of researchers: Phillips-Caesar; Human Ecology faculty members Elaine Wethington, associate professor of human development and of sociology, and Carol Devine, professor of nutritional sciences; Brian Wansink, the John S. Dyson Endowed Chair of Marketing in Cornell's College of Agriculture and Life Sciences; and Martin Wells, the Charles A. Alexander Professor of Statistical Sciences in Cornell's School of Industrial and Labor Relations.
The team is concluding a pilot study of 115 participants, which will inform full-scale trials set to begin later this summer. Participants are asked to select a small-change eating approach--such subtle strategies as filling half their plates with fruits and vegetables or switching to smaller dishes to control portion sizes--to try for 12 weeks. They pair this approach with a tactic to get more exercise--exiting the bus two stops early and walking, for instance. The researchers are aiming for a 7 percent or more weight reduction in participants.
In his Food and Brand Lab on the Ithaca campus, Wansink has demonstrated how his small-change eating techniques have led to sustained weight loss in research participants. SCALE is attempting to translate these successes into people's communities and homes--places where many factors are steering them toward overweight and obesity.
"Diets are restrictive and demanding and force people to make large sacrifices," said Devine. "Small changes, on the other hand, have the potential to form into sustainable habits that take hold for a long time. This is a test of whether what works in the lab can be effective in people's homes."
Gaining trust neighbor to neighbor
When she first entered Harlem-based health centers to recruit people for SCALE, Tori Velez encountered deep skepticism. People scoffed at the idea of loading up on fruits and vegetables. "They would tell me, I don't eat salads, that's rabbit food,'" she said. …