Losing weight and increasing overall health is never easy. Changing bad eating habits can be difficult even when we have access to health food co-ops. Add to that the difficulty we often face engaging in physical activity; even a membership at a fitness center isn’t a sure guarantee we’re going to consistently exercise the way we need to.
For those who live in rural communities, these problems are compounded and can make healthy behavior even more difficult, says Rebecca A. Seguin, Nutritional Sciences. In a series of studies, Seguin has looked at medically underserved rural populations across the country, especially middle-aged and older overweight or obese women. “These women don’t have good access to medical care,” she says. “They also might not have good access to healthy, fresh, affordable food or physical activity resources. When we design our community interventions, we figure out what the problems are first. We ask, ‘what’s stopping people from living healthy, aside from the most apparent things?’”
Designing Healthy Food Interventions
To discover the issues, Seguin and her fellow researchers start by talking with people in the communities they are targeting. “We really dig in,” she says. “We talk one-on-one with people, and we talk with them in small groups, which can foster rich discussion. Then we design interventions that are targeted, culturally appropriate, specifically tailored to a group of individuals to change their behavior within their community context.”
One factor Seguin considers when designing her studies is food availability. People who live in rural communities are less likely to have access to a range of healthy nutritional food year around. This was true for participants in studies in Arkansas and Kansas, Seguin says, where researchers had to change the list of suggested healthy foods because some of them were unavailable at local grocery stores. In another study in Alaska, researchers had to consider the overall food environment. A box of cereal or a loaf of bread can cost $10 there. Stores can run out of food. And what food stores do have can get moldy due to the long wait for new shipments.
“You have to understand what people are doing with their food and look for the things that are really positive that you can leverage,” Seguin says. “Alaska is a good example: you don’t want to encourage eating fresh tomatoes in December. They have a long history of canning and preserving for obvious reasons, and it’s best to work with that. We tell them, ‘here’s a small change you can make that would make these behaviors much healthier for you’ at the same time honoring their context.”
Walking and Other Physical Activities
Seguin also looks at community walkability—access to physical activity through walking. “People think it’s easy to walk in rural communities,” she says, “but that’s not always the case.” It may be difficult to do outdoor physical activity when the weather is prohibitive, but there also may be less obvious, cultural barriers to walking. In one particular community in Alaska, for example, Seguin found that people did not walk to the grocery store even when they could. “There was a social stigma. If you’re seen walking from the grocery store, carrying groceries, people might think you either don’t have enough money for gas or that you got a DUI and lost your license.” That was an important and completely unexpected social barrier Seguin and her team only learned about through first talking with residents.
Community Engagement for Promoting a Healthy Lifestyle
Barriers such as this are exactly what Seguin works with communities to address. Recently she and colleagues ran a study looking at civic engagement as a means to promote healthy lifestyle. The study included rural communities in eight states. In each community, the researchers gathered local people together for three days of intensive focus on their food and health situation. “We had community walk-abouts,” she says. “We looked at grocery stores to see what was available. We visited people’s homes and looked in their refrigerators and pantries, and we talked with them about their food environment and their physical environment.”
“When we design our community interventions, we figure out what the problems are first. We ask, ‘what’s stopping people from living healthy, aside from the most apparent things?’”
After those preliminaries, the researchers helped participants identify an opportunity to make healthy living easier within their community and come up with a plan for change. Projects the communities took on—some are still in progress—ranged from building fitness stations at a local playground to producing a brochure and map highlighting local opportunities for physical activity.
Community-Supported Agriculture Programs
Currently Seguin is working on a five-year nutritional behavioral study with the United States Department of Agriculture (USDA). The study is in year two and targets low-income families with children in New York, North Carolina, Washington, and Vermont. Working with local farmers, the researchers set up a way for the families to take part in community-supported agriculture (CSA) programs that provide a weekly supply of produce to each member family throughout the growing season. For each family participating, the study pays for half the CSA fee upfront, and the family pays the other half with weekly installments using their food stamp benefits or cash. Families are given a choice of a few high-quality cooking tools at the start, and throughout the growing season, participants attend classes to learn how to use the produce to cook more nutritional meals.
“We’re trying to get more fruits and vegetables into these households with the hope that they will replace unhealthier choices,” Seguin says. “The key is that we spent the first year of the project doing interviews in all those states and then used that information to inform the intervention.” The researchers gathered data from farmers, low-income parents and children, and educators who would be teaching the project classes. They also spoke to full-paying CSA members. “The idea is that, over time, the full-paying CSA member might donate extra funds that will offset the cost for low-income families,” Seguin explains. This would be in addition to grants and other sources of funds for subsidized shares.
Staying Engaged, a Result of Community Support
As with other projects, community buy-in and solidarity should make a difference. Seguin knows from another of her studies, the Strong Woman Follow-Up Study, that successful long-term weight loss is possible when people have social support. In this follow-up study, conducted three years after the original intervention ended, she found that rural women who had lost weight during the 12-week project had kept that weight off and in some cases lost even more. Seguin calls the findings “exciting and surprising” given that weight cycling (loss and regain of weight) is so common.
“I think there is something important and meaningful about getting these women together to work on their own health issues,” she says. “Most of them have been focused on taking care of husbands and children. The group brings them together in a safe environment that is non-judgmental. They told us over and over that this is the one hour twice a week where it’s about them. That keeps them coming back and keeps them engaged.”
Seguin hopes to use data gathered from her studies to design on-going interventions for specific subsets of people in communities throughout the country. The USDA study, for instance, may help her and her fellow researchers understand in greater depth the issues that keep low-income families with young children from following healthy diets and lifestyles. “We’ll follow these families through time to see if those who received the economic and behavioral benefits of the study ultimately change their behaviors long term,” Seguin says. “We can use the data and knowledge we gather to inform further community-based interventions and to also inform related policies and practice.”
Many thanks to Full Plate Farm Collective, our photography site.