Statement of Need

         Obesity is a condition where there is excessive accumulation of fat primarily due to eating habits and lifestyle. Numerically, a body mass index (BMI) over 30 indicates an individual who is obese. A BMI between 25.0 – 29.9 and individual is considered overweight.  A BMI between 19.9 – 24.9 is considered normal weight. Below 19.9 is considered underweight. According to the CDC, the prevalence of obesity in America is 41.9% between 2017 and 2020 (CDC, 2022). Non-Hispanic African Americans have the highest rates of obesity along with individuals who were less educated (no college) along with individuals who were in the lowest income group (CDC, 2022). In Prince George’s County in Maryland, there was a 32.2% prevalence of Obesity amongst adults in 2016 compared to 29.7% in the rest of Maryland (Health Report, 2018). There are many diseases associated with obesity including heart disease, sleep apnea, diabetes, hypertension, osteoarthritis, dyslipidemia, and stroke. In addition, individuals who are obese may have mental health issues such as depression and anxiety (Sarwer et. al, 2018).

          The literature suggests that there is a link between individuals who suffer from adverse childhood experiences (ACE) and later become overweight/obese into their adulthood. Hemmingsson et al. (2014) systemic review investigating a link between ACE and obesity revealed unhealthy behaviors such as overeating/binge eating contributed to an individual’s development of obesity.  This may be due to maladaptive stress coping mechanisms as well as metabolic dysfunction.  There may be a dose response with ACE and obesity. Sugalia et al. (2016) suggests that women who experienced four or more ACE were more likely to be obese compared to women who experienced fewer ACE.  Emotional abuse early in childhood was also associated in adults with obesity (Widom et al., 2016).

Target Audience

          The target audience for this individual are adults who have experienced at least one ACE, over the age of 25, African American, and have a BMI over 25. Individuals who are overweight are included in the target audience because they have the potential to become obese. Several individuals of the target population will function as key stakeholders to help direct the intervention project and interject their needs from the project.  A stakeholder would also help work as a community advocate to help gather other individuals who may benefit from the project.

Project Activities

          Our intervention project would include several opportunities for our target audience to participate in. Peer support and education are the top priorities for our project. Bearing this in mind, weekly peer support groups would be held to encourage shared experiences as well as providing tips to help work towards a healthier lifestyle. Education would come in the form of health/wellness coaches that are certified in holistic healing and are familiar with the social determinants of health.  Cooking classes would be encouraged to be attend that encompasses many healthy lifestyles such as Mediterranean dishes, West African vegetarian cuisine, Southern-Style cooking with a healthy twist, and much more. Friendly individual and group competitions would be encouraged by participating in weekly walking with the usage of pedometers. Bi-weekly visits to community gardens, farmers markets, and/or farms would be encouraged to ensure individuals develop a deeper understanding of where their food comes from.

Project Goals

          There are several project goals our organization would like to achieve. First, to address ACEs, we would like to facilitate trauma-informed care in the healthcare setting with our trained individuals as well as help increase access to other mental health services. Second, increase access to healthy food options by creating partnerships with community supported agriculture as well as nutrition education programs.  Third, promote physical activity through fostering community engagement. Weekly walk along programs would be encouraged. Our goals would be evaluated by a survey of our target population as well as developing evaluation questions and analyzing the data.

Public Health Framework

          The Trauma-Informed Philanthropy document provides an excellent backdrop for our organization to utilize the public health framework. The impact will be larger as well as sustained due to vast systems that our considered as well as recruiting policy makers from a variety of landscapes (Philanthropy Network Greater Philadelphia, 2016).  Within the public health practice framework, there are three distinct levels of prevention that our organization intends to use. The primary prevention component of the project will focus on promoting healthy behaviors and preventing the development of obesity in the first place. This will include community-based nutrition programs, collaborating with local community supported agriculture, as well the promotion of physical activity.  The secondary prevention component focuses on identifying and addressing early signs of obesity in African Americans adults who have experienced ACEs (Filetti, 2002). Health screenings through our medical doctor as well as providing early intervention options for at risk individuals/community members. The tertiary prevention component would focus on individuals who are already obese. Promoting access to nutritionist/health coaches, integration of social workers/psychologists that are trauma history trained, and promotion of physical activity would all be promoted in our program.

Social Ecological Model

The Social Ecological Model (SEM) addresses the interrelatedness of factors that contribute to health outcomes at various levels: individual, interpersonal, community, and societal (CDC, 2022.). In the context of obesity and adverse childhood experiences (ACEs), the SEM can be applied to understand the complex interactions that contribute to obesity and its associated health risks (Jumbe et al., 2017).

At the individual level, ACEs are associated with maladaptive stress coping mechanisms and metabolic dysfunction, leading to unhealthy behaviors such as overeating or binge eating (Hemmingsson et al., 2014). Evidence suggests a dose-response relationship, with a higher likelihood of obesity in individuals who experienced more ACEs (Sugalia et al., 2018).  To encourage improvement at the individual level, individuals should be taught self-efficacy and empowerment to make healthier choices and take control of their lives.

Interpersonal factors, such as emotional abuse, also contribute to obesity in adulthood (Widom et al., 2015). The proposed intervention targets African American adults with a BMI over 25 and at least one ACE, focusing on peer support, education, and community engagement to foster healthier lifestyles.  Furthermore, we would encourage improvement of communication skills via evaluating participants ability communicate effectively with others, express their needs, and resolve conflicts.

At the community level, the intervention partners with our local organizations and interdisciplinary teams to implement evidence-based solutions addressing social determinants of health contributing to obesity and ACEs. This includes trauma-informed care, increased access to healthy food options, and promotion of physical activity (Philanthropy Network Greater Philadelphia, 2016). In addition, we would assess changes in community beliefs related to physical activity, healthy eating habits, and mental health to help create positive social norms.

At the societal level, improvement can be demonstrated by evaluating changes in policies, public awareness, and broader cultural shifts that promote healthier lifestyles and address the root causes of obesity. We would look to improve access to mental health services both at the county level and state level. Regarding public awareness, evaluating changes in public awareness about obesity and its causes and consequences would be measured through surveys, media coverage, and public health campaigns.