Promoting policy and environmental change for obesity prevention: A framework to inform public health practice at the local and state levels

Obesity poses a major threat to the nation's health. Consistent with the socio-ecological model, leading public health organizations have identified policy and environmental change as a promising approach to mitigating the epidemic. Successful obesity prevention is likely to be dependent upon the capacity of the nation's public health workforce to lead policy change efforts that result in increased levels of physical activity and healthy eating. Yet, many public health professionals have not received adequate training in the application of policy for obesity prevention, and specifically in the strategies that hold promise for facilitating the adoption of desired policies by decision-makers. The public health literature has yet to fully explore the complexities of the policy process as they relate to public health practice. We conducted a review of the literature across the policy science and public health fields, distilled key theories of policymaking, and developed a framework to inform policy change efforts on obesity prevention. Beginning with a conceptual description, we focus on understanding three domains of the policy process: the problem domain, the policy domain and the political domain. We identify key activities in the policy process including: (1) identifying and framing the problem; (2) engaging and educating key individuals and groups; (3) developing evidence-based policy solutions; (4) assessing the social and political environment; (5) building public support and political will; and 6) iteratively evaluating the process. We present case studies of policy change for obesity prevention to illustrate the potential uses of the framework for practitioners.