Performance of Local Health Departments in Obesity Prevention Efforts in Relation to Jurisdiction Obesity Prevalence

The high prevalence of obesity in the U.S. is a result of a complex of factors including, but not limited to, dietary intake, physical activity, and socioeconomic status. In response to increasing obesity rates, local health departments (LHDs) must expand their efforts to include less conventional activities such as improving the built environment. The purpose of this study is to assess LHDs' performance in obesity prevention efforts in relation to the prevalence of obesity in their jurisdiction. The assumption is that jurisdictions with a higher prevalence of obesity are more engaged in obesity prevention activities. The 2008 National Profile of Local Health Departments Study was linked to adult obesity rates from the Centers for Disease Control and Prevention (CDC). The two variables that measure LHDs' performance include:1) ten essential public health services specifically targeting obesity prevention and 2) activities indicating involvement of LHDs in facilitating access to a healthy environment. The latter included activities related to access to healthy food resources; parks, trails, and open spaces; safe walking spaces; and safe and walkable schools. Applying Poisson regression we controlled for LHDs' characteristics. Our results show LHDs in obese counties do not tend to increase their level of performance in response to a high prevalence of obesity. To effectively address the obesity epidemic, LHDs must adopt obesity control measures that are aligned to the needs of the jurisdictions they serve.