Obesity and Breast Cancer: An Environmental Approach
The Ribbon

Mary Maley,
Health Educator, BCERF

Over the last twenty years, the levels of overweight and obesity in the United States have increased to epidemic proportions, with 62% of the population considered either overweight or obese (BMI> 25) (Natl. Ctr. Health. Stats. CDC, 2000). Obesity has been linked to a substantial increase in the relative risk of postmenopausal breast cancer. This risk is progressively increased with greater body weight and may be decreased as levels of obesity are reduced. Preventing overweight and obesity can potentially contribute to a substantial reduction of breast cancer risk and to increased breast cancer survival.

A number of factors contribute to obesity, including genetics, behavior, environment, and culture. However, the current consensus is that the recent increase in overweight and obesity appears to stem from changes in our environment that encourage overeating and discourage physical activity, rather than changes in biology. Our current living environment is considered "obesogenic."

In response to this problem, BCERF is taking an environmental approach to obesity prevention for breast cancer risk reduction, with funding from the US Department of Agriculture/Cooperative State Research, Education and Extension Service.

What is an environmental approach to obesity prevention?

An environmental approach to obesity prevention takes all aspects of obesity (individual, social, economic, policy and physical) into consideration when planning an intervention. It also specifically focuses on the changeable aspects of an environment rather than the changeable aspects of an individual. Environment-based interventions make it easier for people to live healthy lives.

The chart below can further explain the differences between an individual and an environmental approach to obesity prevention:

Examples of Environmental Interventions

The following are a few examples of interventions that a workplace community might choose to prevent weight gain within its population.

Community Participation

An important element of an environmental approach is the participation of stakeholder groups and members of the community in assessing the environment and identifying opportunities to change the environment. Participation is key to identification of unique social and physical features of a community that might present sustainable opportunities for intervention.

A BCERF Research Project: Building Capacity to Address Obesity to Reduce Breast Cancer Risk in Rural Communities: An Environmental Approach

The current BCERF project will provide tools and strategies for use by community members in a comprehensive, integrated approach to obesity prevention. This will include community assessment through the intervention and evaluation stages. As a result of this work, health professionals, extension educators, community leaders, and the public will increase their understanding of the relationship between overweight and obesity and breast cancer risk. In addition, they will improve their capacity to take an environmental approach to breast cancer risk reduction through obesity prevention in their community.

The pilot project began in 2004, with coalition building and an environmental needs assessment in Stamford, NY, a rural northern Catskill community. The assessment process consisted of multiple measures of the built and social environments for healthy eating and active living. This was conducted in partnership with the Delaware County Cancer Coalition and Cornell Cooperative Extension of Delaware County, a community project steering committee and others representing businesses, schools, medical, civic and religious organizations.

During the first project year, the built and social environments for healthy eating and active living were assessed using several different measures, as described in the table below.

Community Assessment Data Presented

A group of interested community members met in June 2005 to discuss the results of the community assessment and begin to identify opportunities for intervention. Participants included representatives from churches, the local cancer coalition, the American Cancer Society, the office of a local assemblyman, Rotary, local government, employers, schools, banks, and other businesses, as well as Delaware County Cooperative Extension and Cornell University staff and faculty. During the discussion, emphasis was placed on identifying small, sustainable changes to prevent weight gain, "tipping the balance" of calories taken in and calories expended.

Next Steps

During the coming year, work will continue with the local leadership team to select and implement a locally relevant and sustainable intervention in Stamford, NY, to combat the rising rates of obesity and reduce the risk of breast and other cancers. In addition, BCERF researchers will continue their critical evaluation of the literature addressing built and social environments and possible relationships to overweight, obesity, and breast cancer.

The tools, strategies, and results of this project will be made available on the BCERF web site for use by other communities interested in an environmental approach to obesity prevention for breast cancer risk reduction.

For more information on this project contact BCERF Health Educator Mary Maley by email at mm153@cornell.edu or by calling (607) 255-1871.

The US Department of Agriculture/Cooperative State Research, Education and Extension Service provide funding to support this BCERF project.

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Obesity and Breast Cancer: An Environmental Approach The Ribbon

Obesity and Breast Cancer: An Environmental Approach
The Ribbon