Implementing Policy, Systems, and Environmental Obesity Prevention Interventions in Rural Georgia: The High Obesity Program

To evaluate the implementation of policy, systems, and environmental (PSE) obesity prevention interventions in rural Georgia from 2016-2023 under The High Obesity Program (HOP). Poor diet and sedentary behavior are significant risk factors for obesity. Guided by the Social Ecological Model, which identifies multiple levels that contribute to health behavior, HOP (CDC-DP18-1809) aims to improve individual nutrition and physical activity behavior through increased access to affordable healthy food, safe and convenient places to be physically active, and policies to support obesity prevention behaviors. Citizens of five rural Georgia counties (Clay, Calhoun, Steward, Taliaferro, Dooly) with a high prevalence of adult obesity (>40%). HOP, known as Healthier Together (HT) in Georgia, works at the local level to implement evidence-based strategies and leverage partner resources to address obesity and its associated factors. Beginning in 2016, HT facilitated development of community coalitions, needs assessment and prioritization, intervention selection, implementation, and evaluation. Coalitions selected community gardens, healthy food pantries and coolers, sidewalk repair, walking trails, playground modifications, and active community design. Counts of interventions implemented and sustained, food pantry healthy standard implementation checklists, themes identified from qualitative project staff records (program and coalition meeting agendas, county activity reports), and annual progress reports were used to evaluate process and implementation outcomes. HT planned and implemented 22 community gardens, 8 coolers, and partnered with 7 food pantries. Of those, 72%, 50%, and 72% of gardens, coolers, and food pantries, respectively, are still active. No food pantries fully implemented healthy standards. HT repaired/enhanced 11 playgrounds; one is planned for 2023. Nine walking trails were installed; 8 are still accessible. Four counties received walking signs, (50% installed). All counties received active design plans. HT implemented obesity prevention PSE interventions with varying degrees of sustainability. Staff identified grant restrictions, large geographic spread, and limited human and material resources as significant challenges for rural communities which can inform future strategy selection. Center for Disease Control and Prevention