The Hidden Influence of Community and Environment with Christina Economos

James Hill:
Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:
And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

James Hill:
Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:
Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

James Hill:
Ready for the “And” factor?

Holly Wyatt:
Let's dive in.

James Hill:
Here we go.

Holly Wyatt:
Jim, I think most people grow up believing weight and health are mostly personal responsibilities. Did you eat too much? Do you exercise? Did you have enough discipline? And honestly, that's how many of us in healthcare were trained to think too.

Jim Hill:
Yeah, and then you start noticing something that might be a bit uncomfortable? Why do some neighborhoods have sidewalks, parks, grocery stores, and safe places to get out and walk and others don't? Why are some schools surrounded by opportunity and others by fast food? And Holly, why does your zip code maybe predict your health outcome almost as strongly as your genetics?

Holly Wyatt:
Interesting. Zip code versus genetics. I like it. That's what makes today's conversation so important. Because what if obesity is not just an individual issue? What if it's the environments people live in are quietly shaping health every single day, often in ways people cannot fully maybe realize or control?

Jim Hill:
Well, Holly, you're in luck because today's guest, Dr. Christina Economos, is one of the leading voices in community health and obesity prevention. Chris is dean. We have a dean here, Holly. We're really going up in the world. Chris is dean of the Friedman School of Nutrition Sciences and Policy at Tufts University, and she has spent decades studying how schools, neighborhoods, food systems, and policy shape health outcomes.

Holly Wyatt:
She's best known for the landmark Shape Up Somerville study, one of the first major demonstrations that community-wide obesity prevention can actually work in the real world. But honestly, her work is, I think, becoming more relevant now because we're entering this strange moment. We talk about, Jim, this strange moment in health care where weight loss medications are advancing really rapidly, while many communities are still struggling to provide basic conditions that support health in the first place.

Jim Hill:
So, yeah, one of the questions we wanted to address with Chris, if medications are becoming more and more powerful, does community even matter anymore? Or, Holly, does it matter more than ever?

Holly Wyatt:
Absolutely. So, Chris, welcome to Weight Loss And.

Christina Economos:
Thank you for having me. So nice to be here.

Jim Hill:
Chris, it's nice to see you. And before we get into some really, really interesting questions. I want to go back a little bit in your career. I've actually known you for a long, long time. What pulled you into working with communities? Because you really made that commitment early on.

Christina Economos:
I did. So early in my career, I wrote a paper about what elements were required to produce social change at the population level. We studied seatbelts, recycling, breastfeeding, and tobacco as models. And what we learned is that each of those social change movements had the same key elements that led to their success. So, I wanted to replicate that in the obesity prevention field by applying those elements, and one of them being a strong science base, which enabled me to really construct a portfolio of evidence-based strategies that were ripe for community deployment. And really, I thought I could impact thousands of people rather than working one-on-one. And I hoped that those interventions would spill over from children into the home where parents and caregivers were living.

Holly Wyatt:
I love that scale. How do we scale this? It's something I always think about, too. How do you make this bigger than just the individual people you touch? Before we get into the real questions, I wanted to just make sure our listeners understand a little bit about Shape Up Somerville. It's become one of those legendary public health papers and experiences that we all talk about. But for the listeners who may not know it, what were you actually trying to do and what surprised you the most once it started?

Christina Economos:
Sure. So, Shape Up Somerville, Eat Smart, Play Hard was a trial I conducted between 2002 and 2005. It was right after I published that social change paper. And it was really designed to prevent childhood obesity in early elementary school children, and that's really grades one through three, by using a multi-level community-based participatory approach. So, what do I mean by that? We were really working from the individual all the way out to systems and environments. And we put together, again, a portfolio of evidence-based strategies and deployed them into the community. And what we were really looking for was a surround sound for children. So they weren't just getting an intervention at home or in the doctor's office or in a restaurant or in a school or in an after-school program. They were getting the intervention everywhere. So we really changed and reshaped their environments. And that way, every little bit of the caloric expenditure or maybe the healthier foods they were getting added up to a large dose. And that dose actually led to a significant finding with respect to BMI z-score, preventing obesity, and in fact, a spillover into the parents. So it was a community-wide intervention with two control communities where we measured those children over the same time period and did a comparison.

Holly Wyatt:
And it worked?

Christina Economos:
It worked.

Holly Wyatt:
It worked.

Christina Economos:
And, you know, we published a lot, including the spillover in the parents, the economic piece that showed if this were sustained over a period of time, there's a payback. And we all know that it takes longer for prevention to actually have an economic impact, but it does work.

Jim Hill:
Well, I think it's the model. That's really helped others think about community interventions. Chris, you've spent decades working in community health, and my guess, you tell me if I'm right, my guess is you may see obesity a little bit different than many of the guests that we have that are talking about weight loss and medications and health improvements and blood pressure and lipids. Is that true? Do you see it a little differently?

Christina Economos:
A little. I mean, you know, Jim, I was trained more in the basic sciences and nutritional biochemistry, and I definitely understand and appreciate individual level change with the goal of shifting biology. I feel like I'm a partner to all the practitioners and scientists working at the individual level because I've spent my career working in communities, particularly those with disadvantage, trying to prioritize policy systems and environmental change. I want everyone working with someone one-on-one to let them loose into a community that helps them live a healthy lifestyle that's conducive to the practices and the behaviors they need to actually accomplish weight loss and then sustain it. So I think it's all of us working together. It's impossible for someone, unless they're highly motivated and highly resourced, to practice a healthy lifestyle in this country. You need to have surrounding environments that enable that.

Jim Hill:
I love it. The idea that you're partnering with the people that are working on individual change. Let's dive a little deeper into why the environment matters. So if we're looking at communities, again, the way I see it is we talk about behavior. We're trying to change diet and physical activity and so forth. But where we live, the communities we live impact that behavior so much. So let's talk about some of the elements in a community that might affect it. Things like the built environment and food access. What do you see are some of these major factors that influence behavior within a community?

Christina Economos:
Great. So let's start with the food environment, which we all study a lot. It acts as a powerful systemic force that's often pushing excess calories and low-quality food into the settings where we live, learn, and play. There's no doubt about that. People often refer to communities, particularly those with disadvantage, as obesogenic. They're saturated with 24-hour food availability, aggressive marketing of energy-dense products, and built environments that discourage physical activity. So I currently have a large NIH-funded study in the Mississippi Delta. I'll use that as an example. There have been food environment assessments done there that found, you know, well, 45% of food sources were fast food restaurants, 32% were convenience stores. There were only 4% that were grocery stores or supermarkets. So that kind of says it right there. If you're shopping at dollar stores, you're ultimately eating a large percentage of your calories from ultra-processed foods.

Jim Hill:
So we can tell people to eat healthy, but if the choices they have aren't healthy foods, they can't do it.

Christina Economos:
And these aren't accidental. If we look back at historical decisions and structural discrimination, there's reasons why some communities have been set up in this way. And then think about urban sprawl or lack of green spaces or poorly maintained sidewalks. It's really hard to practice active living unless, again, you have the resources to join a fitness center where you can do it in an air-conditioned safe space. That's a smaller percentage of Americans who can do that. So the environment really matters. And, you know, we could talk a lot about ultra-processed food. I know you're probably familiar with UNICEF's recent analysis showing that children are trying to navigate these environments that are saturated with marketing and ultra-processed foods. And it's really widening, you know, inequalities.

Holly Wyatt:
Yeah, so we've got the food environment, but also, and I think just as equally important is the activity piece of this. The environment, how it impacts how much you move. So what have you seen about that? How have you looked at that before?

Christina Economos:
Yeah, I mean, especially in, you know, urban environments where safety is an issue or rural environments where there are no sidewalks and there's trucks going by, you really can't go out and walk. It's very, very difficult. And a lot of schools have really struggled in maintaining space where children can be physically active as well. Either they're overcrowded, and they're using the gym for, you know, classroom activities, or there's one space that they use as a gym, an auditory Amanda cafeteria. There's not a lot of opportunity for kids to be active there. So we really haven't prioritized it. We've actually squeezed it out and prioritized, understandably, the academics. But we need to really think about how children learn. And we know that they're going to learn better if they have the chance to move, to be physically active, to stimulate their brain in a different way. So it's a problem. I mean, physical activity, inactivity, excuse me, is a big risk factor in this country, and we have yet to solve for it.

Jim Hill:
Chris, I want to focus a little bit more in on schools, and I know you've been very interested in kids and making sure that we can prevent obesity in kids. It seems to me, in a naive way, schools should be this wonderful place where every kid that goes to school gets to eat healthy. You can get one, maybe two meals at school. You could be physically active. Where have the barriers been? I know there have been a lot of school interventions, and I think overall they've been a little bit disappointing. Maybe they moved the needle a little, but where do you see the potential to do more with schools and communities?

Christina Economos:
Sure. I mean, we can think about schools as a hub for health, right? Schools, they do have resources, and it depends how they're allocating those resources. So that's sort of number one is really working with leadership and having them value food and physical activity as really part of their budget. Then there's the regulatory framework, and that can be federal or state, where states are prioritizing what children actually need and trying to reach all children. And, you know, making schools a default healthy environment is really what we should all be prioritizing. And children are only in school six to seven hours a day, 180 days a year. There are many other environments, and many of the school studies have done an excellent job, but you can't have a biological result if the rest of the child's day is undermining what happens in school. And that's why I really advocate for more environments, more sectors, more levels, so we can make sure that we're not doing really good in one place, but as soon as the child exits the door, we're just really erasing all of that good work. But we do know, lastly, that lifetime trajectories are key. And if we want to establish things early in life and have them carry forward, we need to go K through 12 and into higher ed and into the workforce. We can't just expect to do good when a child is five or six and have them on their own keep that behavior going.

Holly Wyatt:
Yeah, that makes sense. I also think it fits really well with some of the things Jim and I talk about that we want a simple solution. And I think sometimes people think schools, that's it. Let's fix the schools. We fix the problem. And I think what you're showing is, yes, let's work on schools. They're a great place to start. But alone, it's not that simple. When they walk out of school, what are they walking home? Are they able to even walk home? And what are they grabbing to eat that's around the corner away from school, etc. Showing that it's a complex problem that we have to hit from multiple angles and everybody just wants there to be one reason and one fix. So I love how you're putting it all together. My question, and I don't know if you can answer this, and it's a complex one too, is we're now really seeing this biology and physiology come in with these new weight loss medications. And we know that that's really critical for people. There's a genetic predisposition. How much of the obesity epidemic or how much of weight or weight issues in the United States are due to our biology? And how much do you think it's really the environment that's causing the problem?

Christina Economos:
Yeah. I mean, you know, I think the combination, right? I mean, epigenetics is I think what we're thinking about now. There's, you know, early programming. We know that from a lot of the study that's being done, you know, during pregnancy. But I think I personally am not going to assign a percentage because I think there's some variability there. But I do think even if you're not predisposed genetically, it's still easy to develop obesity. So we have, two things working against some people who are predisposed and then get put into an obesogenic environment. And later on top of that, we have stress. We have trauma. We have historical marginalization. We've got a lot of things going on, which makes it even harder for someone to get a good start. So what I would say about the medications now that are doing a lot of good for people is that we have to, again, partner and make sure there's lifestyle intervention along with the medications (and I know you're advocating for that) during the course of the medication and if people are able to and are choosing to go off the medication. And we need healthy environments to support them once they're trying to maintain or sustain, I would say, weight loss over time.

Jim Hill:
Yeah, I want to come back a little bit later on to the medications. I have some more questions there. But what we try to do is create some practical information for our listeners. So how do you approach a community intervention? And for example, if we have listeners that say, “Oh, I would love to get involved in my community and starting something like that.” How do you start and what are the elements that are important as you think of a community intervention?

Christina Economos:
Sure. Well, one thing is, you definitely need the community to be ready. What we have found is experts going in with a list of evidence-based strategies to a community that isn't ready, that is, you know, really plagued with much more pressing issues, it's going to be difficult. You know, if it's an unsafe environment, if there's incredible violence, if people are dealing with other trauma issues, you need to either link it to that or you need to be patient so that some of those root causes can be addressed to a point where people are then willing to think about physical activity and nutrition. You can definitely pair them, but it's a sensitive issue and there's a lot of trust that needs to be built. So readiness, time for trust building. Actually matching the intervention with the community needs.

Christina Economos:
There are plenty of data out there that we can use. We can layer data. We can harmonize. We can understand the demographics and the health needs of a community so we don't have a mismatch where you put an intervention in where it really isn't meeting the needs of that community. Then you need stakeholders to be involved in the co-design and co-creation and implementation. You absolutely need to value implementation science, because you can't just come in and say, here's what you need to do. You need to work with the community on how you need to do it. Implementation science is key. And then you need to share in the understanding of the results and a plan for sustainability. So those are some key things that I would say. And so what I'm really talking about is partnerships. You can't find a couple people on the street and say, can we do this together? It's the public health department, the schools, you know, the political appointees or elected officials and their offices. It's a hospital system. I could keep going, but it's a multi-sector approach.

Jim Hill:
Wow. Many systems have to work together to be successful in a community.

Christina Economos:
Right. And that's why I use system science to actually understand what's happening. You know, some of the basic statistical tools that we were trained with don't really capture the complexity. And so, using things like complex modeling like group model building or, agent-based modeling or social network analysis, this allows us to put a lot of data together and really understand what's happening and how the diffusion of information is working. And how multiple interventions at once can be captured and understood.

Holly Wyatt:
So I always think about individuals who come to me and say, “I know that the built environment's important. I know, you know, we need this, but I can't control that. You know, I can try to maybe advocate for it, but ultimately it's bigger than what I can do.” How do you bring personal responsibility into this discussion versus lots of things you don't control and may take a long time to get put into place versus what are we personally responsible for?

Christina Economos:
Yeah, I mean, I think, you know, a relationship between an individual and their provider is key and getting good evidence-based information at that individual level and understanding the ability they have to get good food or let's talk about the foundational programs in our country like SNAP and WIC and school meals and the elderly feeding program. You know, we do have supplemental nutrition programs, and that can often be introduced by a provider or to a parent through a school or through social services. And that is someone with agency signing up for a program, taking advantage of the opportunities to get more food and to get better food.

Christina Economos:
And then from there, it's accessing good information. And you both know we have government information that's available. We have excellent organizations like the Academy of Nutrition and Dietetics, for example, the NIH website. It's going after the information that is evidence-based and solid, and helping them to understand that in a way that meets them where they are. And then from there, it's really navigating the environment. And that can be challenging to do. You know, where is there a grocery store? Where is there a park that's well lit that I can go and walk with my family? So there is a lot someone can do on their own, but I will tell you, working with a lot of families with multiple jobs that are resource constrained, it's very hard to do alone because there are competing priorities. That's where public health comes in. That's where the kinds of interventions I'm talking about with policy and environmental changes, regulation when possible, can pick up and really transform the environment so people don't have to work so hard on their own to find the healthy nuggets.

Jim Hill:
Yeah, I love that. We don't know everything about obesity treatment and prevention, but we know a lot. And one of the problems I think that community interventions have suffered with is the scaling problem, the sustainability problem. I know lots of people that got grants. They went in, they made some changes, the grant went away, and the program went away. How do you address sustainability and scalability in community interventions?

Christina Economos:
Yeah, I mean, you're absolutely right. Scaling is really hard because a lot of the trials we do are resource intensive. They require a lot of time, funding, coordination. And how do you blow that up when you're starting with a multimillion dollar study? Now you need to go to hundreds of millions of dollars. Where is that money? So it's really, I think, challenging for people to think about. What I like to think about is institutionalizing the components into existing systems. So what I've often done with scaling some of my work is bringing physical activity into the school day, bringing physical activity and healthy snacks into existing after-school programs, like, for example, soccer leagues or Boy Scouts and Girl Scouts or 4-H, or working with restaurants to reshape their menus for children. Places people are already going, how do we use the evidence to reshape that? Or making sure the school meals program is delivered effectively. And what I mean by that is reaching a lot of children with high quality food. So how do we institutionalize within current settings rather than try to create new things? So that's a lot of what I work on. But when it really troubles me is when you can't get the same dose. Because that's what happens a lot is the dose becomes diluted when you then scale it up and then essentially it's not effective anymore. So sometimes you really have to be narrow when you're thinking about what you're trying to scale in a particular setting so you get it right. So you're still effectively delivering that dose. In other words, what I'm trying to say is sometimes less is more.

Jim Hill:
Gotcha. I want to return for a minute to the GLP-1 meds because in our field, these have been game changers in a very, very positive way. And they focused on the fact that for the first time, we have a successful treatment. But it doesn't really directly affect prevention. So how do you see this? I mean, on one hand, I think about, well, people can get really excited about losing weight and want to go in and change the environment. On the other hand, it's like, well, we have a treatment now, so we don't need to spend any money on worrying about this other stuff. How do you see that balance, Chris?

Christina Economos:
Yeah, I mean, people are going to live in the real world for the rest of their lives. And I'm a strong believer, as you know, in lifestyle intervention to accompany any weight loss program, whether we're talking about cognitive behavioral therapy or medication or bariatric surgery, you know, learning along with that, the lifestyle practices that are going to be required to live in the real world, to go out to dinner with your family, to go on a trip, to be at work and be part of the community there. So, I'm just a very strong believer on lifestyle medicine and intervention, being very strong as we are distributing these medications across the country. So I think that's where it starts. And I'll go back to the community, the environment, the systems, you know, continuing to engineer those to be the healthiest that they can be that's only going to enable people to make better choices when they're out in the real world.

Holly Wyatt:
I just wonder if the push, the reason why now is going to become less because people are going to be able to lose weight effectively. You know, a lot of reasons why people change their lifestyle is they want to lose weight. I mean, that's the motivator, I guess is what the better word is. Does the motivation leave us to create these when now I have something that I don't want to eat as much food or it's not a big deal to pass up some of the unhealthy food?

Christina Economos:
Yeah, and I think that maybe Jim's point was more like we still need to focus on prevention because I don't think we're going to get in a cycle where we don't have to worry about the environment and what's around us because eventually everyone can just go on a GLP-1. That's really not the power of prevention. I think we want to prevent people from needing to access, if possible, any of these medications. So the prevention part has to be early and often with the kinds of interventions that are evidence-based we know are important, supported by healthy environments. That's going to help with prevention and sustained weight loss if we have a better environment to begin with.

Jim Hill:
Yeah, that's the other thing is Holly and I, as lifestyle people, we actually welcome these medications because they're producing one big part of weight management: getting the weight off. But now I think we're focused on what next? Because Chris, we ask people what their goal is in starting a medication and their goal is weight loss. But at the end of the day, is it really the number on the scale that is success or is it something more than that? And I think there's the opportunity for community to support these people that lose weight on the medications, which is wonderful, but then they want to go beyond just the number on the scale to improve their quality of life. And the community is so critical in that.

Christina Economos:
Right. Absolutely. And, you know, we could talk a little bit about body composition, which is where I really started my career. And, you know, I also want people to maintain the integrity and size of their muscle, right? Especially as they're getting older so that, you know, if they're consuming a healthy diet along with the medication and strength training and doing physical activity, they're going to be better off through the aging process in the preservation of muscle and the prevention of falls and ultimately, you know, being disabled. So we really want people to be taking advantage of lifestyle medicine every step of the way.

Jim Hill:
You mentioned before ultra-processed foods, and now there's a lot of focus on that. Whether you agree with the term ultra-processed foods or not, the idea is that we've gotten away from a lot of what are more natural, healthy foods. Where do you see that going in communities? People are told to avoid ultra-processed foods. I'm not sure that's very different than what we told them before to avoid foods high in sugar and fat and so forth. But where are we going with this in a community and how do you think communities can respond to this?

Christina Economos:
Yeah, I think communities need guidance from the federal or state level, probably federal, with a clear definition and then policies to support the prevention of consumption. And so that's, I think, what people are working on right now. How are we defining it? What is the metric we're using so that then policies can support it? And right now, there's a lot of discussion. People are talking about it in different ways. And the food industry is part of the conversation, but there's no, I would say, motivation, not enough motivation to really make the changes. So I think that's where we're heading from the federal level.

Holly Wyatt:
Yeah, I think that the GLP-1 medications may come in, and I think the food industry is taking note because things are changing. So to me, this is a pivotal time where I hope they not only take note that what's going on with the GLP-1s, but what can we now create that helps overall with health? Like this is, to me, a point where we can really make a big, big change. And the food is medicine. That is a big, we're studying that more. We're understanding that more. What kind of excites you about that initiative? What would you direct the food companies to think about?

Christina Economos:
Yeah. I mean, we have a lot of work going on here at the Friedman School. We have a Food as Medicine Institute led by Dariush Mozaffarian. And many of us have food as medicine studies here that are really looking to integrate food into health care. And that's in the form of produce prescription, medically tailored groceries, medically tailored meals, and really bringing food to the center of health care. And that's both for prevention as well as helping people who have disease manage that disease and recover from that disease. And that influences the supply, right? If we have a bigger demand through health care, through community interventions, through policy, through regulation, then the supply will change. But until we have that, it's really difficult to force change in what we grow and what we manufacture. So it all has to work together. And it goes far beyond the individual up to the level of the food system. And that's where we spend a lot of time at the Friedman School, trying to understand that from a regulatory and economic and a policy perspective. And of course, agricultural policy is a big part of that.

Jim Hill:
We all know that not all communities are the same, and you talked about that before, and you talked about the needs for communities to be ready. But the fact of the matter is there are a lot of communities where there's really a high need, where the readiness is not there, low income, not organized. These are communities, by the way, where people probably aren't going to get a lot of the GLP-1 meds.

Christina Economos:
Right.

Jim Hill:
What do you do there? I know you can't do everything, but how do you see that?

Christina Economos:
Well, I think this is where our programs like Medicaid and Medicare become really important with expansion from a food is medicine, as well as a GLP-1 availability perspective. And that is really advocacy at the level of the community, at the level of the state to actually make the change, right? That's where people can rise up. They can advocate with agency to try to get what they need. People vote. That's a really important part of this is who their elected officials are, how much they understand, are they bringing information and testimony to the right people who can actually serve them? Because these are really big, complex issues that we're talking about right now as we're getting into health care and GLP-1s and availability. That's hard for a community group to really make happen on their own. But if they're well-informed and they do advocacy at their statehouse, they go down to Capitol Hill and they educate, that can really influence the larger landscape of the availability. So I would say that's a really important part. Now, who inspires people to do that? It can be a community-based advocacy group. This is also why we need a strong public health system. And we need public health experts to make sure that people are well-informed and that programs are accessible. So this is really infrastructure and dollars that we are really thinking about flowing down from the federal to the state to the community level.

Christina Economos:
But you're bringing up a really good point. These are hard issues for people to tackle on their own. And we're talking about a lot of dollars when it comes to food and when it comes to medication. And sometimes they're in competition. Can we really support all of it? So let me come back to the evidence base. Nothing's going to happen unless we have strong evidence. And if we can't demonstrate that, for example, a GLP-1 along with the food as medicine intervention is effective, then we're not going to be able to pass anything to make sure that everyone has access to that. And that's the power of the science and the research that many of us do that produces the evidence that makes these changes. I know I went in a couple different directions there, but it all stems from, it's not someone showing up and saying, I think that should happen. I believe that should happen. We are a country where we've faced a lot of really important decisions and the flow of dollars on a strong evidence base. And that's why we need good science to tell us what direction to go in.

Jim Hill:
Love it. Love it. Holly, we've got a lot of good listener questions. Let's do some of those.

Holly Wyatt:
I agree. I'll start.

Jim Hill:
Okay.

Holly Wyatt:
All right. This comes from someone who says, I live in a neighborhood with no sidewalks, no parks. Closest grocery store is 20 minutes away. Sometimes public health advice feels completely disconnected from my life. What are people actually supposed to do when the environment that you live in is working against them every day? And what you're told to do, you can't do where you live, basically, I think is what they're saying.

Christina Economos:
Yeah. I mean, this listener represents a lot of people in this country, and we have to listen to that. People are saying, “You know, I'm hearing what the advice is. How do I do that? I don't live in an area that's conducive to it.” So it really goes back to, you know, the beginning of this conversation. If there's even seed money in a community to help different sectors get together and start to formulate a plan that's evidence-based, they can actually do a number of things, right? They can advocate. They can go after some small dollars to get some pilot work done. They can distribute information to people. And they can vote so the people coming into office prioritize some of the things that this listener wants. It's complicated. I don't want to say it's easy. It's not just writing a letter and saying, can this change? These are big, complex structures and an infrastructure that really needs to change. I will say the individual question you asked me before, if you're extremely motivated, you can navigate within your environment and try to buy in bulk. And try to really think about vegetables and fruits that can be frozen or can be canned. You can start to access healthy recipes that can enable your family to cook better together. You can pack your food instead of relying on restaurant food more. And that's going to go a long way, I'll be honest, with lowering saturated fat, sodium, and sugar. And those are kind of key things that we're really focused on.

Holly Wyatt:
I'm so glad you said that because Jim and I wrote State of Slim, which really was a book helping people lose weight, talking about the environment of Colorado, which is an environment that supports a lot of these healthy behaviors. But one thing we always said is, yes, if you live in Colorado, it may be easier. It's naturally set up, but you can create a micro environment. It's kind of what I call it, your own little environment. There are things you can do to create an environment that can help you. Not as good. We need to be moving toward the bigger community that makes it easier for everybody. But if you wanna make a change, I like to say, let's think about what you can do instead of just saying, okay, I live in this environment and, you know, it's too bad, you know.

Christina Economos:
And let me offer any digital tools, right? People can actually access social support through some of the digital tools out there, health platforms. They might not be people who live in their community, but they're buddies or they're a social network that's like-minded. And you both know that's a big part of this. It's very hard to do this alone. And so if you're in community with other people trying to do the same thing, that can be helpful. You can actually create community. So if it's unsafe to walk, but if it would be safer to walk with a group of five, get that going. And I mean, if it's an issue where you shouldn't be alone versus a sidewalk. So there are things you can do on your own. And I will say there are a lot of good resources out there that people can begin to access.

Jim Hill:
All right, let's do one more. Chris, are there communities in the U.S. that are getting this right now? Maybe not perfectly, but meaningfully. And what are they doing?

Christina Economos:
Yeah, I mean, I've worked through my recent study called Catalyzing Communities with some exemplar communities around the country. I'd say Greenville, South Carolina is one of them, where they've really focused on bringing the power back to the people in the community, and working on food insecurity in a really coordinated way, trying to understand deep levers that have created inequities, like, for example, structural racism and, distribution of power and wealth. And I think that's really valuable. So that's a place I would highlight. They've received a lot of funding. They have an excellent coalition there. And then, you know, in Somerville, where I've spent a lot of time, they continue to value at the individual level as well as the environmental level. They've put in bike paths and, you know, beginning with better crosswalks. When I started the study, now there are many more farmer's markets and there are bike paths and there are incentives for people who work in the community to live a healthier lifestyle. We didn't really talk about what workplaces can do, but they can do a lot by incentivizing. And I don't just mean running a walking challenge. I mean money back. I mean, if you're buying healthier food and you get money off your insurance, or if you're buying healthier food and exercising and you get points to actually purchase something like some new exercise clothing. I mean, it really can be incentivizing to do the right thing. I think it's carrot stick, which we often talk about. And people want to be rewarded for what they're doing. That's part of behavioral theory. Right?

Holly Wyatt:
Why are they going to do it? is always important with that motivation because, you know, I think you've seen the pictures before where there'll be this nice bike path, no one on it, and the cars, you know, waiting in line in traffic right next to it. And so sometimes you can build an environment, but you still have to then say, why will people use it and make that motivational piece.

Christina Economos:
Right. And so I'll go back to one of the elements in the social change model that I studied was spark plugs are champions. All four of those, seatbelts, recycling, breastfeeding, what I shared with you before, if you look deep in the literature and these movements that were constructed and actually executed over a decade, all had key spark plugs and champions. And everywhere I've worked, I've had the same thing. It could be a mayor. It could be someone quietly working behind the scenes as the leader of food service. It could be a parent. It could be anybody who emerges as a leader, but you do need those people. That's just part of history.

Holly Wyatt:
I love this for our listeners, because I think there's listeners out there who could be these spark plugs and that would excite them. And that's a critical piece. So could you be a spark plug? That's something to think about.

Christina Economos:
Right. And you need to figure out where you plug in, you know, in your community. Can it be a call to the health department? Can it be a parent-teacher organization? Can it be an advocacy group where you could volunteer? There are many ways but beginning a movement is really someone who has that charisma and motivation and heart to actually go after something. But all the movements I studied had spark plugs.

Holly Wyatt:
Yeah.

Jim Hill:
So there's a challenge for our listeners. Holly, it's time for your favorite segment.

Holly Wyatt:
Rapid fire questions, Chris. So I'm going to ask a question top of the head. What comes quickly to your mind?

Holly Wyatt:
All right. Most underrated community health intervention.

Christina Economos:
You know, I've looked at tax-based interventions that create more equitable school environments.

Holly Wyatt:
And is that, you think it's underrated?

Christina Economos:
Yeah, I think we don't know enough about it yet, but I think it is something we need to look more into because, you know, school environments are not the same. And they're relying on a tax base that sometimes is inadequate. So how do we think more flexibly about that?

Holly Wyatt:
Okay. One thing communities think matters that actually matters less.

Christina Economos:
And I think what's happening around the world at large, it matters, but you can still make change at the local level. I don't want people to get discouraged because the world feels so challenging right now.

Holly Wyatt:
You don't have to solve it all.

Christina Economos:
Yeah, and you can make small change where you are, in your home, on your street. You know, I have a street that isn't very long, and sometimes it's dark, and I just go out and walk up and down on the street because it's safe.

Holly Wyatt:
I've done that.

Christina Economos:
Yeah.

Holly Wyatt:
One policy change that would improve health immediately.

Christina Economos:
Universal health care.

Jim Hill:
I love it.

Holly Wyatt:
Biggest mistake researchers make in community health.

Christina Economos:
Not asking the community what they want.

Holly Wyatt:
Yeah.

Christina Economos:
It needs to come from the community.

Holly Wyatt:
I agree. One thing America gets wrong about obesity.

Christina Economos:
Well, I'll go back to what you had asked me about. Is it really just the individual we should be blaming? And I think it's far more complex than that. We talked a lot about systems, historical and current, about environments, about failed policies, about when there isn't enough courage to make a good policy. And I think that has impacted people's health dramatically. And we need to be smarter and stronger about where we're headed.

Holly Wyatt:
Yeah. One thing giving you real hope for the future.

Christina Economos:
Yeah. I mean, you know, I'm in academia. I'm with young people all the time. They are remarkable. You know, college students and graduate students, the way they're thinking, they have an advantage over us and that they are connected globally and they understand what's happening at any moment around the world. And they still have a lot of hope and drive. Every day I'm amazed at how So they want to change the world. And, you know, partly it's the age they're at and partly it's how incredibly smart and driven they are. And I feel really lucky to be surrounded by young people on a regular basis who will do better in the future for all of us.

Jim Hill:
Love it. So Chris, our last segment is what we call the vulnerability segment. These questions are less about the science and more about the person behind the work. So I'll do the first one. You've spent decades trying to change systems that often are painfully slow to move. How do you keep yourself from being cynical?

Christina Economos:
So the work that I do involves relationships, And I have met incredible people across this country and now globally as I've expanded my work, particularly to India, who keep me going. The bright spots, the stories, the personal changes, it's all about people for me. And having relationships like I've had with you for many years and so many people on the ground, in academia, in the policy world, that's what keeps me going is connecting with people.

Holly Wyatt:
You know, science evolves. We think we know things sometimes early in our career or at different times, and then we learn something different. What's something maybe earlier in your career that you thought was true or you thought would work, and then later you said, you know, that wasn't the whole story or that was even a mistake?

Christina Economos:
Yeah, I mean, early in my career and particularly my, you know, master's training, I was focused more on individual behavior change. That was the late 80s. And then, you know, as the world of policy systems environments started to emerge and Robert Wood Johnson was really funding this work, to develop the evidence base, you know, I started to appreciate it more doing the social change work. So I still think it's a combination and I value everyone doing work at the individual level. I still do that, but it really is going to take all of us. So I think early I was really trained in that paradigm.

Jim Hill:
Cool. Okay, Chris, before we close, what one thing would you like our listeners to take away from this conversation?

Christina Economos:
That everyone's going to have to play a role. You can't sit back and say, “I'm frustrated that, you know, the information I got a year ago seems to be different now.” You should be happy because science is evolving and we're understanding more and we're trying to disseminate that. Or you shouldn't point fingers at, you know, industry or policymakers. Everyone has a role to play. And if people can really converge on the health of this country and prioritize, especially the next generation and what we need to do, I think that will go a long way. So whoever you are, wherever you're sitting right now, you have a role to play. It could be in your home starting to prepare food differently. It could be starting a walking group on your street. It could be starting a movement at work. It could be running for office. It could be going back for a graduate school. It could be small or large, but I think we need to all stop blaming everyone else and begin to work together more even if it's small. All the small things add up to something much larger in the long run Wow.

Jim Hill:
I love it, Holly. I can't sum it up any better than that.

Holly Wyatt:
Stop with the blame game, all come together. It's like everything was in. That was a perfect pie in the plate moment.

Jim Hill:
Chris, thank you so much for your time. We've enjoyed this conversation and learned a lot. And for our listeners, let us hear from you. Send us questions. Send us ideas for podcasts, topics that you would like to take us on, and we'll see you next time on Weight Loss And.

Holly Wyatt:
Bye, everybody.

James Hill:
And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:
If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

James Hill:
We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at weightlossand.com. Your feedback helps us tailor future episodes to your needs.

Holly Wyatt:
And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.