Olivia Affuso: 3 ways community creates a healthy life | TED

Transcriber: Making lifestyle changes to not only lose weight but to maintain a healthy weight long-term is hard. Ask anyone who has ever tried. So let's consider my mom, for instance. She is 77 years old and has struggled to maintain her weight in order to achieve good blood sugar control over the past 30 years. You see, good blood sugar control requires maintaining a delicate balance between diet, exercise and insulin injections. So early in the COVID-19 pandemic last year, my mom came to stay with me, which led to a change in her usual dietary intake, away from meals provided to the elderly to more healthful, home-cooked meals. What could possibly go wrong? Well, overnight, her blood sugar dropped dangerously low, and she was incoherent and nearly unconscious. Imagine having to inject your mom with a giant horse needle of glucagon to boost her blood sugar until she could take in calories on her own. I was terrified that she would not be OK or that I might need to call for emergency medical treatment during the pandemic. Luckily, she responded to the emergency injection and was able to consume enough calories to bring her blood sugar back up. But of course, this led to a high blood sugar, and she needed even more insulin, which is a fat-storing hormone, to get her blood sugar to a normal range. Although it took a coordinated effort with her doctor to find balance between her diet, exercise and insulin regimen, I was happy to be social-distancing with my mom. And she was able to lose some weight, even though she sometimes complained that I was acting like the food police. Nonetheless, I was grateful to have my biggest fan and run-streak motivator with me during the lockdown. We became a village of two. Each day she would ask me, "Did you go run yet?" You see, she would ride her stationary bike while I was working during the day and running at almost 10pm each night. It was a tough year, to say the least, but at least this arrangement allowed us to create a healthy and supportive environment together. So the problem is, we often think of weight control as an individual challenge. And of course, to some extent it is. But we know that the environments in which we live, learn, work and play affect our ability to engage in healthful behaviors. When the world around us is what we might call an “obesogenic environment” -- in other words, systemically and perpetually geared towards creating obesity -- acting like weight loss or maintaining a healthy weight is a personal responsibility is simply not helpful nor effective. To put this in simple terms, I can't blame you for being overweight if restaurants and grocery stores, or at least all of the ones you can afford, sell an abundance of high-sugar, high-calorie processed foods at low prices. And then if you don't have access to good health care and fitness options and work multiple jobs, you don't have time to exercise anyway. That's like tying your hands behind your back, pushing you into a pool and yelling at you to swim. And if you have a genetic propensity towards excessive weight gain, long-term weight maintenance may simply be unattainable given the current treatments available. Although individual health behaviors are important for positive health outcomes, these behaviors are driven by the context in which we, as individuals find ourselves. Imagine what we could do if we optimized systems, policies and practices for our physical, not to mention mental, health. There are a lot of things that need to change, but that won't happen overnight, such as our work schedules, wages, the availability of healthy, affordable foods in every community and public spaces that make walking

biking and hiking safe, accessible and inviting. As a society, we need to start thinking about these things as not only luxuries but essentials for a high-quality, healthful life. But in the meantime, while we push collectively for our local and national governments to take our health, and the systems that facilitate health, seriously, there are also things we can do right now, on our own, community by community. We know from research in animal and human populations that connections provided through social networks and communities are associated with better health and quality of life. So until we fix the systems that are harming our health, we can all work to buffer the negative impact of these systems. Research also shows that individuals living in socially cohesive communities, or at least those with strong social connections, have better health outcomes than those who are more socially isolated. And these social environments work to combat obesity-related behaviors and promote well-being, even in the face of systemic obesogenic conditions. And how do I know? My research team and I have been studying social environments and women's health. I've also observed the social support strategies of the women in my own network, and their struggles with weight. Although their stories shed light on the lived experiences of navigating long-term health behavior change, how do they align with the science? In my work examining physical activity behaviors among Black women, for whom the prevalence of obesity is disproportionately higher than white women in the United States, we have been able to describe aspects of the social context that support their success. Even among overweight but active women, more than half engaged in physical activity with others for companionship, motivation and accountability. One participant stated that, "If my friends did not bug me, I would rarely work out," while another encouraged other women to get involved with a community that will push you towards your physical activity goals. She described the community as “like-minded individuals.” Also in our work with social physical activity groups, the members said that friendship, motivation, encouragement and accountability were the most important factors for supporting their long-term physical activity success. From conducting research on how social networks and social support strengthen our ability to achieve and sustain health goals and supporting a network of hundreds of women, I can tell you there are three things that all of us should consider. Number one, find or build yourself a tribe of like-minded individuals for motivation and accountability. This could be a tribe of two, like my mom and me, or a group of individuals who enjoy walking in nature. Number two, create monthly wellness goals and share them with your tribe. One or two small changes and realistic expectations will do. And number three, celebrate your success. Don't just push each other, but throw parties and uplift each other for making progress. Remember, maintaining a healthy weight takes more than diet and exercise. It takes the collective power of a village to create a healthy life. Thank you.