A "whole host of factors" contribute to obesity, according to Albert Lang, communications manager for the Trust for America's Health. Some clear contributors, though, lie in convenience of healthy food and exercise.
It is easier to get high-calorie, low-nutrition food, and more difficult for many Americans to access fresh produce. In addition to this, neighborhoods across America have developed in ways that are not conducive to exercise, with few sidewalks and poor lighting in areas.
"We've kind of moved in a way that makes the healthy choice the hard choice. We've made it incredibly hard for people to be healthy," Lang said.
He has seen more of a "buy-in" from communities to create safer neighborhoods and routes to school and in the creation of policies that "have health in mind."
One of the factors in Utah's success could be the Utah's Nutrition and Physical Activity Plan, according to Rebecca Fronberg, program manager for Utah Department of Health's healthy living through environment, policy and improved clinical care program. The department received federal funding to implement the program that aims at getting Utahns to increase their intake of fruits and vegetables, physical activity and breastfeeding, and decrease their "screen time" with electronic devices, consumption of food with a lot of fat and sugar and intake of sugary drinks.
"One of the things that we've really been working hard on is trying to change the environment," Fronberg said, "to make the healthy choice the easy choice."
As part of this initiative, the Utah Department of Health is reaching out to health care workers, employers in the state, schools and communities. It is also working with schools to improve the health of meals offered and to increase physical activity during school hours.
Fronberg also mentioned the state's high activity levels, due to the availability of outdoor recreation in Utah and the state's movement toward more accessible public transportation. Public transportation could be one solution to help increase activity levels, especially among low-income and minority groups, according to a 2005 study by the Centers for Disease Control and Prevention. Those who used public transportation walked an average of 19 minutes each day, to and from transportation sites.
"I just am excited to see that we're finally showing some results," Fronberg said.
For Hansen, success came from being patient with himself.
In the past he would start diets and when he would cheat, he would be frustrated with his mistake and go back to his old eating habits.
This time, he took a different approach.
"I basically just started with baby steps," he said.
How to succeed
He started a food journal and wrote down what he ate for a week. Then he would review what he ate that week and try to improve during the next week. He started drinking more water. He noticed how far he would walk and try to walk a little farther the next day.
A visit to the doctor revealed that he had hypothyroidism, which contributed to his weight retention and recurring depression. He started on thyroid medication and followed his doctor's advice to become more active.
Now Hansen, 32, is a new man. Since 2012 he has run in three marathons and on Saturday competed in his 42nd half marathon, well on his way to accomplish his goal of completing 100 marathons and/or half marathons before he turns 40. He tracks his progress on a blog he keeps to help inspire others to make similar changes.
In his work as an office manager at the University of Utah, he has seen a spike in his energy level and looks forward to running errands around campus, a task he used to dread.
One of his favorite quotes is by Shakespeare, who said “Strong reasons make strong actions.” Hansen's strong reason came from knowing he was worth the change, and from coming to love and trust himself.
"At my lowest point I was numb. And now that I've been able to control my diet and now that I'm exercising regularly and everything, I feel like that helps me enhance and really ... enjoy those moments, really be able to feel life."
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