I’ve been watching the Canadian Broadcasting Corporation (CBC) series “Village on a diet” these last few weeks (ed. I would embed video but the CBC does not allow it, too bad). Village on a diet is interesting to me because it is what researchers would call a community trial. The basic premise of the show is for a village to loose 1 ton of weight in 10 weeks. A community trial is generally trying to a community to change something, in public health we are usually talking about smoking, drinking, diet and physical activity behaviours, but it could be anything really.
The CBC is marketing “Village on a diet” as an innovative reality TV series but there have been a number of community trials conducted in research. These include, among others, the Multiple Risk Factor Intervention Trial (MRFIT), the North Karelia Project, and the Stanford Five Cities project. With the exception of North Karelia, results of these studies have generally been somewhat disappointing, with little or no difference between intervention and control groups at the completion of the study. An important part of the challenge the has been discussed as a result of these community trials is motivating an entire population. For some readings check out:
Schwab & Syme (1997) On Paradigms, Community Participation, and the Future of Public Health. American Journal of Public Health, 87(12): 2049–2052. PDF
Puska, P. (2007). Successful prevention of non-communicable diseases: 25 year experiences with North Karelia Project in Finland. Public Health Medicine, 4, 1, 5-7.
Winkleby, M. A. (1994) The future of community-based cardiovascular disease intervention studies. American Journal of Public Health, 84, 1369–1372.
This weeks episode of “Village on a diet” saw decreased motivation among the motivated people of Taylor. The motivated people are those who are featured on show. They participate in all of the activities, do workouts, probably because they have a camera in their face for much of the day. Now the problem, as was also mentioned on the show, is that the village has more than 10 people in it. If the village is going achieve its goal lots of people, in fact most of the village, is going to have to lose weight. This was the insight of Geoffrey Rose who wrote a great book called Rose’s strategy of preventive medicine.
Rose’s idea is that, if the entire community is going to change on some behaviour or risk factor, the entire distribution, from the least to the most motivated (least to most physically active in the case of “Village of diet”) is going to have to change. It does not make sense to target the most motivated (the people you see on the show) because are the most likely to change anyway. One of the shows trainers realized this (though he may have never heard of Rose) when he saw the dwindling number of people participating in the weekly physical activity challenge. More reading:
Rose G. The strategy of preventive medicine. Oxford: Oxford University Press; 1992.
Culos-Reed NS, Gyurcsik NC, Brawley LR. Using theories of motivated behavior to understand physical activity. In: Singer RN, Hausenblaus HA, Janelle CM, eds. Handbook of Sport Psychology. Toronto: John Wiley & Sons; 2001:695-717.
Based on my experience (ed. by experience I mean sitting at a desk and reading academic articles), I’m skeptical that the town will achieve its objective, unless more people start to get involved in the activities. I would say that for those who are motivated (i.e., featured on the show) it is probable that they will see significant weight lose and reduction in their “body age” (ed. don’t get me started on body age).
Regardless of your research background, tune in a check it out.