One of the risk factors for obesity is lack of exercise for the individual. Physical activity is crucial for an individual to maintain a healthy BMI. It should be noted that physical activity does create some difficulty for determining whether or not the individual is obese. Obesity refers to a condition in which the body mass index (BMI) that is greater than 30.0. If an adult has a BMI that falls between 25.0 and 29.9, the adult is considered to be overweight and at risk for obesity.

It must be noted that BMI does not factor in the difference between muscle mass and actual fat tissue; as such, an individual who has a high percentage of muscle mass may be considered overweight or even obese despite a low percentage of fat tissue. As such, some question the use of BMI to determine obesity in the individual. To properly determine if an individual is overweight or obese, the individual should be assessed by a health care provider who is trained in this specific area (Centers for Disease Control and Prevention, 2015).

However, a trained provider can determine if the individual is obese or merely in excellent physical condition! The ability for individuals to access areas for physical activity remains a crucial part of a healthy lifestyle that ensures a decrease in obesity risk. Unfortunately, the area I am examining struggles to have a community with a healthy lifestyle. It is an urban community in Philadelphia and not a safe community. Communities that are not safe cannot offer their residents opportunities for physical activity. The sidewalks may be uneven and not safe for walking. The streetlamps may be broken, creating dark areas. There may not be recreational areas. There may also be gun violence or gang violence which precludes the ability to engage in outside activity without the risk of danger (Suglia, Shelton, Hsiao, Wang, 2016, p. 7).

With regards to public health initiatives, there are three levels: downstream, midstream and upstream. A downstream initiative tends to focus on the micro level of public health and impacts only the individual. One’s genetics is an example of a downstream determinant of health. One cannot change one’s genetic makeup. However, an initiative can encourage an individual to be aware of one’s genetic and family history with regards to obesity and diseases associated with obesity, such as Type II diabetes. The individual can be made aware of the importance of knowing about family history regarding obesity. As health care professionals, we are trained to ask if the family history includes Type II diabetes, heart disease and cancer; we need to include obesity. We need to train the patients to realize that their family history and genetic makeup puts them at an advantage or disadvantage in this battle. Just as the person with a horrendous family history of cardiac disease needs to be more aware of the risks, the person with a strong family history of obesity also needs to be made aware of the risks.

A midstream initiative for risk can focus on the importance of physical activity. In neighborhoods that lack safe walking trails due to violence or poor lighting, group activities should be planned. If a group decides to all walk together during daylight hours, they can do so in a safer manner. This will encourage greater levels of physical activity in the neighborhood. Higher levels of physical activity help to reduce the risk of obesity. Poor levels of physical activity is an independent risk factor for obesity and can be considered to be a midstream level health determinant.

Upstream factors are macro level factors; these tend to be community and government programs. Community programs may focus on why there is such a high level of violence in the community that precludes a healthy lifestyle for the residents. It may also focus on the issues surrounding nutrition in the community and its tremendous impact on obesity. An upstream initiative may help to build recreational areas that would include playgrounds for children. All of these could help to reduce the risk of obesity in the community (Knickman, & Kovner, 2015, p. 133).