A Win-Lose Proposition
Tufts Train4Change Community Health Initiative Targets Obesity through Fitness Instructor Training
by Anna Burgess
Addressing disparities within the obesity epidemic is more complex
than advocating for healthier eating and exercise habits, say Tufts
University's Train4Change leaders, because socio-economic and
environmental factors can limit access to health-promoting
resources. These factors further constrain the ability of disparate
populations, such as urban Black and Latino communities, to live the
healthiest lives possible.
Train4Change participants gather
before the video shoot: (from left to right) Natasha Mason-Walker,
Sinceree Clarke-Diego, Project Coordinator Andrea Talhami Lozano,
Charlene Best-Brown. Carla Webster-Reid. Donna Brooks-Allen. Jennis
Farquharson, instructor Sean Robertso.
Train4Change is an obesity mitigation program developed
collaboratively by faculty in the School of Arts and Sciences
program, and the Tufts University School of Medicine
Department of Public Health and Community Medicine.
Flavia Peréa, assistant professor at the Tufts University School of
Medicine and one of the principal investigators of Train4Change,
describes how efforts to address the behaviors that contribute to
obesity should be coupled with efforts to address the many factors
that shape those behaviors. "When we think of public health, the
focus needs to be on determinants of health, such as social and
physical environments...not just behavior. We need to address the
issue of equity or the lack thereof."
Peréa and Linda Sprague Martinez, an assistant professor of public
health and community medicine and co-principal investigator for the
study, worked with Boston's immigrant populations before
Train4Change began in 2011. The two partnered with community
organizations such as the Southern Jamaica Plain Health Center
(SJPHC), Healthworks Community Fitness, and the Dominican
Development Center to develop an intervention to address the factors
that contribute to obesity, employment/employability as well as
opportunities for physical activity. According to Martinez, SJPHC
"was explicit from the start that they didn't want to work on a
traditional nutrition or fitness project targeting individual
behavior, says Martinez. "They told us 'our people need jobs.'"
Martinez says the program took on another dimension when they began
thinking about the project in the context of employment. "We thought
perhaps there's a way we can develop an intervention that is
addressing obesity, but also addresses the employability issue [that
many immigrant women face]," says Martinez.
Two years later, as the Train4Change pilot program is coming to a
close, Martinez and Peréa say the project has addressed both obesity
and employability in immigrant populations, giving women the
knowledge and skill sets to teach group fitness classes, as well as
helping them earn group trainer certification from the Aerobics and
Fitness Association of America (AFAA).
Project coordinator Andrea Talhami, a recent graduate from the
Friedman School of Nutrition Science and Policy at Tufts University,
explains that program participants were chosen for Train4Change
based on several criteria. All of the women are of Caribbean origin
and live or work in the target communities of Jamaica Plain,
Roxbury, and Dorchester. Moreover, adds Talhami, "we wanted people
who were involved in their communities, because the point [of the
program] is to give back to the communities, a characteristic shared
by the ladies of Train4Change."
In December, 2011, participants began the fitness instructor
training -- classes in anatomy, physiology, nutrition, and the
health and fitness industry, as well as training in teaching group
fitness classes – from a women's health and fitness expert. The
women studied from the AFAA textbook and took practice tests to
prepare for the certification exam, and were placed in internships
to learn skills for teaching exercise classes or leading walking
groups. In the fall of 2012, the participants were given their own
classes to teach throughout the Boston area at Healthworks Community
Fitness, SJPHC, the YMCA, and at various community organizations.
In October 2013, Train4Change released an exercise video featuring
their new fitness instructors, about which the Train4Change
participants "feel very empowered," says Peréa. For Martinez and
Peréa, the exercise video means the project will have wider impact:
the video will be disseminated throughout the communities, and to
hospitals, health centers, health insurers, and other organizations
that can have an effect on the health of Boston's immigrant and
In measuring the program's success, Martinez saysTrain4Change has
had an undoubtedly positive outcome for participants. Talhami, who
has worked closely with the women, says their attitudes toward
health and fitness are now extremely positive. The women are now
engaged in a variety of health and fitness activities in their
communities, an important goal of Train4Change, and she hopes that
they will continue with this work.
For Martinez, the next steps in the program are important. She
believes that Train4Change can impact even more lives and
communities, as well as potentially affect public policy. "We got
[to work with] this wonderful group of empowered women who are
leaders in their communities," she says. "And now they're also
leaders in health and fitness."
Train 4Change is funded by The Boston Foundation, The Carol R.
Goldberg Family and Friends, and the Cabot Family Charitable Trust.
It is part of the Carol R. Goldberg Civic Engagement Initiative, a
collaboration between the Jonathan M. Tisch College of Citizenship &
Public Service at Tufts University and The Boston Foundation.