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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 Community Health 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.

Watch the Train4Change video trailer.

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 minority communities.

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.