title: Community factors related to healthy eating & active living in counties with lower than expected adult obesity rates.
abstract: BACKGROUND
  Adult obesity rates in the United States have reached epidemic proportions, yet vary considerably across states and counties. We sought to explore community-level factors that may be associated with reduced adult obesity rates at the county level.
  
  
  METHODS
  We identified six U.S. counties that were positive deviants for adult obesity and conducted semi-structured interviews with community leaders and government officials involved in efforts to promote healthier lifestyles. Using site visits and in-depth qualitative interviews, we identified several recurrent themes and strategies.
  
  
  RESULTS
  Participants: 1) developed a nuanced understanding of their communities; 2) recognized the complex nature of obesity, and 3) implemented a county-wide strategic approach for promoting healthy living. This county-wide approachwas used to a) break down silos and build partnerships, b) access community resources and connections, and c) transfer ownership to community members.
  
  
  CONCLUSIONS
  We found that county leaders focused on establishing a county-wide structure to connect and support community-led initiatives to promote healthy living, reduce obesity, and foster sustainability. Findings from this study can help inform county-level efforts to improve healthy living and combat the multi-faceted challenges of adult obesity across the U.S.
authors.affiliation: Department of Health Policy and Management, Yale University School of Public Health, 60 College St, New Haven, 06520 CT USA ; Yale Global Health Leadership Institute, 2 Church Street South, Suite 409, New Haven, 06529 CT USA.
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Canavan
authors.affiliation: Department of Health Policy and Management, Yale University School of Public Health, 60 College St, New Haven, 06520 CT USA ; Yale Global Health Leadership Institute, 2 Church Street South, Suite 409, New Haven, 06529 CT USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Cherlin
authors.affiliation: Department of Health Policy and Management, Yale University School of Public Health, 60 College St, New Haven, 06520 CT USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Boegeman
authors.affiliation: Department of Health Policy and Management, Yale University School of Public Health, 60 College St, New Haven, 06520 CT USA ; Yale Global Health Leadership Institute, 2 Church Street South, Suite 409, New Haven, 06529 CT USA.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.affiliation: Department of Health Policy and Management, Yale University School of Public Health, 60 College St, New Haven, 06520 CT USA ; Yale Global Health Leadership Institute, 2 Church Street South, Suite 409, New Haven, 06529 CT USA.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Talbert-Slagle
keywords: Community dynamics; Organizational factors; Strategic thinking