​Susan H. Babey is lead author of a new study that looks at "protective social factors" ― including positive role models ― that can help teens combat obesity. In this interview, Babey talks about how good role models can guide healthy choices, the challenges facing professional mentors, and why so few teens choose family members as role models.

Q: Your previous study found that 32 percent of adolescents were either obese or overweight. In this study you suggest "social protective factors" such as role models, mentors and belonging to a club can help teens avoid obesity. How does that work?

​Data from CHIS showed that adolescents with role models, those who participate in clubs or volunteer outside of school, and those who feel supported by adults at school are more likely to have a healthy weight and are more physically active. It makes sense: Being in a club encourages socialization and activity, even if adolescents aren't in a sports-related club ― they're not sitting around waiting for something to happen. As for role models, teens who admire someone will imitate what they see, for better or worse, so we want to expose them to positive role models. And adult mentors at school can help guide kids toward healthy choices.

Q: You suggest in the study that schools encourage teachers and staff be more aware of how they can mentor teens. Some high schools have more than 4,500 students -- how can they handle that volume?

​​It's true that some schools lack the resources of other schools. Our study showed that teens from low-income families were less likely to feel supported by adults at school. This finding may be driven in part by links between family income and resources available at schools with high proportions of low-income students. Fortunately, many kids already have social support outside of school, but for those who don't get positive guidance at home or from their peers, school teachers and staff can be an incredible resource. Adolescents are at school about six hours a day ― that's a long time. And it's an opportunity to provide support and guidance. But it's more than just being aware of how teachers and staff can mentor teens, schools can also incorporate this into professional development programs. These programs can provide teachers and staff with the training and tools they need to meet the social and emotional needs of their students. Schools may also be able to work with community organizations like Boys & Girls Clubs or Big Brothers/Big Sisters to provide more access to potential role models, mentors and support.

Q: There's a great fatherhood.gov commercial from a few years ago that shows a dad taking time to teach his daughter a cheer routine. But the study found only 1 in 5 teens considers a family member as a role model. What contributes to this?

​Unfortunately, our study found that the largest share of teens, 38 percent, reported not having a role model at all. Other research suggests that teens are more likely to identify role models that are like them, the same gender and the same race. However, many teens are just not exposed to positive, healthy role models who they can identify with. But among teens who did identify a role model, a family member was the most common type. Our study didn't directly address why more teens don't identify a family member as a role model, and the process through which teens identify role models is not well understood. In some cases, it could be a resource issue. Some parents work multiple jobs to keep the family afloat financially and aren't around when the kids are awake. Some parents may face language barriers and find it difficult to provide guidance in a teen's complex world. And teens can be a little rebellious and look for "flashier" role models that their parents might not approve of. This is where a good mentor at school or in the community can help ― they can direct adolescents toward better role models and be a sounding board themselves.

​Susan H. Babey is co-director of the Center's chronic disease program and lead author of a policy brief about high rate of prediabetes and undiagnosed diabetes among adult Californians. In this brief interview, Babey discusses why people are unaware they have prediabetes, how they can avoid prediabetes and type 2 diabetes, and how the lack of choice plays a role in health.

Q: Your study reports people are unaware they have prediabetes ― why is that? Should people use those $15 mail-in blood glucose test kits to find out?

​​The Centers for Disease Control and Prevention estimates that 90 percent of those with prediabetes do not know they have it. Prediabetes has no symptoms. The only way to know if you have prediabetes is with a blood glucose test. But not everyone should ask for a blood glucose test.

The risk factors for prediabetes include age, especially after 45 years of age; obesity; a family history of diabetes; a history of diabetes while pregnant (gestational diabetes); and a lack of physical activity.

The American Diabetes Association has an online quiz people can take to see their risk score for prediabetes, which may be a place to start. If you’re concerned, or if you have a number of the risk factors, you should discuss with your health care provider whether a blood glucose test would be appropriate.

Q: Is there anything specific a person can do to avoid prediabetes or reduce the risk of type 2 diabetes if they already have prediabetes?

​There is very good evidence that for those with prediabetes, losing weight by increasing physical activity and improving diet can cut the risk of developing type 2 diabetes in half. According to the CDC, losing 5 percent to 7 percent of your body weight (10 to 14 pounds for a 200-pound person) and getting at least 150 minutes each week of physical activity, such as brisk walking, can help you prevent or delay type 2 diabetes.

Referral to and participation in a Diabetes Prevention Program recognized as effective by the CDC can help people make these changes and prevent type 2 diabetes. Check here for other information on prediabetes prevention.

Q: In your policy brief, you recommend promoting communities and environments that encourage physical activity and healthy eating. Aren't what you eat and how much you exercise up to you?

​We do make choices about what to eat and whether to do something active or sit on the couch, but choices are made within a context and that context has a lot of influence on the choices available to us. Lack of physical activity and unhealthy eating often result from a lack of opportunity to make better choices.

For example, living in neighborhoods where people feel unsafe or don't have access to safe parks limits their ability to exercise outdoors. If people live in areas where fresh fruits and vegetables are less available or affordable, people can't eat the recommended amount.

Having transportation constraints prevent people from getting to better-stocked grocery stores where there are healthier options, so they eat the less healthy foods available in their neighborhoods. People can't afford to live near where they work so they must spend a lot of time commuting between home and work.

If we can improve neighborhoods so that they support physical activity and healthy eating, then those healthy choices should be easier to make.

Susan Babey is a Center senior research scientist and co-author of a new policy brief on the increase in teen junk food consumption in neighborhoods that are crowded with fast food and other unhealthy food outlets. In this interview, Babey describes how junk food remains abundant even in places (like schools) that have ostensibly banned it, how having a healthier option matters, and why zoning – and not just education – is important in keeping Californians healthy.

Q: Policies have gone into effect restricting teen access to junk food. Yet junk food continues to reach teens. How?

​​Many school districts and more recently the state of California have taken steps to reduce the availability of fast food and soda on school campuses during school hours. However, there are still many, many sources of fast food and soda that teens can access. On the way to and from school, whether teens walk, bike, take the bus or drive, fast food restaurants are everywhere. In fact, there is research demonstrating that fast food outlets cluster around schools. This suggests that schools may be seen as a desirable site for fast food outlets to locate. There are also food trucks and street vendors that may frequently stop near schools before or after school, or during lunch-time. None of these potential sources of junk food are impacted by the existing state and school district policies that have been implemented to improve the healthfulness of foods and beverages available on school campuses. In addition, many teens still have access to soda and fast food after school, at events, or during hours when many students practice sports or engage in other after-school activities.

Q: Unhealthy food outlets will always outpace the number of grocery stores, farmers markets and other purveyors of healthy food. So aren’t communities always going to be outnumbered?

Less healthy food outlets do tend to outnumber stores with healthier options in most areas. However, the results of our study suggest that the relative availability of these outlets is important. For example, kids who live and go to school in areas with 8 times as many fast food outlets, convenience stores and liquor stores as there are grocery stores and produce vendors are more likely to drink soda and eat fast food than kids who live and go to school in areas with just 3 or 4 times as many of the less healthy outlets compared to the number of healthier outlets. This suggests that despite being outnumbered by outlets that sell primarily junk food, the presence of more grocery stores and farmers markets may help to temper the effect of the less healthy stores.

Q: What role does education campaign play in helping parents and teens make better food choices?

Education efforts are very important, but education alone is not enough. There have been efforts to educate kids and adults about healthy eating for a long time. For example, California launched its "5 A Day for Better Health" campaign in 1988 and that campaign was widely adopted across the country by 1994. When these campaigns were very active and well funded, people did eat more fruits and vegetables, but the increase in consumption was not sustained. In addition, the prevalence of obesity continued to rise despite education efforts. Why? It’s important to eat more fruits and vegetables, but it is also important to eat less sugar, fat, and sodium, and also eat fewer calories. I think part of the problem is that the message of any education campaign can be drowned out by people’s daily experiences – passing by dozens of purveyors of junk food, billboards with pictures of appetizing but unhealthy foods, the marketing for cheap and tasty fast food, even the smell of French fries. All of these can undermine the message of a campaign to eat better. There are also many barriers to healthy eating that people encounter every day. Many people have no grocery stores or farmers markets nearby and this limits their access to fresh produce and other healthy grocery items.