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Background

Obesity is a major threat to the health of the nation. The prevalence of obesity 1, 2 and its associated health risks are well documented. 3, 4 Known determinants of obesity include physical activity and dietary behaviors. Public health efforts to increase physical activity and improve nutrition among the general population have traditionally been aimed at individual-level health changes. Such approaches have been found to be minimally effective, costly, and difficult to sustain. 5 In 2002, the Institute of Medicine (IOM) endorsed a broad approach to public health problems recommending the adoption of an ecologic model, where individuals and their behavioral choices are situated within and influenced by their broader social and environmental context. 6, 7 Physical activity and nutrition researchers and practitioners have applied the ecologic model. 8 Researchers currently recommend a systems-oriented …