Addressing obesity behind bars has increasingly attracted attention from public health researchers and correctional administrators, while still remaining an often elusive goal. Certainly, obesity prevention in any current context has proven challenging [15][16][17][18]. In some ways, addressing obesity within the correctional setting offers opportunities, for example, the benefit of the "captive audience" who may not otherwise access healthcare [19]. Finally, the burgeoning costs of managing chronic conditions associated with obesity in the incarcerated setting further engage otherwise unlikely partners for public health interventions [20,21]. For example, the expense of diabetes-related health care has been estimated at $25,675 per inmate annually [22].A health intervention to address obesity within the incarcerated setting could focus on individual behaviorthrough education, one-on-one or group counseling or other tailored programming-or could focus on facility level change such as impacting the foodscape within prison, or other systemic restructuring. Interpersonal counseling, which has been shown to be an effective means to dietary change [23][24][25], plays a limited role in correctional settings due its high cost. Targeted health education interventions, tailored to the needs of their specific target population, are a promising strategy for addressing obesity in incarcerated populations [26][27][28][29][30][31][32][33]. However, few of these tailored interventions have been developed for low income, ethnically diverse audiences and those adapted for use in correctional settings have not yet been documented to effectively deliver on outcomes [32][33][34]. One possible reason for the lack of effectiveness of these tailored intervention is a lack of understanding of the specific barriers and facilitators to healthy weight maintenance while incarcerated. Indeed, new participatory based research has offered more successful interventions [35]. Island, 111 Brewster Street, Pawtucket, RI 02860, Tel: 401-729-3400; Fax: 401-729-2494; E-mail: Jennifer_Clarke@brown.edu
AbstractIn the context of the ever-increasing incarcerated population in the U.S. and our "obesity epidemic," recent work has investigated whether incarcerated individuals are at higher risk for obesity and related diseases. We build on this scholarship by interviewing incarcerated men and women, as well as correctional facility staff to parse the barriers and facilitators to maintaining a healthy weight on the inside. This qualitative analysis forms the groundwork for a collaborative health intervention to address weight gain and weight maintenance in a U.S. correctional facility.