Policies must be put in place to insure that students have a requisite number of minutes of physical activity each week and that schools have adequate equipment and facilities and trained physical education teachers. Are You Talking to ME? The Importance of Ethnicity and Birch LL, Fisher JO: Mothers child-feeding practices influence daughters eating and weight. African Americans also have lower levels of adiponectin than white subjects during childhood and adolescence, which may help explain their increased risk of diabetes and cardiovascular disease despite having less visceral adiposity (38). Obesity Drugs Are Moving Way Past Ozempic - The Atlantic Ethnicity is used to categorize on the basis of cultural characteristics such as shared language, ancestry, religious traditions, dietary preferences, and history. Side effects of this drug include increased heart rate and blood pressure. sharing sensitive information, make sure youre on a federal After diagnosis of obesity, the next step is to consider the possibility of identifying the cause(s) and to determine the presence of comorbid conditions. Obesity affects children as well as adults. Another study suggested that metformin was more effective for weight loss in white adolescents than black adolescents, perhaps due to differences in insulin secretion and sensitivity (74). A strategy of early intervention targets children at increased risk for long-term obesity and obesity-related disease at a time when treatment may prevent the complications of obesity. Health care providers should play an active role in advocacy for local and national policies that foster a healthy environment for all children, including: Restriction of youth-targeted television advertising of foods of low nutritional value, Promotion of regular physical activity and healthy food choices in schools, Provision of safe places for children to play and access to healthy food choices in poor and minority neighborhoods. Whereas whites in the bottom quintile of income had some accumulated resources, African Americans in the same income quintile had 400 times less or essentially none. Adair LS, Gordon-Larsen P: Maturational timing and overweight prevalence in US adolescent girls. Obesity in children is associated with severe impairments in quality of life. National Health and Nutrition Examination Survey 2017March Accessibility 3,4 The first has been termed the surface structure and describes the matching of materials and messages to cultural The panel agrees with the report's call to restrict television advertising of food items of low nutrient density to children. The prevalence of obesity has increased markedly in U.S. children and adolescents in the past 30 years. Healthy Eating Index scores are inversely associated with body weight and positively associated with education and income (24). The influence of race/ethnicity and culture on preventive efforts in the clinical health care setting and in the public health domain requires further understanding and evaluation. For instance, exposure to food-related television advertising was found to be 60% greater among African American children, with fast food as the most frequent category (54). Future studies will need to address the timing and long-term effects of pharmacotherapy on clinically relevant end points. Overweight prevalence by race/ethnicity for adolescent boys and girls. Williams DR: Race and health: basic questions, emerging directions. Among African American parents, there is greater awareness of acute health conditions than of obesity. Similarly, there have been changes in patterns of physical activity linked to risk of obesity in both adults and children worldwide, including increased use of motorized transport, fewer opportunities for recreational physical activity, and increased sedentary recreation (44). This marketing, in turn, may produce alterations in belief systems as to the desirability of foods high in calories and low in nutrient density. We need to better understand how to translate the socio-ecological model into practice. Living in high-poverty areas has been associated with higher prevalence of obesity and diabetes in adults, even after controlling for individual education, occupation, and income. The loss of manufacturing jobs, the growth of a service economy, and the increasing number of women in the labor force have been associated with a dramatic shift in family eating habits, from the decline of the family dinner to the emerging importance of snacks and fast foods (26). BMI is based on an individuals weight and height. We need to identify robust markers of risk for poor outcomes and determine whether such markers differ by race or ethnicity. Obesity is serious because it is associated with poorer mental health outcomes and reduced quality of life. Among adults aged 20 and over, the age-adjusted prevalence of obesity was 41.9%, severe obesity was 9.2%, and diabetes was 14.8%. A study by Katz et al. How Neighborhoods Can Reduce the Risk L.A.P. Available from. While this price is attractive, it has been estimated that TFP menus would require the commitment of 16 h of food preparation per week. Guidelines exist to identify, evaluate, and treat obese children (66), but there is insufficient evidence to recommend a specific treatment approach according to the race/ethnicity of the child. Americans (some or many) are literally killing themselves. The allocation of time resources by individuals and households depends on SES. The optimal diet for successful long-term weight loss in children is controversial and requires controlled clinical trials to resolve. S.R.D. African Americans have lower rates of basal lipolysis than whites (37). Roberts DF, Foehr UG, Rideout VJ, Brodie M. Henderson VR: Longitudinal associations between television viewing and body mass index among white and black girls. A major barrier to the treatment of obese children is the lack of insurance reimbursement. Notably, the rate of improvement of obesity-related comorbidities was equivalent among race/ethnic groups, despite differences in weight loss. Whether genetic differences across populations are associated with obesity development also remains unclear. Illness is shaped by cultural factors governing perception, labeling, explanation, and valuation of the discomforting experiences (39). Powell AD, Kahn AS: Racial differences in women's desires to be thin. To address the evidence base and gaps in knowledge in this area, Shaping America's Health and the Obesity Society convened a consensus development conference on 911 April 2008. Rhee K: Childhood overweight and the relationship between parent behaviors, parenting style, and family functioning. Thus, TFP may provide adequate calories at low cost but requires an unrealistic investment in time. Of the 58 million schoolchildren in this country, about 28 million take part in the subsidized National School Lunch Program (NSLP) and eight million in the School Breakfast Program. A.L.R. Cultural approach is key to tackling obesity Obesity is a complex disease that occurs when an individuals weight is higher than what is considered healthy for his or her height. Centers for Disease Control and Prevention: CDC Growth Charts: U.S. [online], 2008. U.S. Department of Agriculture: The Thrifty Food Plan, 1999: revisions of the Markey Baskets. There is an association between parents perceptions of neighborhood safety and childhood obesity (65). This systematic review identified culturally influenced risk and protective factors for childhood obesity in ethnic minorities. The role of socio-cultural factors in the obesity epidemic | Obesity For instance, cultures vary with respect to which body type is associated with wealth and health, with low-income societies generally believing that a larger body size and high-income societies generally believing that a thinner body is an indicator of wealth and health. Although the government advises more consumption of fruits and vegetables, these are relatively expensive items. Schwimmer JB, Deutsch R, Kahen T, Lavine JE, Stanley C, Behling C: Prevalence of fatty liver in children and adolescents. The second medication, orlistat, is an inhibitor of fat absorption and is labeled for use in children aged 12 years and over. Powell LM, Szczypka G, Chaloupka FJ: Adolescent exposure to food advertising on television. Behavior change tools that are culturally sensitive should be used. Is Obesity Cultural? - US News Health | Find a Doctor or Top-Rated Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV: Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measuresthe public health disparities geocoding project. Affordability, availability of foods and ingredients, palatability, familiarity, and perceived healthfulness prompt immigrant families to retain or discard certain traditional foods and to adopt novel foods associated with the mainstream culture. Rural migrants abandon traditional diets rich in vegetables and cereal in favor of processed foods and animal products. No mechanistic explanation was provided for this finding. In contrast, Latinas tend to prefer a thin figure for themselves but a plumper figure for their children (48). The dynamic nature of culture and increasing pace of cultural change suggest that additional research is needed to determine whether cultural patterns of shared understandings are the causes or consequences (or both) of childhood obesity. has served on advisory boards of Lifescan, NovoNordisk, Medtronic Minimed, Nutrition 21, Clinical Products, Nestle, Amylin, Abbott, Kinexium, McNeil Nutritionals, Insulet, Health Maintenance Corporation, and DLife; has received research support from Medtronic Minimed, Lifescan, Johnson & Johnson, Nutrition 21, Eli Lilly, Glaxo Smithkline, and Pfizer; is a stockholder in Amylin, Diabetes Prevention Source, Clinical Products, Mannkind, and Insulet; and has family members who are principle shareholders of Diabetes Prevention Source. Cultural Influences on Childhood Obesity in Ethnic Minorities: A 2006 Food Marketing to Children and Youth: Threat or Opportunity, 2005 Preventing Childhood Obesity: Health in the Balance, Kaufman FR: Reading, writing, and diabesity. Pubertal maturation is known to impact on obesity development. Palinkas LA, Colcord CL: Health risks among enlisted males in the U.S. Navy: race and ethnicity as correlates of disease incidence. Background Worldwide obesity has more than doubled since 1980. reports none. What are the biological and cultural factors associated with racial/ethnic differences in childhood obesity? Globalization, a social process in which the constraints of geography on social and cultural arrangements recede, can affect obesity through the promotion of travel (e.g., migration of populations from low-income to high-income countries), trade (e.g., production and distribution of high-fat, energy-dense food and flow of investment in food processing and retailing across borders), communication (promotional food marketing), the increased gap between rich and poor, and the epidemiologic transition in global burden of disease (40). A socio-ecological framework should be used to guide the prevention of childhood obesity (Fig. In Pima Indians, 2.2% of 10- to 14-year-olds and 5% of 15- to 19-year-olds had type 2 diabetes in the 1990s, an increase from none in the younger group and <1% in the older group 20 years earlier (13). More research is needed to better understand the stressors associated with race/ethnicity and SES, and better measures are needed to quantify the biological effects of stress. Racial/ethnic differences in body fat distribution, insulin dynamics, fatty liver, dyslipidemia, and diabetes, and the influence of SES and culture on health, suggest that optimal treatments could well differ according to the race/ethnicity of the obese child. The effect of the federal government's farm subsidy program may also be contrary to sound dietary practices. Factors Affecting Weight & Health - NIDDK Optimal outcomes occur with high intensity and long duration of treatment. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM: Prevalence of overweight and obesity in the United States, 19992004. In a study of obese children ages 219 years (15), fatty liver disease was present in 50% of Hispanics, 35% of whites, and 10% of blacks (J.B. Schwimmer, unpublished data). This pattern may vary by ethnicity. does obesity affect The prevalence of childhood obesity among African Americans, Mexican Americans, and Native Americans exceeds that of other ethnic groups. The most popular USDA-donated foods are cuts of beef, pork, chicken, and turkey that are often high in fat. Before Although ethnic groups can share a range of phenotypic characteristics due to their shared ancestry, the term is typically used to highlight cultural and social characteristics instead of biological ones (3). Fresh fruit, which is not generally subsidized, is offered in about only one-half of meals in the NSLP (64). Chanoine JP, Hampl S, Jensen C, Boldrin M, Hauptman J: Effect of orlistat on weight and body composition in obese adolescents: a randomized controlled trial. Get full access to this article While these relationships are plausible, they are not fully understood. Another drug used for the treatment of obesity, although not labeled for that purpose, is metformin. In contrast, fruit and vegetable consumption by Latinos decreases while their soda consumption increases, so that by the third generation their nutrition is poorer than that of whites (41). Food is both an expression of cultural identity and a means of preserving family and community unity. Cultural factors related to the obesity epidemic Girls who mature early have higher BMI and sum skinfolds during their teenage years than girls who mature later (9), and this interaction is strongest in black girls (10). Consider cultural and gender preferences with regard to advice about physical activity. Spear BA, Barlow SE, Ervin C, Ludwig DS, Saelens BE, Schetzina KE, Taveras EM: Recommendations for treatment of child and adolescent overweight and obesity. For instance, first-generation Asian and Latino adolescents have been found to have higher fruit and vegetable consumption and lower soda consumption than whites. We also need to determine how to effectively deliver the appropriate care, including ways to tailor behavioral interventions to suit an individual's culture and environment. Stress has a direct effect on the hypothalamic-pituitary-adrenal axis, resulting in elevation of plasma cortisol, which has been implicated in the development of obesity (29). As a library, NLM provides access to scientific literature. A barrier to children achieving the recommended 60 min of physical activity per day is that most primary, middle, and secondary schools across the country do not provide even 30 min of daily physical activity to students. Kleinman A, Eisenberg L, Good B: Culture, illness and care: clinical lessons from anthropologic and cross-cultural research. For example, a dance program for African American girls (68) and resistance training for Latino boys (69) have shown good acceptance. Studies expanding such interventions to African American and Hispanic children are ongoing. Additional indexes of social class, social capital, or social context are rarely obtained in research surveys on diets and health. Epstein LH, Valoski A, Wing RR, McCurley J: Ten-year follow-up of behavioral, family-based treatment for obese children. Categories based on race account for only 37% of total human genetic diversity, are not reliably measured, and are not always biologically meaningful (3,4). Being aware of community resources may help with healthy lifestyle adaptations. Understanding the influence of these variables on the patterns of eating and physical activity that lead to obesity will be critical to developing public policies and effective clinical interventions to prevent and treat childhood obesity. (1) In short, diet culture is much more than the prevalence of popular dietsrather, it is a source of societal messages that can influence countless people to engage in harmful behaviors, such as caloric restriction, purging, and cutting out entire food groups, in pursuit of the perceived ideal body. obesity Because culture is changing and peoples beliefs are also being reshaped by society, the rise in obesity can partly be explained by culture but is in general multifactorial. The Bogalusa Heart Study tracked 2,400 5- to 14-year-old children for a mean of 17 years and found that obese black children were even more likely to remain obese as adults (83%) than obese white children (68%) (11). For instance, the increasing proportion of the U.S. population describing their race as mixed or other, as well as changes in ethnic self-identification across generations and occasionally even within the same generation, makes it difficult to assign individuals to invariant categories of race or ethnicity. Another possibility is that there are fundamental metabolic differences by race or ethnicity. The manner in which communities are organized, with regard to both physical and social aspects, may play a role in the prevention of childhood obesity. Social and Cultural Influences on Obesity - International Textbook Because black girls undergo pubertal maturation earlier on average than white girls, differences in pubertal maturation stage can account for some racial differences in adolescent obesity. (Reprinted with permission. The socio-ecological approach requires not only knowledge transfer but also peer support, supportive social norms, and private and public sector collaboration. Disparities were found in children of other race/ethnicities. Acculturation to the U.S. is also significantly associated with lower frequency of physical activity participation in 7th-grade Latino and Asian American adolescents (42). Motivational interviewing can be used to engage patients and understand barriers to change. One secondary analysis of a single-center trial of sibutramine suggested that obese white adolescents may have better weight loss with the combination of behavioral therapy and sibutramine than obese black adolescents (73). Although the overall prevalence of childhood obesity continued to increase during the first half of this decade (17% in 2004 vs. 14% in 2000), the differences by race/ethnicity appear to be diminishing, in part due to rapid increases in obesity in white children: in 2004 the prevalence of childhood obesity was 20% in non-Hispanic blacks, 19% in Mexican Americans, and 16% in non-Hispanic whites, and prevalence was highest in Mexican American boys (22%) and African American girls (24%). http://creativecommons.org/licenses/by-nc-nd/3.0/, http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/background.htm. For instance, perceived ideal body size for African American women is significantly larger than it is for white women, and African American men are more likely than non-Hispanic white men to express a preference for larger body size in women (45). The genes or gene variants that would support this hypothesis have not been identified. Because illness experience is an intimate part of social systems of meaning and rules for behavior, it is strongly influenced by culture. Unger JB, Reynolds K, Shakib S, Spruijt-Metz D, Sun P, Johnson CA: Acculturation, physical activity, and fast-food consumption among Asian-American and Hispanic adolescents. NBER working paper no. It is critical from the outset that the physician, parent, and child have mutually agreed upon goals. Stovitz SD, Steffen LM, Boostrom A: Participation in physical activity among normal- and overweight Hispanic and non-Hispanic white adolescents. The California Fitnessgram data showed that higher prevalence of childhood obesity was observed in lower-income legislative districts. Hence, efforts should be made to prevent GDM and excess maternal weight gain during pregnancy; otherwise, this vicious cycle may continue and affect subsequent generations in a family. Darmon N, Drewnowski A: Does social class predict diet quality? Hispanics also have lower insulin sensitivity than whites, after controlling for BMI and body composition, and have higher insulin levels in compensation for their relative insulin resistance (35). Evidence for the benefits of comprehensive lifestyle interventions including behavioral modification, currently based primarily on studies of white middle-class children, needs to be expanded through more studies targeting children of lower SES and non-white race/ethnicity. Many influencers span more than one domain. Fatty liver is more common in obese boys than in obese girls and differs significantly by race/ethnicity. One possible contributor to racial/ethnic disparities in the metabolic comorbidities of obesity may be related to different patterns of fat distribution. Whereas fats and sweets cost only 30% more than 20 years ago, the cost of fresh produce has increased more than 100%. Race/ethnicity may have underlying genetic components; however, self-identified race/ethnicity is complicated by genetic admixture (31). Airhihenbuwa CO, Kumanyika S, Agurs TD, Lowe A: Perceptions and beliefs about exercise, rest, and health among African-Americans. When it comes to diet selection, the common trade-off is between money and time. Obesity-related risk factors and diseases formerly seen only in adults are increasingly being recognized in obese adolescents and even younger children. While consumption of traditional food with family may lower the risk of obesity in some children (e.g., Asians) (52), it may increase the risk of obesity in other children (e.g., African Americans) (53). There are major racial differences in wealth at a given level of income. According to the World Health Organization (WHO), obesity is defined as the fatness level sufficient to increase risk of morbidity or mortality ().The prevalence of this health issue in young populations has risen substantially worldwide in less than one generation, especially in developing countries ().Excess body fat in children and Obesity The construct of culture may represent in part adaptation to limited options or the prevailing economic conditions. Obesity Henderson (58) found that white girls who watched more television at baseline showed a steeper increase in BMI over early adolescence than girls who watched less, while television viewing was not associated with adolescent BMI change in black girls. Culture and culturally specific beliefs or practices may influence perceptions and decisions, potentially contributing to childhood obesity. Although some evidence suggests that the effects of weight loss medications or bariatric surgery may differ among racial or ethnic groups, decisions about the use of these interventions in children should not be based on race or ethnicity. To help prevent obesity, particularly in minority and low-SES students who are most impacted by school food policies, optimal nutrition, calories, and food behaviors must be offered and promoted. Childhood experiences of SES can be defined by race/ethnicity, household economic resources, or some combination of both. Culture is a system of shared understandings that shapes and, in turn, is shaped by experience. Whether diet composition in ad libitum conditions leads to differences in long-term energy intake remains an open question.