Many influencers span more than one domain. Katz ML, Gordon-Larsen P, Bentley ME, Kelsey K, Shields K, Ammerman A: Does skinny mean healthy? Perceived ideal, current, and healthy body sizes among African-American girls and their female caregivers. The prevalence of obesity in Asian American boys and girls was 10 and 4%, respectively (8). We need to better understand how to translate the socio-ecological model into practice. Thus, TFP may provide adequate calories at low cost but requires an unrealistic investment in time. There are few full-service supermarkets in poorer neighborhoods but many convenience stores selling calorie-dense less nutritious foods. Obesity has deleterious associations in childhood and adolescence that increase morbidity and contribute to risk for cardiovascular disease and diabetes. Cultural influences such as preparing and eating traditional foods can be a protective influence on childhood obesity, as can eating together as a family. Cutler DM, Glaeser EL, Shapiro JM: Why have Americans become more obese? reports none. Cultural beliefs and practices and levels of acculturation may contribute to racial/ethnic disparities in obesity. Consider cultural, individual, and family preferences and the realities of time and money in advice about meal planning. Available from. National Library of Medicine Although the implication of a given BMI is known to differ by race and ethnicity in adults, analogous data are lacking in children. WebGenetic changes in human populations occur too slowly to be responsible for the obesity epidemic. obesity More. Also, parental concern about neighborhood crime and, therefore, their children's safety may lead to children remaining at home after school (particularly if no adult caretakers are available) and engaging in sedentary rather than physical activity. Studies expanding such interventions to African American and Hispanic children are ongoing. 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). Cultural Influences on Childhood Obesity in Ethnic Minorities: A government site. Sibutramine, an appetite suppressant that inhibits the reuptake of norepinephrine and serotonin, is labeled for those age 16 years and older. The prevalence of dyslipidemia (higher triglyceride and lower HDL cholesterol levels) also increases with obesity in youth. School snack lines, vending machines, and in-school stores typically offer less-than-optimal food choices, including sweetened soft drinks, candies, fried chips, and bakery goods. Spear BA, Barlow SE, Ervin C, Ludwig DS, Saelens BE, Schetzina KE, Taveras EM: Recommendations for treatment of child and adolescent overweight and obesity. Obesity The Centers for Disease Control reported that in 2000 the prevalence of obesity was 19% of non-Hispanic black children and 20% of Mexican American children, compared with 11% of non-Hispanic white children. Accessibility Weight loss achieved with metformin is typically modest, and therefore its primary benefits may be for obesity-related consequences such as hyperglycemia and ovarian hyperandrogenism. These studies will need to address the influence of culture and genetics on treatment efficacy. WebMexicans and Mexican Americans share culture, genetic background, and predisposition for chronic complications associated with obesity and diabetes making imperative efficacious treatments and prevention. 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. This pattern flattens and then reverses as country-level income increases. 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). A 2006 Institute of Medicine report (62) cited television advertising as influencing children and adolescents to adopt unhealthy lifestyle choices. The panel's consensus recommendations for the prevention and treatment of childhood obesity, accounting for the influence of race, culture, and ethnicity, are summarized in Table 1. Measures of accumulated wealth and access to resources and services are usually not included in studies of children's diets and childhood obesity. 1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, 2Department of Pediatrics, University of Colorado, Aurora, Colorado, 3Department of Epidemiology, University of Washington, Seattle, Washington, 4Department of Medicine, University of Washington, Seattle, Washington, 5Department of Pediatrics, University of Southern California, Los Angeles, California, 6Department of Communications, University of Southern California, Los Angeles, California, 7School of Social Work, University of Southern California, Los Angeles, California, 8Department of Pediatrics, University of Florida, Gainesville, Florida, 9Department of Pediatrics, University of California, San Diego, California, 10Rady Children's Hospital San Diego, San Diego, California. Behavioral modification focuses on successive changes using family support for the practice and reinforcement of lifestyle changes. In addition, about 20% of schools offer brand-name fast food items. Calorie for calorie, refined grains, added sugars, and fats provide inexpensive dietary energy, while more nutrient-dense foods cost more (21), and the price disparity between the low-nutrient, high-calorie foods and healthier food options continues to grow. With succeeding generations, the intake of these items by Asians remains stable. The California Fitnessgram data showed that higher prevalence of childhood obesity was observed in lower-income legislative districts. Providers should offer anticipatory guidance and give specific information about the health benefits of physical activity and good nutrition and how to diminish sedentary behavior. 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). With both acculturation and globalization there are changes in preferences for certain foods and forms of leisure/physical activity, as well as educational and economic opportunities. There is an association between parents perceptions of neighborhood safety and childhood obesity (65). For instance, non-Hispanic white mothers dietary restraint or their perceptions of their daughters risk of overweight can influence their young daughters weight and dieting behaviors (47). Through the lens of overweight, I examine health citizenship in the context of universal health provision funded from general taxation, and track attitudes toward overweight once its health implications and medical costs affected a public service as well as individual bodies and households. Stovitz SD, Steffen LM, Boostrom A: Participation in physical activity among normal- and overweight Hispanic and non-Hispanic white adolescents. How might socioeconomic factors influence racial/ethnic differences in childhood obesity? Percent poverty and poverty-to-income ratios have also been used to stratify survey participants by income groups. The answers to your question are obvious, and obesity is not the most important result. Although federal regulation requires that these meals must meet certain nutritional standards, the NSLP relies upon foods purchased and donated by the USDA. (1) Background: The influence of food culture on eating behavior and obesity risk is poorly understood. BMI is based on an individuals weight and height. For instance, beliefs relating the normative and pragmatic rules for engaging in health-promoting behavior (diet and exercise) or leisure activity (watching television or playing video games) will change as individual members of an ethnic group experience and come to value innovative practices, while losing interest in and thereby disvaluing traditional practices. Robinson TN, Killen JD, Kraemer HC, Wilson DM, Matheson DM, Haskell WL, Pruitt LA, Powell TM, Owens AS, Thompson NS, Flint-Moore NM, Davis GJ, Emig KA, Brown RT, Rochon J, Green S, Varady A: Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study. Given that women typically assume primary responsibility for the care, feeding, and education of children, including the transmission of shared cultural understandings, the beliefs that women possess with respect to their own body image have implications for their perception of and response to the body image of their children. How Neighborhoods Can Reduce the Risk Bilingual school-age children from immigrant Mexican households serve as agents of dietary acculturation by rejecting the lower-calorie traditional foods prepared at home and favoring the higher-calorie foods, beverages, and snacks they consume at school or see advertised on television (50) and may resist efforts by their parents to restrict the availability of foods from the mainstream culture. Cultural Influences on Childhood Obesity in Ethnic Minorities: A However, the evidence is primarily derived from white, middle- class, mildly to moderately obese children with intact families. People who are female, middle-aged, ethnic minority, unemployed or in unskilled jobs, lower income, less educated, living with others, married, parents, rural, and/or living in particular regions are more likely to be obese. This marketing, in turn, may produce alterations in belief systems as to the desirability of foods high in calories and low in nutrient density. Goals should be realistic, of specific duration, and revised as needed. WebObjectives It is unclear whether cultural differences or material disadvantage explain the ethnic patterning of obesogenic behaviours. Future studies will need to address the timing and long-term effects of pharmacotherapy on clinically relevant end points. Triglycerides are highest in obese Mexican Americans and lowest in obese African American children. Cultural approach is key to tackling obesity Following presentations by invited speakers and in-depth discussions, a seven-member panel of experts in pediatric endocrinology, cardiology, gastroenterology, nutrition, epidemiology, and anthropology developed this consensus statement on the influence of race, ethnicity, and culture on childhood obesity, addressing the following questions: What are the prevalence, severity, and consequences of childhood obesity across race/ethnicity in the U.S.? Cultural variation in the population is maintained by migration of new groups, residential segregation of groups defined by their culture and ethnicity, the maintenance of language of origin by the first and, to a lesser degree, the second generation of immigrants, and the existence of formal social organizations (religious institutions, clubs, community or family-based associations). While this price is attractive, it has been estimated that TFP menus would require the commitment of 16 h of food preparation per week. WebAbstract Introduction:Childhood obesity remains an unrelenting public health problem disproportionately affecting ethnic minorities. Both race and ethnicity are, in fact, social constructs. 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. Careers, Unable to load your collection due to an error. Clinicians need to understand the social and physical context in which children live, attend school, and play. Consensus recommendations for the prevention and treatment of childhood obesity: implications of race, culture, and ethnicity. Obesity is serious because it is associated with poorer mental health outcomes and reduced quality of life. 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. The socio-ecological approach requires not only knowledge transfer but also peer support, supportive social norms, and private and public sector collaboration. 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. 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. WebCultural predispositions to obesity are found in the productive economy, the mode of reproduction, social structure, and cultural beliefs about food and ideal body size. Two medications are labeled for use in weight loss in adolescents when combined with an intensive lifestyle intervention program. They are not all the same. Childhood obesity is a major public health challenge and its prevalence continues to increase in many, but not all, countries worldwide. Inclusion in an NLM database does not imply endorsement of, or agreement with, The association of obesity in childhood with the emergence of type 2 diabetes is also disproportionately seen in Hispanic, Native American, and African American adolescents. 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. International data indicate that the prevalence of obesity is greater among boys than girls 519 years of age in the majority of high and upper middle-income countries worldwide. Culture provides meaning to a set of rules for behavior that are normative (what everyone should do) and pragmatic (how to do it). Available from. To complicate matters, data on education and income tend to be treated as confounding factors in analyses and not as independent variables of interest. In children, bariatric surgery has been largely limited to white adolescents, and there are no data to inform whether race/ethnicity influences outcomes. Lumeng JC, Appugliese D, Cabral HJ, Bradley RH, Zuckerman B: Neighborhood safety and overweight status in children. Fast food consumption, in particular, has been associated with energy-dense diets and to higher energy intake overall. Williams DE, Cadwell BL, Cheng YJ, Cowie CC, Gregg EW, Geiss LS, Engelgau MM, Narayan KMV, Imperatore G: Prevalence of impaired fasting glucose and its relationship with cardiovascular disease risk factors in US adolescents, 19992000. Consolidating these recommendations evidenced from the literature fills a gap relevant to ED treatment and provides empirically derived, culturally-accommodating guidance on how future studies may include ethnic and racial considerations when developing treatment approaches and/or evaluating outcomes. Rural migrants abandon traditional diets rich in vegetables and cereal in favor of processed foods and animal products. Before African Americans have higher circulating insulin levels than whites, due to not only a more robust -cell response to glucose but also decreased clearance of insulin in the liver. Hispanic children are more likely to be uninsured than black children, who are more likely to be uninsured than white children. Obesity The relationships between stress and illness differ markedly by race/ethnicity, in part due to differences in exposure to social and environmental stressors; the degree to which the environment, SES, and discrimination are appraised as stressful; culturally appropriate strategies for coping with stress; biological vulnerability to stress; and the expression of stress as illness (30). Cultural contexts shape values and norms about body weight and change weight through modernization, migration and acculturation, and historical contexts change weights and attitudes about weight over time. Get full access to this article Your personal culture affects your attitudes about acceptable body weight. In addition, a certain degree of sophistication is required in order to navigate the health care system. Parikh M, Lo H, Chang C, Collings D, Fielding G, Ren C: Comparison of outcomes after laparoscopic adjustable gastric banding in African-Americans and whites. WebBy arguing this way, obesity prevention comes into view as a public endeavor that involves public discourse as well as shared action. Overweight prevalence by race/ethnicity for adolescent boys and girls. The relationship between television watching and obesity may vary by race. Nevertheless, the social importance given to these constructs to describe groups that have been treated in similar ways based on presumed biological characteristics, as well as the acknowledgment that such classifications themselves have contributed to inequalities in health and health care access, necessitates that we continue to use the terms race and ethnicity. Your culture permeates every aspect of your life, including how much exercise you get and how you view your own body. Culture influences preferences for and opportunities to engage in physical activity. Bacha F, Saad R, Gungor N, Janosky J, Arslanian SA: Obesity, regional fat distribution, and syndrome X in obese black versus white adolescents: race differential in diabetogenic and atherogenic risk factors. Low birth weight is also a risk factor for obesity and obesity-related diseases in childhood, particularly in poor populations. NBER working paper no. Setting Five primary 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). It is important to plot BMI, to show the child/family the plot of BMI over time, and to explain the meaning of BMI, BMI percentile, and upward crossing of percentiles. Bethesda, MD 20894, Web Policies Fast foods, snacks, and soft drinks have all been linked to rising obesity prevalence among children and youth (20). Maryanne Davidson of the Yale University School of Nursing and Kathleen Knafl of Oregon Health and Sciences University reviewed 20 The child and family are influenced by a wide variety of factors such as economic resources, geography, the built environment, available grocery/food stores, community resources, transportation, media/messaging, the work site, and schools. There are further race-dependent differences in income by different levels of education, as well as differences in neighborhood poverty at different levels of income. When it comes to diet selection, the common trade-off is between money and time. 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). does obesity affect Neighborhood of residence may influence access to healthy foods, opportunities for physical activity, the quality of local schools, time allocation, and commuting time. Race has traditionally been used to categorize populations on the basis of shared biological characteristics such as genes, skin color, and other observable features. Berkowitz RI, Fujioka K, Daniels SR, Hoppin AG, Owen S, Perry AC, Sothern MS, Renz CL, Pirner MA, Walch JK, Jasinsky O, Hewkin AC, Blakesley VA; Sibutramine Adolescent Study Group: Effects of sibutramine treatment in obese adolescents: a randomized trial. This pattern may vary by ethnicity. S.C. reports none. Depending on the severity of obesity, dietary interventions may range from minor modifications to major changes. The aim of this study was to examine ethnicity as a predictor of obesity-related behaviours among children in England, and to assess whether the effects of ethnicity could be explained by deprivation. GDM is associated with high birth weight and higher percent body fat of the neonate, both of which are risk factors for obesity during childhood and adolescence. Being aware of community resources may help with healthy lifestyle adaptations. 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). Centers for Disease Control and Prevention: CDC Growth Charts: U.S. [online], 2008. 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. Atlantis E, Barnes EH, Singh MA: Efficacy of exercise for treating overweight in children and adolescents: a systematic review. Cultural contexts shape values and norms about body weight and change weight through modernization, migration and acculturation, and historical contexts change weights and attitudes about weight over time. Whether genetic differences across populations are associated with obesity development also remains unclear. In high-income countries, those living in less affluent circumstances are more likely to experience overweight and obesity. An open dialogue is needed to assure that everyone is working toward the same end. In adults, whites experience more weight loss following gastric bypass surgery or gastric banding surgery than blacks or Hispanics (75,76). WebCulture influences the risk of obesity in children, and cultural differences may account, in part, for the disparities in childhood obesity. A study by Katz et al. Epstein LH, Valoski A, Wing RR, McCurley J: Ten-year follow-up of behavioral, family-based treatment for obese children. On explicit questions, critical science, and current controversies: an ecosocial perspective. 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. Behavior change tools that are culturally sensitive should be used. The prevalence of obesity has tripled since 1980 among children 611 years of age and adolescents 1217 years of age, according to the National Health and Nutrition Examination Survey (NHANES) (5). Available from. 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. A large middle schoolbased trial involving mainly minority, low-SES students is currently assessing whether a comprehensive environmental approach involving food services, physical education, a classroom curriculum, and a social marketing campaign will reduce rates of physiologic outcomes such as overweight/obesity and risk factors for type 2 diabetes. We need to identify robust markers of risk for poor outcomes and determine whether such markers differ by race or ethnicity. Addressing socioeconomic inequalities in obesity - Home - PLOS Community planners need to design and organize communities to maximize opportunities for safe walking or cycling to school, recreational activities, and neighborhood shopping as means to encourage greater physical activity. Health behaviors of the individual (inner oval) are influenced by interpersonal, organizational, community, and public policy domains represented by the progressively larger ovals. The allocation of time resources by individuals and households depends on SES. A major barrier to the treatment of obese children is the lack of insurance reimbursement. 1). Influence of Race, Ethnicity, and Culture on Childhood Obesity is a complex disease that occurs when an individuals weight is higher than what is considered healthy for his or her height. These changes may differ by ethnic groups. Culture may affect health-related communications and interventions in 2 ways. Cultural factors play a role in why some groups of people are more likely to become obese during their lifetime. Goran MI, Bergman RN, Cruz ML, Watanabe R: Insulin resistance and associated compensatory responses in African-American and Hispanic children. See. The prevalence of hypertension is increased in obese youth, with no clear racial/ethnic disparities when data are controlled for obesity. As a library, NLM provides access to scientific literature. For health care providers to have a meaningful interaction about energy intake and energy expenditure with children/families, providers should have training in cultural competency in order to understand the specific barriers patients face and the influence of culture and society on health behaviors. The prevalence of childhood obesity among African Americans, Mexican Americans, and Native Americans exceeds that of other ethnic groups. 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). 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. Lower-cost foods make up a greater proportion of the diet of lower-income individuals (23). Additional indexes of social class, social capital, or social context are rarely obtained in research surveys on diets and health. Are You Talking to ME? The Importance of Ethnicity and Obesity Obesity in children is associated with severe impairments in quality of life. When recommending a physical activity program, it is important to take into account cultural and sex preferences. It is important to promote self-regulation, allowing young children to determine their intake, which may naturally vary from meal to meal and day to day. (59) found that both obese African American girls and their female caregivers were unaware of the potential health consequences associated with their current body size. The increase since 1980 is particularly evident among non-Hispanic black and Mexican American adolescents (Fig. Breastfeeding should be encouraged. Chopra M, Galbraith S, Darnton-Hill I: A global response to a global problem: the epidemic of overnutrition. F.R.K. Such findings could have important implications for personalized and predictive strategies in both the prevention and treatment of childhood obesity. the contents by NLM or the National Institutes of Health. 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). In contrast, Latinas tend to prefer a thin figure for themselves but a plumper figure for their children (48). Is Obesity Culturally Influenced ? - Health Beat Access to resources and services may not be equivalent for a given level of education or income. Culture may influence parental perceptions of their children's health status and behaviors.
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