Depicting Obesity in Black America

DEPICTING OBESITY IN BLACK AMERICA

Overview

Obesity is a major health problem for millions of Americans. Dietary patterns, physical inactivity, medication use, and other exposures contribute to the prevalence of obesity in America. In an article, "Is Fat the New Normal?" Sherry Rauh likens obesity among Americans to tallness among basketball players.

African American adults are 1.5 times as likely to be obese compared 

with white adults, and over 75% of African Americans are overweight

compared with 67.2% of White Americans. 

(State of Obesity - RWJ Foundation)

"If you're tall enough to stand out in a crowd, you're probably aware of your tallness - maybe even self-conscious about it. But imagine that you're in a room full of basketball players. Suddenly, you don't seem so tall anymore. Your above average height feels normal." - S. Rauh

Rauh suggests that if we equate "normal" with average, it's not a stretch to say that in America, it's normal to be obese. The average or "normal" American adult's BMI is 28.6, which signifies overweight.  The new normality of excess weight makes it very difficult for Americans to recognize what obesity looks like. This poses a serious concern in populations such as African Americans where obesity is highly prevalent. 

Rush University MC Study

A study conducted by researchers from the Rush University Medical Center in Chicago, recruited sixty-nine African American women from a low income neighborhood of Chicago and asked them to identify which of the nine women (shown below) were overweight, obese, and "too fat". The consensus was that of the nine women shown, only 8 and 9 were "too fat" (Boosely).

Implications

This simple study conveys a larger disagreement between cultural and medical definitions of "healthy" in the African American community. This disconnect poses a much larger problem considering the effect of obesity on quality of life and risk for other chronic diseases such as diabetes, heart disease, hypertension, and some types of cancer. Since these illnesses are already disproportionately prevalent in minority populations, measures must be taken to mend this disconnect and push African Americans toward health equity. 

What could be done?
1. Examination of social determinants of health that contribute to African American obesity. Determinants such as income, neighborhood, educational attainment, food advertising, and access to parks, grocery stores, and green space all play a critical role in the overall health of a community. African American communities face significant disparities in these determinants. Therefore, to help African Americans live healthier lives, these disparities must be eradicated. This will require strategic programs, policies, and neighborhood revitalization efforts that increase the availability and access to healthy food and safe space to be physically active in African American communities.

2. Development of culturally relevant healthy living and weight loss programs tailored to meet the unique needs of African Americans. To enhance cultural relevance and appeal to African Americans, these programs should solicit input from population members, use culturally relevant intervention content, incorporate population media figures, utilize culturally relevant forms of physical activity, and address specific population linked barriers to activity (Conn). For example, Steps to Soulful Living, a weight loss intervention for African American women, successfully reduced participants' weight by 8 - 15 pounds using these strategies (Karanja).

3. Use of nontraditional partners to increase health education in minority and low income communities. Instead of relying on traditional health education providers such as hospitals and clinics, providers should use nontraditional sources such as churches, community centers, sorority and fraternities, and barbershops/salons to conduct successful lifestyle interventions in settings that are both familiar and comfortable in the Black community (Kennedy et al).

Sources:
Boseley, Sarah. "Do You Know What Fat Looks Like?" Editorial. Obesity: The Shape We're In Blog. The Guardian, 10 Sept. 2014. Web. 29 Sept. 2015.

Conn, Vicki S., Keith Chan, JoAnne Banks, Todd M. Ruppar, and Jane Scharff. "Cultural Relevance of Physical Activity Intervention Research with Underrepresented Populations." Int Q Community Health Education34.4 (2013): 391-414. NCBI. U.S. National Library of Medicine. Web. 30 Sept. 2015.

Karanja, N., VJ Stevens, JF Hollis, and SK Kumanyika. "Steps to Soulful Living (steps): A Weight Loss Program for African-American Women." Ethnicity and Disease 12.3 (2002): 363-71. National Center for Biotechnology Information. U.S. National Library of Medicine. Web. 30 Sept. 2015.

Kennedy, Betty, Jamy Ard, Louis Harrison, Beverly Conish, Eugene Kennedy, Erma Levy, and Phillip Brantley. "Cultural Characteristics of African Americans: Implications for the Design of Trials That Target Behavior and Health Promotion Programs." Ethnicity and Disease 17 (2007): 548-54. Cite Seer X. Pennsylvania State University. Web. 30 Sept. 2015.

Rauh, Sherry. "Is Fat Normal in America? A Surprising Reason Why We're Gaining Weight." WebMD. WebMD, n.d. Web. 29 Sept. 2015.

The State of Obesity: Racial and Ethnic Disparities in Obesity. Rep. N.p.: Robert Wood Johnson Foundation, 2014. Web. 30 Sept. 2015.

Shifting the Health Equity Focus from Accessibility to Outcomes

Access to Care < Health Outcomes?

Background

Source: http://www.nyas.org/

It is well documented that racial and ethnic minorities face worse health and health care disparities than any other group. Several socioeconomic factors such as neighborhood, educational attainment, and income level lead to a lesser standard of health care and worse health outcomes in minority communities. To address these disparities, several health care organizations have begun to develop interventions focused on narrowing the gap between social determinants of health and health equity. For years, the focus these interventions has been access to care, which hemmed on the belief that issues such as lack of insurance, cost of services, and availability of providers were the major sources of disparity. However, difficulties in reducing these disparities have prompted public health and healthcare practitioners to look elsewhere.

A Shift in Focus

"Health organizations can promote and sustain equity by broadening the scope of health care systems and promoting interventions that focus on the core contributors to disease."

In the article Achieving Health Equity by Design, authors from the American Medical Association suggest health practitioners shift their health disparities work from efforts to increase cultural competence, patient safety, and health literacy to those that target equity in health outcomes. The authors suggest that instead of focusing on efforts to "retrofit the current healthcare system to make it more accessible to patients," health care organizations should focus more on the factors that cause disproportionate lack of access and sustained treatment in minority communities. This shift requires health care organizations to adopt unconventional methods to provide education and services in places where racial and ethnic minorities live and work. Some health care organizations have already begun to move toward this framework.

Source: media.npr.org

For example, in 2010, the CDC piloted barbershop hypertension management programs in Los Angeles and St. Louis to implement system-level hypertension control interventions for African American men. These programs trained barbers and stylists in the African American community to become community blood pressure specialists who measure and record blood pressure readings of customers, provide information about hypertension,a nd make referrals to providers. Barbershops were specifically targeted because, in the African American community, barbershops are quintessential, gender-specific places for gathering and fellowship. An evaluation of the barbershop intervention found that African American men who received service through the intervention had a decrease in blood presure and an increase in hypertension treatment and control. These results show promise for future collaborations between heatlh care organizations and nontraditional partners such as faith-based organizations, fraternities and sororities, and barbershops. Through these partnerships, health care organizations can circumvent social determinants of health and move minority communities toward health equity. 

Sources:

Centers for Disease Control and Prevention. A Closer Look at African American Men and High Blood Pressure Control: A Review of Psychosocial Factors and Systems-Level Interventions. Atlanta: U.S. Department of Health and Human Services; 2010.

Wein, Harry. "Barbers Help Black Men Beat High Blood Pressure - NIH Research Matters National Institutes of Health (NIH)." NIH Research Matters. National Institutes of Health, n.d. Web. 23 Sept. 2015.


Wong, Winston F., Thomas A. LaVeist, and Joshua Sharfstein. "Achieving Health Equity by  Design." The Journal of the American Medical Association 313.14 (2015): 1417-1418. JAMA Network. American Medical Association. Web. 23 Sept. 2015.