The expanding girth of the obesity problem

The problem of obesity in the West is now a well-known social ill. What are some of the contributing factors behind this unhealthy and dangerous issue?

The World Health Organisation (WHO) states that obesity levels have reached “epidemic proportions” globally, as the number of adults in the world classed as overweight now tops 1 billion. At least 300 million of them are clinically obese and will suffer from associated health diseases including strokes, hypertension, Type II Diabetes, heart diseases and cancers. In the UK, a study published in the British Medical Journal warns that obesity could bankrupt the NHS (National Health Service) as one in five adults are classed as obese. South Africa has joined the rampant global increase in obesity. Throughout Africa, as elsewhere, ethnicity has a major impact on the incidence and pathogenesis of comorbid diseases (presence of one or more disorders), particularly diabetes. From the 1960s until the late 1980s, the notion of 'healthy' or 'benign' obesity was propagated in South Africa. This led to ignorance around the problem of obesity, and treatment of some of the comorbid diseases was neglected. An increasing number of studies are looking more closely at the misperception of benign obesity and a new framework for research is also emerging to help define the factors underlying the impact of ethnicity on obesity.

According to a 2003 California study by Thomas W. Hopkins, MD, 65% of US adults are overweight; 31% of adults are obese; 77% of black women and 72% of Mexican-American women are overweight, 50% of black women and 40% of Mexican-American women are obese. With 300,000 related deaths annually, obesity is the second leading cause of preventable death in the United States.

In addition to the contributing factors such as genetics, neurological and physiological, biochemical, environmental, cultural and psycho-social, denial adds to the crisis, as many blacks are less likely to recognize being overweight and obese.

According to a study led by Dana-Farber Cancer Institute researchers, weight misperception was most common amongst black men and women, and also was found amongst Hispanic men (but not women) compared to their white counterparts. Overweight black Americans are two to three times more likely than heavy white Americans to say they are of average weight, even after being diagnosed as overweight or obese by their doctors. The study found that men were more likely than women to misperceive their weight. Amongst women, the prevalence of misperception was highest in overweight black women (40.9%, compared to 20.6% in overweight white women) and men (66.4%, compared to 43.2% in overweight white men)

Key Factors:
Perception

“I’m just big boned.” Many folks have refused to accept that there’s some big meat wrapped around those big bones. Less pressure exists in the black community for people to lose weight through diet and exercise because of a cultural acceptance of higher body weights and heavier body shapes. And though that misperception is a strength in combating ridiculous body image ideals and eating disorders, it can be a problem when people fail to realize the health consequences associated with obesity. In the July 2007 issue of the journal Ethnicity & Disease, it was found that African-American women did not differ from Caucasians in terms of concerns about body shape and weight, but white women were more likely to be influenced by those concerns to seek help. Many would argue that black women are more inclined to be overweight because black men prefer them to be so.

Traditions:
The History of Cuisine

Influences of history, religion, culture, friends, family and environment have all had an effect on the traditions of soul food cooking. Black people have turned hog maws into a delicacy. Soul food is an intimate part of black culture. African-Americans have a tradition of eating fatty, high-salt diets that include various parts of animals, mainly pig parts. During times of slavery, slaves had to eat what was left over from the master’s table and what could be grow themselves. That tradition of soul cooking lives on today but in addition to that, availability of food choices and the cost associated with making healthy choices is plaguing urban communities. There is some ambiguity around the cost comparison of maintaining fresh produce in a household and in urban neighborhoods. There are fast food carry-outs on nearly every corner and mini markets that mainly offer fried fatty foods wrought with grease and salt. In addition, there are processed foods and sugar-filled drinks to wash it down with. The cultural education in black families does not usually put nutrition as a priority, so family tradition as a community is soul food.

Physical Activity and The Hair Factor

If you have any kind of intimate relationship with a black American woman, then you know what her hair means to her. You will find many a sister waiting the obligatory day in the salon to get her ‘do’ done. Folks hate waiting for the subway, the bus and the doctor, but they will sit for hours and watch their toenails grown in a beauty shop for their hairdresser to work their tresses. Hair care and maintenance is one of the issues that keep black women from working out at the gym and swimming laps in the pool. Many can’t empathize with or understand the time and money black women spend to maintain and style their hair. Sweating and chemically treated water in pools tends to undo styles quickly, and causes frizziness and other problems. This becomes a major hindrance in maintaining a work-out regiment that would contribute to a healthy lifestyle. A culture of exercise is also not as prevalent in black communities. Activities like swimming are often-times a luxury. Black children between the ages of 5 and 19 are 2.6 times more likely to drown than whites. Experts say minority kids are not learning to swim as often or as well as their white counterparts and blame a number of issues surrounding the problem on race, class, culture, privilege, and poverty. Minorities make up a disproportionate number of drownings in the U.S. every year. In 2002, nearly 650 children between the ages of 5 and 19 drowned. More than 40 percent of the victims were minorities. “Kids in urban areas drown more than kids in suburban areas,” says Sabir Muhammad, a black competitive swimmer from Atlanta, Georgia and founder of Swim for Life, a nonprofit group that helps teach inner-city kids to swim. “Unfortunately, water safety is something that is not very high on a lot of people’s list of things to teach their children in urban, minority communities.”

It is also important to understand the historical and cultural contexts surrounding minorities and swimming that extend back to slavery. At that time, slave owners kept blacks from learning to swim to prevent them from escaping. In addition, some used water as a torture device, drowning blacks and Native Americans as punishment for poor behavior. During the Civil Rights Era, Jim Crow laws kept many blacks out of public swimming pools. This kind of rampant discrimination contributed to the historic hesitation between minorities and the water.

Socio-Economics

At the University of California, Irvine, a sociologist has found that black immigrants who arrive in America from black-majority regions of the world are healthier than those from white-majority regions; still, regardless of how healthy black immigrants are when they come to the U.S., the longer duration they stay in the United States, the more their health erodes. The study and findings, published in the September 2005 issue of Social Forces, would suggest that racial discrimination in the US is a major cause of poor health for American blacks: native and foreign-born alike.

At the 98th annual NAACP (The National Association for the Advancement of Colored People) Convention, a nearly 100-year-old civil rights organization for ethnic minorities in the United States, leadership stated, “The number one reason why we’re dying at higher rates is because we’re less likely to have access to health care.” About 45.8 million Americans are uninsured, and half of them are African-Americans or other minorities, according to FamiliesUSA, a US consumer advocacy group. Lack of adequate health care in addition to budget cuts in public school systems have contributed to levels of obesity in not only adults, but children, as well. Physical education, once required for graduation, is experiencing budget cuts by up to half, and costly programs like aquatics often are the first casualties. New schools in urban areas are often times built without a gymnasium, relying on already-strained area facilities for recreational space. “The food African-Americans eat and an increasingly sedentary life have swelled the number of black kids with bulging waistlines,” said Roniece Weaver. “Physical activity is at an all-time low, and eating is at an all-time high.” Roniece Weaver, along with Yvonne Sanders-Butler, are co-authors of The New Soul Food Cookbook for People With Diabetes. Nearly 36% of 6 to 11-year-olds are overweight, and 19.5% are obese. About 40% of blacks age 12-19 are overweight while 23.6% of them are obese, according to the American Obesity Association. In April of 2007, the Robert Wood Johnson Foundation announced a $500 million commitment to reverse childhood obesity in the US. They will expand research, school and community efforts, with focus on reaching kids and families in underserved communities.

It will take much to combat the issue and consequences of obesity. We need to work toward creating universal understandings of health that include cultural understandings, healthy and wide-spanning perceptions of beauty, as well as understanding belief systems, identifying barriers, setting realistic goals and expectations, enhancing education and communication, and a universal access to information and fair and affordable health care. Health speaks to race, money, privilege, access, information, public policy, politics and perceptions. There is hope that people will increasingly recognize the health consequences of not only being overweight, but also the environmental factors that contribute to it.