Reframing Childhood Obesity Through a Cultural Lens

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Latino family eating dinner.
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In the last few years, childhood obesity has become a global epidemic.

The effort to change individual choices – like diet and physical activity – hasn’t solved the problem, and also contributes to weight discrimination.

That is why we need to use cultural insights, nutritional science, and a systemic focus to improve child health, according to a new report from the Vanderbilt University Cultural Context of Health and Wellbeing Initiative.

“What we label ‘obesity’ is produced by interrelated systems in which human biology interacts with environments, social norms, economic structures, and historical legacies,” according to a Robert Wood Johnson Foundation blog post about the report, Reframing Childhood Obesity: Cultural Insights on Nutrition, Weight and Food Systems. “To effectively improve child nutrition, we must de-center the role of the individual, look beyond weight, and have policies and interventions that take into account the cultural contexts and colonial legacies that produce community environments that can contribute to obesity.”

How do cultural traditions and norms among Latinos and other people of color contribute to childhood nutrition and obesity? And how can cultural insights and global examples help improve health policy around childhood obesity?

Is Nutrition Always Valued?

When someone is eating, they don’t always choose their food based on nutritional value.

Oftentimes, they choose what they eat based on personal preference, cultural norms, and even structural constraints.

“Familial and cultural traditions shape childhood eating habits and form the basis for adult habits, but these are not static. Cultural values around food–like all cultural processes–are open and dynamic, not simply replicating established norms. Thus, nutritional and weight-based policy and interventions need to take seriously the changing cultural contexts and culinary desires of target populations,” according to the report.

The report further discusses how children, especially children of color, have been targeted in marketing campaigns by processed food and beverage companies for sodas and cheap, convenient, and hyper-palatable packaged foods.

“Sodas and ultra-processed foods are major contributors to poor nutrition among adults and children,” the report states.

As highlighted in a Salud America! research review, fast food places and corner stores outnumber supermarkets and farmers’ markets in many Latino neighborhoods.

The report encourages public health policy should take children’s preferences as seriously as commercial food and beverage companies.

In 2014, Brazil revised their dietary guidelines to relate to its population better culturally.

The guidelines include the following principles:

  • Make natural or minimally processed foods the basis of your diet
  • Use oils, fats, salt, and sugar in small amounts when seasoning and cooking natural or minimally processed foods and to create culinary preparation
  • Limit consumption of processed foods
  • Avoid consumption of ultra-processed food
  • Eat regularly and carefully in appropriate environments and, whenever possible, in company
  • Shop in places that offer a variety of natural or minimally processed foods
  • Develop, exercise, and share cooking skills
  • Plan your time to make food and eating important in your life
  • Out of home, prefer places that serve freshly made meals
  • Be wary of food advertising and marketing

“The [Brazil] guidelines are simple and culturally appropriate, depicting plates with natural, unprocessed foods regularly eaten by all social classes, including traditional Brazilian foods,” according to the RWJF blog post.

Health is More Than Weight

Classifications of obesity typically use a variant of the Body Mass Index (BMI).

“Since at least 1975 there has been a dramatic increase in children’s (and adults’) body sizes as measured by the BMI in the U.S. and globally. By 2017-18, the overall rate of U.S. children classified as ‘obese’ was 19.3%, with significantly higher rates in low-income households and among Native American, Black, and Hispanics,” according to the new report.

Photo Courtesy of the Vanderbilt Cultural Context of Health and Wellbeing Initiative.

However, it has been shown that not all who are classified as obese by BMI are in poor health.

“Not all individuals—classified as obese by BMI are ill—a sizable percentage have healthy metabolic measures,” according to the RWJF blog post.

The report discusses how population studies and clinical care, overall health status often gets reduced to BMI.

The idea that fat equals unhealthy can contribute to the shame, stigma, and stereotypes for large-bodied kids that can ultimately cause psychological distress.

In places like Japan, annual checkups include a battery of laboratory tests in addition to body size measures to assess risk of obesity.

“Japan recognizes that a high BMI is just one risk factor that, depending on the individual physiology, may or may not need to be treated,” the same blog said.

Body size can carry different meaning based on factors like culture and religion. Information from the report mentions that social media can deeply impact the size of younger people.

“Social media algorithms have been shown to influence body size and shape ideals among children, and a number of studies have shown a correlation between activities like scrolling through Instagram and negative body image,” the report said.

Mental health can also be deeply impacted by body size, especially in younger children.

“Weight-based stigmatization has a severe impact on children and youth, reproducing weight prejudices and normalizing hostile environments for young people,” according to the report.

Diet is More than Individual Choice

Cheap and convenient processed foods are easily accessible in resource-limited settings.

In fact, the report shows that in 2018, 67% of U.S. children’s calories came from ultra-processed foods. These foods are backed by large corporations with deep research and development budgets and far-reaching supply chains.

According to a Salud America! resource, “Millions of Latinos and other Americans of color suffer from a lack of reliable access to a sufficient quantity of affordable, nutritious food.”

The study further highlights how different factors help reproduce racial/ethnic and gendered inequalities in relation to child health and nutrition such as economic disparities, time-poverty, and weight stigma.

Chile’s 2016 Law of Food Labeling and Advertising was the first national regulation to mandate prominent front-of-package warning labels, restrict child-directed marketing, and ban sales in schools of all foods and beverages containing added sugars, sodium, and saturated fats.

“Purchases of high-in beverages significantly declined following implementation of Chile’s Law of Food Labeling and Advertising; these reductions were larger than those observed from single, standalone policies, including sugar-sweetened-beverage taxes previously implemented in Latin America,” an evaluation of the law concludes.

Another good example is the Amsterdam Healthy Weight Approach in the Netherlands.

First launched in 2013, the “20-year marathon” has a goal of o reducing overweight and obesity rates of children in Amsterdam to the national average, and to make Amsterdam one of the top five healthiest European cities, by 2033.

“The Amsterdam Healthy Weight Programme is working across government units, including housing and schools, with the business sector and local food entrepreneurs, and in partnership with local neighborhood and civic groups to advance an integrated approach to child weight,” according to the RWJF blog post.

How Do We Improve Child Nutrition & Health?

Following the data from the report, the authors give recommendations to further improve children’s nutrition such as:

  • Acknowledge food as embedded in cultural contexts, allowing for creative adaptation to local circumstances.
  • Limit marketing of ultra-processed foods to children.
  • Understand and build on cultural dynamics around children’s food, engaging youth through policy dialogue and school lunch programs.
  • In clinical care and population studies, avoid reducing children classified as overweight or obese to this single aspect of their health.

For the complete list of recommendations, visit the full report.

You can also make a difference in your community.

Download the Salud America! Health Equity Report Card.

The Report Card will help you explore local data visualizations on access to food, grocery stores, fast food abundance, and other health equity issues. You can compare the local data to your state and nation and see where help is needed!

Email your Health Equity Report Card to community leaders, share it on social media, and use it to make the case to address childhood nutrition!

GET YOUR HEALTH EQUITY REPORT CARD!

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