Childhood Obesity in Ethnic Minorities

Caleb McKusick

HUMA 201 (G)

Dr. P. C. Kemeny
April 15, 2013

2
Thesis Statement:
Children from diverse ethnic, racial, and cultural backgrounds living in the United States are
more likely to be overweight or obese compared to their non-Hispanic white peers due to various
combinations economic environmental factors, and cultural and behavioral patterns.

Outline:
I.

Introduction

II.

Defining Childhood Obesity

a. How is childhood obesity defined differently from adult overweight/obesity?
b. Increased concern about childhood obesity worldwide
c. Causes of childhood obesity

III.

Detriments of Childhood Obesity for Ethic/Racial Minorities

a. Physical, social, and psychological disadvantages

IV.

Global Trends in Childhood Obesity

a. Global trends
b. Community/cultural influences

V.

Cultural Trends and Factors Influencing Ethnic/Racial Childhood Obesity in the

United States
a. Five main racial classifications
b. Socioeconomic Status
c. Immigrants

VI.

Problems Facing Overweight Ethnic/Minority Groups

a. Lack of culturally specific solutions

3
b. Cultural motivations/low participation in programs
c. Ethnicity as a predictor of obesity risk
VII.

What Is Needed to Solve the Crisis of Childhood Obesity in Ethnic/Racial

Minorities?
a. Research for designing culturally relevant prevention/treatment programs
b. Components of treatment
i. Diet, physical activity, cultural and individual behavioral change
ii. Ideas, options, studies

VIII.

Conclusion

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Introduction
The prevalence of overweight or obesity among those of low socioeconomic status (SES)
has been clearly seen in modern western societies, particularly in the United States.1 Historically,
groups with a low SES tend to be heavily populated with racial/ethnic minorities, causing some
to suspect a correlation between ethnicity and socioeconomic status. However, research has not
shown a correlation between SES and racial/ethnic background, but it has shown that minorities
have a greater propensity towards overweight as they transition from childhood and adolescence
into adulthood across all SES groups.2 Childhood obesity in particular has become a great
concern across all racial groups. Almost every survey conducted since 1988 has shown a strong
inverse correlation between the body weights of children and the SES of their parents for all
children of every race and socioeconomic status.3 This correlation was non-existent in every
report published before 1988.4 This relationship is especially concerning for racial/ethnic
minorities considering their apparent predisposition towards childhood and adult obesity.
Children from diverse ethnic, racial, and cultural backgrounds living in the United States are
more likely to be overweight or obese compared to their non-Hispanic white peers due to various
combinations economic environmental factors, and cultural and behavioral patterns. Society has
started to encounter the problem of childhood obesity during the past twenty-five years, but there

Paul Ernsberger, Does Social Class Explain the Connection between Weight and Health? in The Fat Studies
Reader, ed. Esther Rothblum and Sondra Solovay (New York: New York University Press, 2009), 25.
1

M. Scharoun-Lee et al., Obesity, Race/Ethnicity and Life Course Socioeconomic Status across the Transition
from Adolescence to Adulthood, Journal of Epidemiology and Community Health 63, no. 2 (2009): 133.
2

S.L. Gortmaker et al., Social and Economic Consequences of Overweight in Adolescence and Young Adulthood,
New England Journal of Medicine 329, no. 14 (1993): 1009.
3

Ernsberger, Social Class, 25.

5
are still questions about its causes, concerns about its consequences, and culturally relevant
solutions needed for its treatment and prevention.
Defining Childhood Obesity
Childhood obesity is not defined in the same manner as adult obesity; in fact, there is no
universally accepted definition of childhood obesity.5 Adult obesity (or overweight) definitions
are based upon relationships between morbidity and mortality at various weights. These are not
helpful when dealing with children, because morbidities and mortality are not always apparent
early in life. A common method of classification in children is to identify those 95th percentile
of body mass index (BMI) as overweight, and to categorize those 85th and < 95th percentile as
at risk for becoming overweight. BMI is a weight-for-height index that accurately correlates with
adiposity in children and is easy to calculate.6 BMI is not always an accurate method of
discerning overweight, but it is generally an accurate predictor among relatively sedentary
populations.7
While obesity has been a concern for several decades in many Westernized cultures,
global perspective on obesity is now possible due to the standardized classifications of normal
body weight based on BMI, which have been published by the World Health Organization
(WHO).8 This standardization has continued into the realm of childhood obesity. An

Denise E. Wilfley and Brian E. Saelens, Epidemiology and Causes of Obesity in Children, in Eating Disorders
and Obesity: A Comprehensive Handbook, ed. Christopher G. Fairburn and Kelly D. Brownell (New York: The
Guilford Press, 2002), 429.
5

Ibid., 430.

World Health Organization, Physical Status: The Use and Interpretation of Anthropometry, in Technical Report
Series No. 854, Report of a WHO Expert Committee. (1995).
7

W. Philip T. James, A World View of the Obesity Problem. in Eating Disorders and Obesity: A Comprehensive
Handbook, ed. Christopher G. Fairburn and Kelly D. Brownell (New York: The Guilford Press, 2002), 414.
8

6
International Obesity Task Force has been formed and has suggested preliminary reference BMIs
on an age- and sex-specific basis for designating varying levels of overweight and obesity among
children.9 No matter what method is used to classify childhood obesity, there is no debate among
scholars that it is a growing problem in Western cultures and worldwide. The most up-to-date
representative data in the United States has shown a twofold increase in the number of children
ages 6-17 years with BMI 95% since the mid-1970s.10 There is particular concern about
childhood obesity among children in minority populations, which will only intensify as these
populations increase in the United States, because minorities are more socially disadvantaged
and have worse health profiles compared to non-Hispanic whites.11
The causes of childhood obesity are as complex as they are numerous, but there are
several key factors that experts agree upon which can dramatically influence a persons weight
throughout childhood, adolescence, and into adulthood. These are various cultural, social, and
environmental factors which ultimately affect behavior. In Westernized cultures, the occurrence
of decreased physical activity along with decreased consumption of healthy foods are two
behaviors that stem from cultural roots. In the United States, travel by automobile is essentially
the only viable mode of transportation for most people. Furthermore, an increased dominance of
processed, low-cost, high-density foods has influenced obesity rates.12 When adopted by parents,
these cultural behaviors have the potential to negatively influence the lives of their children.
Decreased physical activity, or a sedentary lifestyle, can lead to a positive energy balance in

James, A World View, 412.

10

Wilfley and Saelens, Epidemiology and Causes, 431.

Shiriki K. Kumanyika, Obesity in Minority Populations, in Eating Disorders and Obesity: A Comprehensive
Handbook, ed. Christopher G. Fairburn and Kelly D. Brownell (New York: The Guilford Press, 2002), 441.
11

12

James, A World View, 413-14.

7
children or adults.13 Excess calories from a positive energy balance will eventually lead to
obesity as the human body attempts to store this excess energy.14 Ultimately, all of these causes,
when properly understood, can aid in the formulation of treatment programs to negate the
impairments of pediatric obesity as much as possible.
Detriments of Childhood Obesity for Ethnic/Racial Minorities
Before further discussing cultural factors which can influence childhood obesity in
minority groups, it is important to fully understand the detriments that childhood obesity can
place upon a childs life in the present and in the future. There are several important reasons to
treat and prevent pediatric obesity. First, children who are obese are more likely to become obese
adults, when compared to lean children. Second, pediatric obesity is related to morbidity and
mortality more than 50 years after adolescence. Third, childhood obesity is directly involved in
producing adverse physical and psychological consequences, such as cardiovascular disease,
asthma, and low self-confidence.15 These impairments could cause obese children to maintain a
flawed perception of themselves and the world around them. The relationship between some
physical side effects of obesity such as hypertension, colon cancer, and osteoarthritis have been
found to be less significant in minority populations, but these differences may be only temporary,
as these populations undergo current epidemiological shifts.16 While these morbidities may be

13

Wilfley and Saelens, Epidemiology and Causes, 432.

C. Ekmekcioglu and Y. Touitou, Chronobiological Aspects of Food Intake and Metabolism and Their Relevance
on Energy Balance and Weight Regulation, Obesity Reviews 12, no. 1 (2011): 14.
14

Gary S. Goldfield and Leonard H. Epstein, Management of Obesity in Children, in Eating Disorders and
Obesity: A Comprehensive Handbook, ed. Christopher G. Fairburn and Kelly D. Brownell (New York: The Guilford
Press, 2002), 573.
15

John P. Foreyt, Weight Loss Programs for Minority Populations, in Eating Disorders and Obesity: A
Comprehensive Handbook, ed. Christopher G. Fairburn and Kelly D. Brownell, (New York: The Guilford Press,
2002), 586.
16

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less significant among minorities, cardiovascular disease, cancer, and diabetes (particularly type
2 diabetes) are major causes of fatality in all U.S. ethnic groups.17
Upon further examination, the social consequences of childhood obesity can be severe in
Western cultures, particularly for girls and young women. Children begin to discriminate against
their overweight classmates as early as kindergarten, and obese adolescent girls have lower
college acceptance rates compared to nonoverweight girls with similar academic backgrounds.
These girls more frequently remain unmarried, complete fewer years of higher education, and
have higher poverty rates than their peers of normal weights.18 Females also tend to have a
distorted perception of their own body size, and often overestimate it on body image scales.19
While these social and psychological concerns of childhood obesity are more pronounced in
women, they effect men similarly, though typically to a lesser degree. Additionally, overweight
and obese school-aged children are more likely to be victims and perpetrators of aggression and
bullying compared to their non-obese peers.20 Once the detriments and causes of pediatric
obesity are properly understood, global perspective becomes necessary to fully recognize what
the current childhood obesity situation means in the United States.
Global Trends in Childhood Obesity
Contrary to popular discourse, Americans are not the heaviest people in the world. Nor is
obesity confined to Western cultures, but some level of obesity is now evident in almost every

17

Kumanyika, Obesity in Minority Populations, 442.

William H. Dietz, Medical Consequences of Obesity in Children and Adolescents, in Eating Disorders and
Obesity: A Comprehensive Handbook, ed. Christopher G. Fairburn and Kelly D. Brownell (New York: The Guilford
Press, 2002), 474.
18

19

Alexandra A. Brewis, Obesity: Cultural and Biocultural Perspectives (New Brunswick: Rutgers University Press,
2011), 86.
Ian Janssen et al., Associations between Overweight and Obesity with Bullying Behaviors in School-Aged
Children, Pediatrics 113, no. 5 (2004): 1188.
20

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country worldwide. In fact, the only remaining region without significant recent increase in the
risk of pediatric obesity is sub-Saharan Africa.21 Countries that previously seemed immune to the
epidemic of childhood obesity are on the verge of reaching the same levels of concern felt by
many developed countries. These emerging areas of concern, such as China (the worlds most
populous country), are dealing with many of the same cultural behavioral patterns that have
promoted obesity in other countries around the globe.22 Traditionally, excess body weight was a
indication of affluence in most cultures globally, but now, in both developed and many
developing countries (e.g. Latin America), overweight is particularly striking in the lower
socioeconomic classes.23 While it is unclear how much adult obesity rates will rise in the coming
decades, it is probable that the level of childhood obesity will continue to rise around the globe
unless effective solutions are implemented.24
Cultural Trends and Factors Influencing Ethnic/Racial Childhood Obesity in the U.S.
In the United States there are three racial classifications (black or African American,
Asian or Pacific Islander American, and American Indian or Alaska Native) and one ethnic
classification (Hispanic or Latino) that are used to define minority populations. These groups
vary within themselves, and in relation to the nonminority (white) population, across numerous
variables, such as fertility rates, percentage of immigrants, occupation and more.25 Of these four
minority classifications, all of them have been found to have a greater percentage of overweight

21

Brewis, Obesity, 32.

Cheng Ye Ji and Tsung O. Cheng, Prevalence and Geographic Distribution of Childhood Obesity in China in
2005, International Journal of Cardiology 131, no. 1 (2008): 1.
22

23

James, A World View, 414.

24

Brewis, Obesity, 33.

25

Kumanyika, Obesity in Minority Populations, 443.

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youths compared to non-Hispanic whites, except for Asian Americans. Despite this fact, the rate
of overweight among immigrant Asian/Pacific Islanders has been found to increase with the
number of years lived in the U.S.26 While pediatric obesity is a definite concern among
nonminority whites in the United States, data from the Centers for Disease Control and
Prevention (CDC) shows that one in five non-Hispanic whites are obese, compared to about one
in three non-Hispanic blacks or Mexican Americans. Moreover, among minorities, fifty percent
of the obese people are younger than forty years of age.27
The prevalence of childhood obesity among ethnic minorities is particularly prominent
when taking socioeconomic status into consideration. In addition to low SES corresponding to
minority groups, epidemiological data suggest that minority children from a low SES have a
nearly one in two chance of being overweight.28 Community context is an important factor
leading to pediatric obesity. Racial and cultural differences with regard to the content of bag
lunches, breastfeeding rates, consumption of fruits and vegetables, and physical activity have
been shown to interact with other variables of importance in minority populations, such as
acculturation. These interactions are often adverse in nature, increasing the probability of
pediatric obesity. In essence, socioeconomic status and its relationship with ethnicity
considerably increases childrens risk for overweight and obesity.29

Debra L. Franko and Jessica B. Edwards George, Overweight, Eating Behaviors, and Body Image in Ethnically
Diverse Youth, in Body Image, Eating Disorders, and Obesity in Youth: Assessment, Prevention, and Treatment,
ed. Linda Smolak and J. Kevin Thompson (Washington, DC: American Psychological Association, 2009), 99.
26

Rodolfo Valdez and David F. Williamson, Prevalence and Demographics of Obesity, in Eating Disorders and
Obesity: A Comprehensive Handbook, ed. Christopher G. Fairburn and Kelly D. Brownell (New York: The Guilford
Press, 2002), 418.
27

Eve Kutchman et al., Proximal Causes and Behaviors Associated With Pediatric Obesity, in Body Image, Eating
Disorders, and Obesity in Youth: Assessment, Prevention, and Treatment, ed. Linda Smolak and J. Kevin Thompson
(Washington, DC: American Psychological Association, 2009), 160.
28

29

Kutchman et al., Proximal Causes and Behaviors, 164.

11
Interestingly, obesity risk increases for Hispanic/Latino Americans with both time and
number of generations in the United States. U.S.-born children of immigrant parents seem to be
at the greatest risk of pediatric overweight or obesity.30 Regrettably, many determinants of a
childs weight status that have been observed are probably markers of other underlying causes,
provoking more research questions than answers. For example, the relationship between SES and
childhood obesity provides little information about how lower SES leads to a positive energy
balance.31
Problems Facing Overweight Racial/Ethnic Minorities
The greatest problem for racial/ethnic minorities facing the childhood obesity epidemic is
not a lack of research the health disparities and variances of access to care and treatment for
minorities has been well documented. Despite this fact, there have been few culturally relevant
interventions established to combat any of these health concerns.32 Most experts would agree that
childhood obesity is a growing global crisis, but few know exactly what is needed to solve the
problem when dealing with specific ethnic minorities. Among minority populations there is little
physical activity occurring, along with a pronounced lack of strong social pressure to lose
weight, despite cognizance of the health risks associated with obesity. Published data suggest
that minorities do not participate in formal intervention programs as readily or as frequently as
whites.33

30

Brewis, Obesity, 69-70.

31

Wilfley and Saelens, Epidemiology and Causes, 431.

32

Franko and Edwards George, Overweight, Eating Behaviors, and Body Image, 106.

33

Foreyt, Weight Loss Programs, 585.

12
In addition to these cultural complications, in many middle-income countries (and some
wealthier sectors of low-income areas in the U.S.) there is a dual burden of overweight and
underweight in the same communities. There is little knowledge among experts as how to deal
with this phenomenon. Furthermore, some researchers wonder what the underlying factors are
that explain why people of certain racial/ethnic categories are at an increased risk of obesity
compared to those in other categories.34
What Is Needed to Solve the Crisis of Childhood Obesity in Ethnic/Racial Minorities?
As a result of the problem of childhood obesity, ethnic groups in the United States and
around the world are in need of a solution. There continues to be a great need for treatments that
are racially, culturally, and ethnically appropriate to address pediatric obesity, eating disorders,
and body image concerns. There is little need of research about the problem of obesity, but there
is a need for future research to focus on designing prevention and treatment programs for youth
of ethnic minorities.35
However, cues in designing these future cultural treatment programs can be taken from
successful components of treatment in programs designed for the American public. The first
aspect of a successful treatment program is a proper diet, in which energy expenditure exceeds
energy intake. This can and should be supplemented with increased physical activity, which
accelerates and improves maintenance of weight loss. The final and most difficult aspect of
successful treatment is proper behavior change. This involves discovering the most effective way
to acquire and sustain improved eating and activity habits during development.36 When dealing

34

Brewis, Obesity, 76-77.

35

Franko and Edwards George, Overweight, Eating Behaviors, and Body Image, 111.

36

Goldfield and Epstein, Management of Obesity in Children, 575.

13
specifically with minority populations, interventions that utilize intergenerational ties (e.g.
grandmother/mother/daughter/granddaughter relationship) may be more effective than traditional
methods of inhibition and management. The church, extended family, and indirect counseling
strategies that focus on storytelling or folk beliefs could play a more prominent role for weight
loss in minorities than for whites.37 There is an insufficiency of weight management programs
among these groups, despite the influence these institutions could potentially have upon
minorities by presenting a perspective on life that encourages the pursuit of a healthy weight.
Conclusion
In conclusion, the prevalence of childhood obesity in minority populations in the United
States generally exceeds that of the white population, and pediatric overweight is becoming a
global epidemic. The detriments of overweight and obesity in children are serious, but can be
remedied. However, the current cultural climate is not conducive to promoting healthy lifestyles
among minority populations through environmental conditions and positive reinforcement on
both micro and macro levels. There is a desperate need for culturally relevant and results
oriented clinical and public health initiatives to help provide a solution to this growing threat to
the well-being of minorities and cultures around the globe.

37

Foreyt, Weight Loss Programs, 586.

14
Works Cited

Brewis, Alexandra A. Obesity: Cultural and Biocultural Perspectives. New Brunswick: Rutgers
University Press, 2011.
Dietz, William H. Medical Consequences of Obesity in Children and Adolescents. In Eating
Disorders and Obesity: A Comprehensive Handbook, edited by Christopher G. Fairburn
and Kelly D. Brownell, 473-476. New York: The Guilford Press, 2002.
Ekmekcioglu, C., and Y. Touitou. Chronobiological Aspects of Food Intake and Metabolism
and Their Relevance on Energy Balance and Weight Regulation. Obesity Reviews 12,
no. 1 (2011): 14-25.
Ernsberger, Paul. Does Social Class Explain the Connection Between Weight and Health? In
The Fat Studies Reader, edited by Esther Rothblum and Sondra Solovay, 25-36. New
York: New York University Press, 2009.
Foreyt, John P. Weight Loss Programs for Minority Populations. In Eating Disorders and
Obesity: A Comprehensive Handbook, edited by Christopher G. Fairburn and Kelly D.
Brownell, 583-587. New York: The Guilford Press, 2002.
Franko, Debra L., and Jessica B. Edwards George. Overweight, Eating Behaviors, and Body
Image in Ethnically Diverse Youth. In Body Image, Eating Disorders, and Obesity in
Youth: Assessment, Prevention, and Treatment, edited by Linda Smolak and J. Kevin
Thompson, 97-112. Washington, DC: American Psychological Association, 2009.
Goldfield, Gary S., and Leonard H. Epstein. Management of Obesity in Children. In Eating
Disorders and Obesity: A Comprehensive Handbook, edited by Christopher G. Fairburn
and Kelly D. Brownell, 573-577. New York: The Guilford Press, 2002.
Gortmaker, S. L., A. Must, J. M. Perrin, A. M. Sobol, and W. H. Dietz. Social and Economic
Consequences of Overweight in Adolescence and Young Adulthood. New England
Journal of Medicine 329, no. 14 (1993): 1008-1012.
James, W. Philip T. A World View of the Obesity Problem. In Eating Disorders and Obesity:
A Comprehensive Handbook, edited by Christopher G. Fairburn and Kelly D. Brownell,
411-416. New York: The Guilford Press, 2002.
Janssen, Ian, Wendy M. Craig, William F. Boyce, and William Pickett. 2004. Associations
between Overweight and Obesity with Bullying Behaviors in School-Aged Children.
Pediatrics 113, no. 5 (2004): 1187-1194.
Ji, Cheng Ye, and Tsung O. Cheng. Prevalence and Geographic Distribution of Childhood
Obesity in China in 2005. International Journal of Cardiology 131, no. 1 (2008): 1-8.

15
Kumanyika, Shiriki K. Obesity in Minority Populations. In Eating Disorders and Obesity: A
Comprehensive Handbook, edited by Christopher G. Fairburn and Kelly D. Brownell,
439-444. New York: The Guilford Press, 2002.
Kutchman, Eve, Sarah Lawhun, Jenn Laheta, and Leslie J. Heinberg. Proximal Causes and
Behaviors Associated With Pediatric Obesity. In Body Image, Eating Disorders, and
Obesity in Youth: Assessment, Prevention, and Treatment, edited by Linda Smolak and J.
Kevin Thompson, 157-174. Washington, DC: American Psychological Association,
2009.
Scharoun-Lee, M., J. S. Kaufman, B. M. Popkin, and P. Gordon-Larsen. Obesity,
Race/Ethnicity and Life Course Socioeconomic Status across the Transition from
Adolescence to Adulthood. Journal of Epidemiology and Community Health 63, no. 2
(2009): 133-139.
Valdez, Rodolfo, and David F. Williamson. Prevalence and Demographics of Obesity. In
Eating Disorders and Obesity: A Comprehensive Handbook, edited by Christopher G.
Fairburn and Kelly D. Brownell, 417-421. New York: The Guilford Press, 2002.
Wilfley, Denise E., and Brian E. Saelens. Epidemiology and Causes of Obesity in Children. In
Eating Disorders and Obesity: A Comprehensive Handbook, edited by Christopher G.
Fairburn and Kelly D. Brownell, 429-432. New York: The Guilford Press, 2002.
World Health Organization. Physical Status: The Use and Interpretation of Anthropometry.
Report of a WHO Expert Committee. Technical Report Series No. 854. (1995).