What role can culture play?What role can culture play?

Shiriki Kumanyika, Ph.D., M.P.H.Shiriki Kumanyika, Ph.D., M.P.H.University of Pennsylvania School of University of Pennsylvania School of MedicineMedicine

CCEB

Three ThemesThree Themes

Body ImageBody Image Ethnic Minority PopulationsEthnic Minority Populations Cultural ChangeCultural Change

Body ImageBody Image

Concern about Concern about eating disorderseating disorders

Stigmatization Stigmatization of obese peopleof obese people

Ethnic or socio-Ethnic or socio-economic economic differencesdifferences

Focus Group Findings – Girls Focus Group Findings – Girls Health Enrichment Multisite Health Enrichment Multisite Studies (GEMS), Memphis, TNStudies (GEMS), Memphis, TN

Dual meaning of the word “healthy”Dual meaning of the word “healthy” Relate hairstyles and clothing to Relate hairstyles and clothing to

“looking good”; not size“looking good”; not size Changing your body is not necessary Changing your body is not necessary

– “Make the best of what you have”– “Make the best of what you have”

Source: Beech B et al, presented at the American Public Health Association

Ethnic Minority Ethnic Minority Populations Populations Highest risk groups in the Highest risk groups in the

U.S. for childhood obesity U.S. for childhood obesity include ethnic minority include ethnic minority populationspopulations– African AmericansAfrican Americans– Hispanic or Latino AmericansHispanic or Latino Americans– Native AmericansNative Americans– Pacific IslandersPacific Islanders

Increasing % of populationIncreasing % of population

0

5

10

15

20

25

30

1963-65 1971-74 1976-80 1988-94 1999-2000

White Black Mex Am

Per

cen

t of

pop

ula

tion

*BMI at or above the sex and age-specific 95th percentile BMI cutoff points

**age-adjusted Source: Health United States, 1998 and Ogden JAMA Oct 9 2002

Overweight Children: Overweight Children: Boys 6-11Boys 6-11

Overweight childrenOverweight childrenGirls 6-11Girls 6-11

0

5

10

15

20

25

30

1963-65 1971-74 1976-80 1988-94 1999-2000

White Black Mex Am

Ethnic differences in factors Ethnic differences in factors that promote excess weight that promote excess weight gain during children?gain during children? Mother’s weight status and Mother’s weight status and

pregnancy weight gainpregnancy weight gain BreastfeedingBreastfeeding Infant feeding practices Infant feeding practices Foods at home and parenting styleFoods at home and parenting style Eating while watching TVEating while watching TV Community normsCommunity norms

Cultural Changes

Cultural ChangeCultural Change

Definition of a healthy Definition of a healthy dietdiet

MediaMedia Communication patternsCommunication patterns Women’s roles Women’s roles Parenting stylesParenting styles Population diversityPopulation diversity Globalization of marketsGlobalization of markets

If culture is part of the If culture is part of the problem, then it must problem, then it must also be part of the also be part of the solutionsolution

Culturally positive Culturally positive obesity prevention obesity prevention strategiesstrategies Do not focus on obesity as suchDo not focus on obesity as such Increase awareness of changes while Increase awareness of changes while

they are happeningthey are happening Demand healthier mix of foodsDemand healthier mix of foods Leverage diversity in food culturesLeverage diversity in food cultures Create positive, psychologically and Create positive, psychologically and

socially meaningful experiences with socially meaningful experiences with healthy foodshealthy foods

Empower parentsEmpower parents

National Heart Lung and Blood Institute, NIH