University Times

Monica Baskin of the University of Alabama-Birmingham's School of Public Health

Obesity in America is on the rise, with growing cause for concern. Government studies have shown that one in three children in the United States is overweight or obese. Obesity is associated with negative health outcomes including type 2 diabetes, apnea and depression, as well as low self-esteem, teasing and other psychosocial issues. And childhood obesity tends to extend into adulthood, raising the risk for heart attacks, cancers, cardiovascular disease and orthopaedic complications, a public health researcher noted in a recent lecture sponsored by the Center for Race and Social Problems.

In addition to health impacts, obesity has an economic impact as well, making it cause for concern even for those who aren’t overweight, said Monica Baskin, a faculty member in the University of Alabama-Birmingham’s School of Public Health, noting that medical costs associated with overweight and obesity are estimated at more than $90 billion annually — with about half the cost paid by Medicare and Medicaid.

“Even if it doesn’t hit home with you individually or your family, it’s likely you are contributing to the health care costs by providing funding for Medicaid and Medicare,” she said, noting that obesity-related medical costs for public-sector health plans cost each taxpayer about $180 per year.

Disparities

Research has shown that obesity disproportionately affects people of color in America. “Most groups are having increased prevalence of overweight but in particular, when you compare non-Hispanic blacks to either their counterparts who are non-Hispanic white, or even Mexican-Americans, there are higher rates among non-Hispanic blacks,” said Baskin in her April 19 lecture, “Addressing Obesity in Black Communities: Is Food Justice the Answer?”

The highest rates of obesity in women are among African Americans — nearly 60 percent qualify as obese and a disproportionate percentage of African-American women fall into the extremely obese category, with body mass indexes (BMIs) of 40 or more, she said, citing studies by the Centers for Disease Control and Prevention.

Geographic disparities exist as well: States in the Southeast tend to have the highest rates of overweight and obesity, Baskin said, adding that those areas also tend to be poor, largely rural and populated by a larger percentage of African Americans and people of color.

“Pursuing health equity means elimination of these disparities and inequalities,” she said.

Contributing factors

Some argue that social and environmental inequities contribute to obesity disparities, Baskin said. Targeted marketing of high-calorie foods to African Americans has been associated with some of the diet disparities between African Americans and whites, and research has found that people with better access to supermarkets and limited access to convenience stores, corner stores and fast-food restaurants tend to have healthier diets and better health outcomes in general.

Some see food justice — access to healthy foods as a human right — as a factor contributing to increased obesity and poor health outcomes among residents of predominantly black neighborhoods.

However, obesity is a complicated issue, said Baskin, who shared details of her research that examined overeating among children that contributed to a multi-site study through the African American Collaborative Obesity Research Network.

Research

“What we really wanted to figure out is what is it about the community, the neighborhood environment that might be influencing children’s overconsumption of calories,” she said. The study assessed the perceptions of caregivers of children ages 3-11 as to what factors contributed to children’s overconsumption of high-calorie foods.

Most of the communities studied were poor and predominantly African American. Caregivers were mostly parents or guardians, although some grandparents participated, she said.

Food justice issues emerged as part of a broader range of factors identified by participants, who saw the home and neighborhood environments as contributors to childhood obesity.

The limited availability of healthier foods, lack of access to supermarkets, abundance of fast foods and marketing of unhealthy foods were cited as factors, she said.

Other factors included kids’ preference for certain foods, such as corn dogs and sugary cereals, Baskin said. “I can’t get them to eat anything different,” participants would say.

They also reported having little time to cook and being lured by the convenience of fast-food restaurants.

In addition, “many of these communities … did not have grocery stores or supermarkets in the area,” she said, adding that residents would buy staples at dollar stores or general all-purpose stores that typically didn’t offer healthier foods.

“Because they were close, this is where people went,” she said, adding, “If only snack and junk foods are at home, then of course, that’s what the kids are going to eat.”

Advertising also played a part. Ads at fast-food restaurants — such as dollar menus, in-store ads and posters and 2-for-1 deals — had an influence, as did celebrities and popular characters.

“Seeing rappers, or now Mary J. Blige, doing commercials for Burger King influenced what kids were eating … so if it means you eat a Whopper like this rapper, that makes you cool.”

Enticing TV commercials also tempted some into eating things they might otherwise avoid. “You can almost smell the nachos coming through the TV,” Baskin said.

Researchers also found that many families felt obligated to patronize businesses that contributed in the community as sponsors of sports teams or school events, for example.

“Caregivers were not as quick to perceive of [these] advertisers as harming the community further — they supported these companies,” Baskin noted.

Several solutions emerged: combating junk food at home by educating people about nutrition and teaching them how to cook; cutting the number of fast-food restaurants or forcing them to serve healthier items, and demanding better access to grocery and wholesale stores, either in the neighborhoods or through improved public transit “so people aren’t limited to shopping within walking distance of their homes,” she said.

Food justice for whom?

In building support for a food justice movement, the issues must resonate with individuals. What is the message? Baskin asked. Is it around addressing obesity and eating less? Eating whole foods? Going organic and returning to farming and gardening? Personal responsibility?

Likewise, who should be targeted? Just African Americans? Kids? Seniors? Rural residents? Urban dwellers?

“We haven’t come up with who we might be targeting and where to focus efforts,” she said.

“Clearly there is need for community leaders, policy makers and food marketers to galvanize in this demand for healthy food,” Baskin said.

A complex issue

A chicken-and-egg dilemma also has emerged: While there is documentation attesting to limited access to healthier foods, particularly in black communities, “on the other hand, you have food retailers suggesting that consumer demand is the reason for food supplies,” Baskin said.

“Which came first? Is it that consumers aren’t demanding, so the stores aren’t coming in? Or is something else going on?” she said. “If you buy into the retailers’ side of it — if there is a demand, then we will bring the stores — then you’ve got to increase the demand.”

Other factors play a role as well. “Just food access and availability aren’t the only part of it. There is a physical activity piece of it. We can’t discount that there’s a biological part of it, so there are things that, as children, you inherit from your parents that predispose you to have a certain type of temperament or activity or certain taste for foods, or predisposition to being heavier. … I don’t think that just focusing on food addresses everything,” Baskin said.

“It is very complex. We need to further explore what else may be contributing there.”

—Kimberly K. Barlow