Consider ethnic, cultural influences on childhood obesity

Prevention and treatment of obesity should be early, frequent and culturally sensitive.

A new consensus statement by Shaping America’s Health and The Obesity Society takes into account the influence of race, ethnicity and culture on childhood obesity.

The consensus statement was published in Diabetes Care.

“Although childhood obesity is increasing in all ethnic and racial groups, its prevalence is higher in nonwhite populations. The reasons for the differences in prevelence of obesity among groups are complex, likely involving genetics, physiology, culture, socioeconomic status, environment and interactions among these variables as well as others not fully recognized,” the consensus panel wrote.

A seven-member panel of experts in pediatric endocrinology, nutrition, cardiology, gastroenterology, anthropology and epidemiology focused on five main questions:

• What are the prevalence, severity and consequences of childhood obesity across race/ethnicity in the United States?
• How might socioeconomic factors influence racial/ethnic differences in childhood obesity?
• What are the biological and cultural factors associated with racial/ethnic differences in childhood obesity?
• What are the implications of race/ethnicity on the prevention of childhood obesity?
• What are the implications of race/ethnicity on the treatment of childhood obesity?

“Hopefully this statement will make a difference in viewing obesity as a serious problem for children and adolescents,” panel member Sonia Caprio, MD, professor of pediatric endocrinology, Yale University School of Medicine, told Endocrine Today.

Influences on pediatric obesity

The consensus statement recommends that health care professionals routinely discuss obesity and its risks with children and families, especially children at higher risk, such as non-Hispanic blacks and Mexican-Americans, and they should be culturally sensitive.

Efforts should take into account the socioeconomic status and education level of the child and family. The panel recommended using prevention efforts that fall within the framework of the socioeconomic model, which views children in the context of their family, culture and community.

“Socioeconomic position and social class permeate every aspect of life and have a cumulative effect on health status throughout the life cycle. Controlling for socioeconomic status variables, however, is very difficult because many, if not most, of these variables are unobserved,” the panel wrote.

Emphasis should be placed on early treatment and mutually agreed-upon treatment goals. The statement recommends awareness of specific racial, ethnic and sex differences in perception of obesity that may influence goals, such as body image, religious views and realities of time and money. Although comprehensive lifestyle modification is recommended for white middle-class children, further study is needed to determine the benefits of these interventions in nonwhite children.

The panel also suggested that health care professionals play an active role in advocating local and national policies and a healthy environment for children. This includes promoting physical activity and healthy food choices, providing children with safe places to play in poor and minority neighborhoods and restricting youth-targeted unhealthy food advertising.

“Understanding the influence of these variables on the patterns of eating and physical activity that lead to obesity will be critical to developing public policies and effective clinical interventions to prevent and treat childhood obesity,” the panel wrote. – by Katie Kalvaitis

Diabetes Care. 2008;31:2211-2221.

This is a critically important paper at a time when obesity in children is becoming a national epidemic. Until society gets involved, we are not going to solve the problem of childhood obesity. This is a call to arms to involve the medical community and the community at large to counter this epidemic by introduction of didactic lectures on the importance of nutrition and participation by schools in education; healthy lunch options; avoidance of fast foods available in vending machines; and introduction of minimally required exercise programs. Just like cigarette smoking, when society decided that there should be laws to limit smoking in public areas, that is when the rate of smoking went down, and rates of cancer and blood pressure are going down. This is a landmark paper addressing a fundamental health problem of the 21st century.

– Mark A. Sperling, MD

Endocrine Today Editorial Board member