OBESITY INTERVENTION AMONG AFRICAN-AMERICAN CHILDREN AND ADOLESCENTS

https://doi.org/10.1016/S0031-3955(05)70355-2Get rights and content

An overwhelming body of evidence indicates a need for obesity prevention and treatment programs for American youth. In the 1970s, only 6% to 8% of US children and adolescents were significantly overweight (body mass index [BMI] > 95th percentile for age); by the early 1990s, this figure increased to approximately 11%.10, 62 Obesity in childhood and adolescence is linked with several short-term medical risks, including abnormal glucose tolerance, hypertension, hyperlipidemia, sleep apnea, and orthopedic complications.4, 15, 39 In addition, overweight children have a significantly higher risk for becoming overweight adults,25, 53, 67 which, in turn, is associated with a higher prevalence of cancer, cardiovascular disease, and type 2 diabetes.20, 48, 53

Childhood obesity also is associated with negative psychologic consequences. Compared with nonobese youth, obese children and adolescents report lower levels of self-esteem, more depressive symptoms, and increased behavioral problems.5, 9, 16, 56

Section snippets

WHY TARGET?

In designing health interventions for ethnic or sociodemographic subpopulations, there are two key issues to consider: why target, and why tailor? The rationale for targeting subpopulations for health programs is based largely on epidemiologic differences in disease and risk-factor prevalence rates. The case for targeting obesity prevention and treatment programs for African-American youth is compelling.

Although obesity has increased in all racial and ethnic groups over the past 30 years, the

WHY TAILOR?

The epidemiologic differences cited earlier provide the rationale for targeting African-American youth for obesity intervention. Once a population is identified as warranting intervention, a next step is determining how such programs and messages should be tailored to meet the needs of the target group.

Tailoring interventions for ethnic populations can be conceptualized in terms of two primary dimensions: surface structure and deep structure tailoring (see reference48 for a more detailed

Sociocultural Influences

African Americans seem to possess a different standard of physical beauty and ideal body image than do whites. Adult and adolescent African Americans prefer fuller body types than do whites. They report a higher ideal body weight and are more likely to be satisfied with their weight, even when they are statistically overweight, than white women. They also seem to exhibit less shame about what they eat and impose fewer restrictions on their eating than their white counterparts.6, 14, 35, 42, 54

REVIEW OF PUBLISHED OBESITY PREVENTION PROGRAMS FOR AFRICAN-AMERICAN CHILDREN AND ADOLESCENTS

There are few published studies of interventions designed to prevent or treat obesity among African-American children and adolescents. Most pediatric obesity interventions to date have been conducted in white populations.17, 18 The available literature among African Americans is variable with regard to the target population (children, adolescents, obese, and normal weight), intervention components (weight control, physical activity, and health education), intervention settings (school, clinic,

CURRENT RESEARCH AND FUTURE DIRECTIONS

Although the published intervention research in this area is currently thin, numerous ongoing studies are being conducted that will greatly expand the knowledge base. A review of the National Institutes of Health (NIH) Computer Retrieval of Information on Scientific Projects (CRISP) database indicated at least nine currently funded research studies that are designed to develop and test obesity prevention and intervention programs for African-American youth.

One of these studies is the Go Girls!

SUMMARY

Often, researchers and clinicians approach the African-American community from a deficit model with African Americans viewed as having less desirable health practices and higher disease risk; however, in developing interventions for African Americans, it is important to keep in mind positive aspects of black culture as they relate to obesity. For example, the cultural acceptance of a larger body type and less negative views toward overweight individuals need not be viewed as problematic or

References (71)

  • S.R. Srinivasan et al.

    Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: The Bogalusa Heart Study

    Metabolism

    (1996)
  • M. Sun et al.

    A longitudinal study of resting energy expenditure relative to body composition during puberty in African American and white children

    Am J Clin Nutr

    (2001)
  • M.S. Treuth et al.

    Effects of familial predisposition to obesity on energy expenditure in multiethnic prepubertal girls

    Am J Clin Nutr

    (2000)
  • D.R. Wagner et al.

    Measures of body composition in black and whites: A comparative review

    Am J Clin Nutr

    (2000)
  • C.O. Airhihenbuwa et al.

    HIV/AIDS education and prevention among African-Americans: A focus on culture

    AIDS Educ Prev

    (1992)
  • S. Arslanian et al.

    Insulin secretion and sensitivity in black versus white prepubertal healthy children

    J Clin Endocrinol Metab

    (1997)
  • S.E. Barlow et al.

    Obesity evaluation and treatment: Expert committee recommendations

    Pediatrics

    (1998)
  • C.G. Baum et al.

    Social factors associated with adolescent obesity

    J Pediatr Psychol

    (1984)
  • D.M. Becker et al.

    Body image preferences among urban African Americans and whites from low income communities

    Ethn Dis

    (1999)
  • C. Braet et al.

    Psychological aspects of childhood obesity: A controlled study in a clinical and nonclinical sample

    J Pediatr Psychol

    (1997)
  • E.E. Calle et al.

    Body-mass index and mortality in a prospective cohort of US adults

    N Engl J Med

    (1999)
  • W.B. Carey et al.

    Tempermental factors associated with rapid weight gain and obesity in middle childhood

    J Dev Behav Pediatr

    (1988)
  • Update: Prevalence of overweight among children, adolescents, and adults—United States, 1988–1994

    MMWR

    (1997)
  • Prevalence of selected risk factors for chronic disease by education leve in racial/ethnic populations

    MMWR

    (1994)
  • Youth risk behavior surveillance—United States, 1999

    MMWR

    (2000)
  • S. Desmond et al.

    Black and white adolescents' perceptions of their weight

    J Sch Health

    (1989)
  • W.H. Dietz

    Health consequences of obesity in youth: Childhood predictors of adult disease

    Pediatrics

    (1998)
  • L. Epstein et al.

    Treatment of Pediatric Obesity

    Pediatrics

    (1998)
  • L. Epstein et al.

    Ten-year follow-up of behavioral, family-based treatment for obese children

    JAMA

    (1990)
  • R. Flores

    Dance for health: Improving fitness in African American and Hispanic adolescents

    Public Health Reports

    (1995)
  • D.S. Freedman et al.

    The relation of overweight to cardiovascular risk factors among children and adolescents: The Bogalusa Heart Study

    Pediatrics

    (1999)
  • B. Gannon et al.

    Do African Americans have lower energy expenditure than Caucasians?

    Int J Obes Rel Metab Disord

    (2000)
  • S.L. Gortmaker et al.

    Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health

    Arch Pediatr Adolesc Med

    (1999)
  • R.A. Hahn et al.

    The prevalence of risk factors among women in the United States by race and age, 1992–1994: Opportunities for primary and secondary prevention

    J Am Med Womens Assoc

    (1998)
  • J.S. Harrell et al.

    Cardiovascular risk factors and socioeconomic status in African American and Caucasian women

    Research in Nursing and Health

    (1998)
  • Cited by (34)

    • Nourishing Our Understanding of Role Modeling to Improve Support and Health (NOURISH): Design and methods

      2012, Contemporary Clinical Trials
      Citation Excerpt :

      In contrast to previous research in the field, NOURISH addresses several urgent research priorities by targeting the underserved and addressing the significant disparity in obesity treatment services. African American children are at particularly high risk for overweight and its related health complications [65,27,22]. However, this ethnic group has traditionally had limited access to obesity treatment [34] and relatively few studies have included sufficient numbers of lower-SES, African American participants.

    • Representation of ideal figure size in Ebony magazine: A content analysis

      2011, Body Image
      Citation Excerpt :

      Some researchers have concluded that these messages may contribute to increases in dieting behavior and the development of eating disorder symptoms (Luff & Gray, 2009; Wiseman et al., 1992). However, education concerning weight loss and diet—particularly when the content is factually correct and evidence-based—is also observed to inform healthy lifestyle decisions (Campo & Mastin, 2007; Duerksen et al., 2005; Luff & Gray, 2009) and may be particularly important in the context of an obesity health crisis (Baskin et al., 2001; Crawford et al., 2001). Further research is needed regarding the context and content of recent articles, and the direct impact of these articles on the attitudes and behaviors of readers.

    • Childhood obesity: A school-based approach to increase nutritional knowledge and activity levels

      2005, Nursing Clinics of North America
      Citation Excerpt :

      The CDC guidelines for children aged 6 to 19 years were followed so that a BMI that fell in the 85th to 94th percentile indicated a child “at risk for overweight.” Overweight or obesity was defined as at or above the sex- and age-specific 95th percentile of BMI based on CDC Growth Charts [18]. Some researchers use the term “childhood obesity,” whereas others feel the term may be too stigmatizing when describing children.

    • Body mass index and breast cancer risk in African American women

      2005, Annals of Epidemiology
      Citation Excerpt :

      Data from the National Health and Nutrition Examination Survey (18) showed that African American women had a higher prevalence of overweight (BMI 25–30) and obesity (BMI ⩾ 30) than Caucasian women and the increase in the prevalence of obesity over time was more striking in African American women. It has also been shown that the prevalence of obesity among African American women was approximately twice that of Caucasian women during the three decades from 1960 to 1990 and the greatest increase in obesity across all racial and ethnic groups of adolescents from 1970 to 2000 was among African American females (21, 22). Since obesity is modifiable, the elucidation of whether BMI is associated with breast cancer risk has important implications in public health.

    View all citing articles on Scopus

    Address reprint requests to Monica L. Baskin, PhD Department of Behavioral Science and Health Education Rollins School of Public Health 1518 Clifton Road Atlanta, GA 30322 e-mail: [email protected]

    Development of this manuscript was supported by the National Institutes of Health/National Heart, Lung, and Blood Institute grant no. HL-62659 (KR).

    View full text