Special ReportRacial and Ethnic Disparities in ObesityBack to Report
Inequities in a range of factors — income, stable and affordable housing, access to quality education and others — all influence a person's chance to live a longer, healthier life.1 These inequities and disparate access to affordable, healthy food or safe places to be physically active, contribute to higher rates of obesity and related illnesses in Black communities.
African American adults are nearly 1.5 times as likely to be obese compared with White adults. Approximately 47.8 percent of African Americans are obese (including 37.1 percent of men and 56.6 percent of women) compared with 32.6 percent of Whites (including 32.4 percent of men and 32.8 percent of women).2 More than 75 percent of African Americans are overweight or obese (including 69 percent of men and 82.0 percent of women) compared with 67.2 percent of Whites (including 71.4 percent of men and 63.2 percent of women).3
Overweight and obesity rates also tend to be higher among African American children compared with White children, with obesity rates increasing faster at earlier ages and with higher rates of severe obesity. From 1999 to 2012, 35.1 percent of African American children ages 2 to 19 were overweight, compared with 28.5 percent of White children; and 20.2 percent were obese compared with 14.3 percent of White children.4
Addressing these disparities requires making healthier choices easier in people's daily lives by removing obstacles that make healthy, affordable food less accessible and ensuring communities have more safe and accessible places for people to be physically active.
Lower-incomes and poverty correlate strongly with an increase in obesity, since less nutritious, calorie-dense foods are often less expensive than healthier foods.9 African American families have earned $1 for every $2 earned by White families for the past 30 years.10 More than 38 percent of African American children under age 18 and 42.7 percent of children under age 5 live below the poverty line,11 and more than 12 percent of African American families live in deep poverty (at less than 50 percent of the federal poverty threshold).12 One in four African American families are food insecure (not having consistent access to adequate food due to lack of money or other resources), compared with 11 percent of White households.13
Families in predominantly minority and low-income neighborhoods have limited access to supermarkets and fresh produce. A study of selected communities found that only 8 percent of African American residents lived in areas with one or more supermarkets, compared with 31 percent of White residents.14 When compared with other neighborhoods, without regard to income, predominantly Black neighborhoods have the most limited access to supermarkets and to the healthier foods such markets sell.15 According to the 2013 YRBS, 11.3 percent of Black youths did not eat vegetables during the prior week, compared to 4.5 percent of White youths.16 Black high school students are almost twice as likely to not eat breakfast daily compared with their White peers, which can be a contributing factor to less healthy eating patterns overall, weight gain and poorer performance in school.17
Each day, African American children see twice as many calories advertised in fast food commercials as White children.18 The products most frequently marketed to African Americans are high-calorie, low-nutrition foods and beverages. Billboards and other forms of outdoor advertisements, which often promote foods of low nutritional value, are 13 times denser in predominantly African American neighborhoods than White neighborhoods.19
Achieving a healthy energy balance also requires engaging in sufficient amounts of physical activity.20 As of 2010, African Americans were 70 percent less likely to engage in physical activity than Whites.21 According to the 2013 YRBS, 21.5 percent of Black youth did not participate in at least one hour of daily physical activity during the prior week, compared with 12.7 percent of White youth.22
Children in neighborhoods that lack access to parks, playgrounds and recreation centers have a 20 percent to 45 percent greater risk of becoming overweight.23 National-based studies show that access to public parks, public pools and green space is much lower in neighborhoods largely occupied by African Americans.24 Safety concerns also further limit outdoor activities among African American children. Sidewalks in African American communities are 38 times more likely to be in poor condition According to a recent study, how African American mothers perceive neighborhood safety, and specifically the threat of violence, strongly influences the amount of daily outdoor play in which their young daughters participate.25
Office of Minority Health: U.S. Department of Health and Human Services
Overweight and Obesity Among African American Youth. Leadership for Healthy Communities. Spring 2014.
On behalf of the Trust For America's Health, the Robert Wood Johnson Foundation and the NAACP, Greenberg Quinlan Rosner Research conducted a set of nine one-on-one, in-depth-interviews among public health leaders in Black communities across the country. The participants represent both the public and private sectors and include health professionals, academics and community organizers, among others. The study was designed to evaluate barriers to and pinpoint solutions for reducing obesity in Black communities. All interviews were conducted between April 29 and May 8, 2014.
Black health leaders and activists are deeply aware of the challenges they face in combating the obesity epidemic that disproportionately affects Black communities. They come to the debate with very clear insight into these challenges, from specific barriers at the community level to broader, systemic hurdles that extend state- and nationwide.
These health leaders generally feel that many identified policy approaches to prevent and control obesity offer strong promise, but that there have been a number of hurdles that get in the way of these policies being successfully implemented in Black communities.
They identified three key areas to work on to improve the implementation of policies, including:
Recommendation: Focus on making existing policy initiatives more scalable, sustainable and equitable across all neighborhoods and income levels.
The health leaders interviewed felt there is a lot of attention on making healthier foods more affordable and accessible, and developing safe, accessible places for people to be physically active — but the hurdles to achieving these goals are still very steep.
While the general policy approaches toward obesity prevention and control are viewed favorably, there is a strong sense that the initiatives introduced on the ground level are not scalable or sustainable in their current forms. There is also recognition that the resources invested in these solutions are often short-term grants and are woefully insufficient to match the scope of the problems.
Some key policies the health leaders stressed included:
They stressed the importance of developing strategies for the range of other factors that impact health — such as accessible, safe, affordable transportation and housing — as a coordinated part of any successful effort to address obesity.
They also quickly point out the need to find improved ways to make these initiatives equitable — across all neighborhoods. There is an acute sense of the different resources available in higher-income versus lower-income neighborhoods — ranging from well-kept green spaces to quality grocery stores. And there is a desire for continued focus on policy changes that help improve resources for everyone, which, they believe, will help an entire community thrive. For instance, the leaders emphasized that the inability to access healthy food was both a financial and geographical hurdle. Many work with low-income individuals living in food deserts or food "swamps" (where there is a glut of unhealthy fast food options) and if healthy food is available, it is usually not economical.
These leaders also stress the importance of designing or redesigning the physical infrastructure of a neighborhood to incorporate safe, accessible sidewalks, public transportation options, parks and exercise trails.
"We need to increase the opportunity for healthy food. All healthy options are concentrated in one area of my city; availability is different, based on different neighborhoods."
"The access is there, but for people with limited resources, they can't afford it."
"A healthy community should have some place that's safe and welcoming. And the ability for all family members to be outdoors, to exercise openly in a safe environment."
"Equitable access to green space. On the more affluent side of my city, there are sidewalks — a lot of them have been redone. There are biking lanes. And then you have other areas; we have three income-based housing projects within a half mile radius, and there's not much green space available there. There is also a city park, but it's been largely neglected."
Recommendation: Focus on policies and programs that are social, enjoyable and integrated into daily life and routines.
The health leaders raised concerns that there is not enough information available in many Black communities about why and how to make healthy choices. Specifically, there was concern about the lack of education provided by both schools and the medical community. Giving a community funding to combat obesity is not enough — Black community leaders are quick to point out that change cannot start to take hold unless there is a proper education campaign to accompany these resources.
Another challenge is that conversations about the obesity epidemic often focus on the issue of weight rather than on health. For example, education about how good nutrition and increased physical activity can reduce risk for or help manage type 2 diabetes, heart disease and stress is lacking. There also is not enough information about ways to manage buying healthy food within a budget.
The participants also emphasized a real need to increase education attainment to combat the greater socioeconomic and environmental factors at play. For instance, the health leaders emphasized the need to increase education to promote good nutrition and increased physical activity to counter the fact that food of lower nutritional value is often more easily available and cheaper, and there is such heavy intensity of marketing junk food in these communities.
The health leaders stressed that some of the most important ingredients to creating successful, long-lasting programs are often not addressed: making them social, enjoyable and integrated into daily life and routines.
For instance, the health leaders in these Black communities place a high premium on the need to teach healthy behaviors in a social atmosphere. As an example, some of the most effective programs they highlighted — or would like to see implemented in their own communities — are healthy cooking classes, and taking advantage of shared-use agreements to start walking clubs, athletic teams and dance classes for both children and adults.
In addition, they emphasized the need to meet people where they are, and make efforts fit into people's needs. Every person, neighborhood, or community has different needs; a "one size fits all" approach to reducing obesity is not sustainable. This goes hand in hand with the social aspect — the programs need to be relevant to the specific community. Many of the participants highlighted cooking classes as an effective way to reach Black communities, not just for the social aspect but also for the usefulness in teaching nutrition and even food budgeting. "This needs to become part of the lifestyle. We need to figure out ways to make Southern cuisine healthier. There has to be a way to retain some of the style and tradition, but with healthier options," said one participant.
"There's very little preventive advice. Most times, people aren't getting any advice on how to get healthy and make small changes, even from their doctor."
"Schools need to educate students about nutrition, so they can make better choices. Parents need to be educated because they did not have the advantage of schools that were providing that sort of information — I think we can all become better advocates for promoting healthy options."
"It takes commitment from the community to see that this is not fly by night. We need to continue to work with young people to get them to see, early on in life, that if you're healthier, you feel better, you learn better."
"There was a man in our community that was working on losing some weight, and so he was getting on the radio, encouraging and challenging parents, students, everybody, to come walk with him. And he wanted a really, really large group of people — they would walk for 30 minutes, and for kids, every time you walked, you got to put your name in for a drawing. That worked really well."
"For kids, [these efforts] would work if you make it fun and social, if you did it around games, activities and sports. Kids want to be part of the group; it's social for them."
Recommendations: Focus on building lasting programs and community engagement — including buy-in from the outset, shared ownership and goals, coordination with existing assets and efforts and providing programs and services that help connect with the needs and interests of the members of the community — from the outset.
The health leaders reported feeling that many of the obesity initiatives introduced in their communities do not have built-in goals of sustainability, long-term focus or strategies that engage people within the community to take ownership. They report there is a need to improve the connection between state and national agencies and local communities, including mechanisms to get "buy-in" from individuals within the community, as well as from policymakers and other change agents.
Building sustainable programs in a community requires this buy-in at the outset. National and state groups often have the ability to develop and evaluate particular approaches and provide financial resources, but unless the community has shared ownership and a shared sense that an initiative is a priority or fit for that community, there is little likelihood that the initiative will gain traction or be successful. Local health leaders have a strong interest in partnering with national and state groups because they recognize the expertise and resources those groups provide. Yet local health leaders also are calling for more shared priority-setting and additional support for technical assistance aimed at engaging and training leaders in communities to take ownership of initiatives.
The leaders reported the main procedural barrier to programs comes from a lack of coordination — which could be addressed by ensuring there is a shared vision from the outset and that there is clear, consistent communication across groups. It is also important to learn about the organizations and agencies already in a neighborhood or community. In many cases, there are groups — such as initiatives by other community- and faith-based organizations or are provided through education or other social service systems — that already exist with shared visions, but there may be limited or no attempts to understand, connect and coordinate with their efforts. The leaders stress the importance of making sure public health officials consult with the communities about existing assets, structures and processes as an essential ingredient when trying to make systemic changes.
The leaders discussed examples of effective programs, which included having a community leader or organization heavily involved in the effort and a sense that the initiative was helping support multiple objectives within a community, such as a shared-use agreement that supports youth sports or walking clubs, which can help foster stronger social and community connections, provide a safe afterschool environment and serve as a crime prevention strategy. The most positive examples of policies and activities focused on making healthy decisions part of a daily routine for both adults and children.
The leaders acknowledge there is often a lot of discussion about community engagement as part of public health initiatives and underscore the importance of having a shared definition of what this means from the community's perspective.
"I think what works is when groups and organizations, and even individuals, get community buy-in. That's very important, because when you look at it from the standpoint of implementing programs or policies, then it has to be sustainable — so even if funding runs out, then you've made inroads within the community."
"I think, when you have these parachute programs where they kind of drop in, do work and disappear, that's not effective. But when there's an investment in empowering the community to become the program, and become leaders of the program, that's very effective."
"Someone has to step up, take the lead, and say, 'Here's what we'd like to do, would you like to sit at the table with us?'"
"There's sometimes a general lack of engagement between organizations. Organizations become sort of a silo, and I'm thinking it becomes siloed because of funding. Everybody wants to identify funding sources and go out and do the work. But the challenge in that is that even if you're competing against organizations — in some sense — to get the funding, you want to hold on to what you have. And they don't fully engage other organizations in a way where everybody benefits from it."
"I think we need to get the word out in a way that the community understands. And I think, often, the state agencies don't drill it down, or they don't know how to get it to the folks that need it the most."
"For me, from start to finish, the process has to include community engagement and data engagement. So, every decision that we make along the way, we make it based on community input AND data input. And let both tell us where we need to go."
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