OBESITY in African-American ADOLESCENTS

The objective of this work is to examine program development of a health need and develop an educational program. Toward this end, this work will focus on obesity in African-American adolescents. Obesity can lead to other more serious diseases such as diabetes mellitus.

Childhood obesity rates in the U.S. are especially prominent among African-American children and because of this a “comprehensive understanding of the numerous environmental factors that influence physical activity, rising rates cannot be effectively curbed.”(Black Health Care, 2008)

According to the Black Health Care document entitled: “Diabetes in African-Americans?” 1.3 million African-American individuals were known to have diabetes in 1993. This is approximately three times higher than African-Americans with diabetes in 1963. For each white American with diabetes, 1.6 African-American individuals have diabetes. Additionally one in every four black females over the age of 55 has diabetes. African-Americans who have diabetes are “more likely to develop diabetes complications and experience greater disability from the complications than white Americans with diabetes.” (Black Health Care, 2008)

The work of William Dietz entitled: “Focus Group Data Pertinent to the Prevention of Obesity in African-Americans” relates that it is likely that “the increased prevalence of obesity among African-American women makes it likely that they bear a disproportionate burden of comorbidities attributable to obesity.” (Dietz, 2000) Dietz reports that a campaign was initiated in Boston for the purpose of promoting health eating and physical activity among African-American women between the ages of 18 and 35. Barriers to healthy eating identified in this study include that of the cost of food particularly related to fruits and vegetables in that the ability for consumption of these two food items was “related to socioeconomic class.” (Dietz, 2000)

Dietz relates that there was a strong interest shown by participants for healthy recipes. This study states findings that women cited their mother as the “most responsible and credible source, physicians and health officials were ranked second, and community-based programs were ranked third.” (Dietz, 2000) This study found that it was perceived by these women that “Celebrities like Oprah Winfrey” had “special access to resources unavailable to most people, such as a personal trainer and personal cook.” (Dietz, 2000) This initiative which was called “Sisters Together” is stated to have designed a program for cable access television which was named “What’s Cooking in the Neighborhood” and that healthy recipes were prepared by neighborhood chefs. Additionally brochures were designed specifically for African-American women and their interests. One example is stated to be a ‘walking brochure’ which is stated to have provided a rationale for walking and warm-up activities and promoted a group walking program.” (Dietz, 2000) Additionally a dance program specifically designed for African-American women was inclusive in the activities in this study.

Dietz relates that CDC has focused increasingly on “youth and recently conducted 12 focus group sessions with adolescents in Atlanta and San Antonio. This study reports 12 focus group discussions comprised of African-Americans, Mexican-American and white adolescents, both males and females; all were either normal weight or overweight. It is related that “one of the biggest obstacles to physical activity is the amount of time and money that African-American spend on hair care and this brochure was incorporated into the program. There was also a “Sisters Together, Move More, Eat Better Program Guide” which provided advice concerning how the program could be replicated. The study states findings that teachers of physical education were found not to be viewed as alliances by adolescents who were overweight. Barriers to adolescent aged African-American students I stated in this study to be one of the nature that viewed barriers to be present in the school cafeteria setting. Noted as well in this study is the barrier presented by vending machines in relation to healthy diets. Dietz states that there is presently a campaign underway which the One Hundred Black Men of America and is a mentoring program “directed at young African-American males, a group with one of the most unhealthy eating patterns.

The campaign is a collaboration between 100 Black Men, the California Adolescent Nutrition and Fitness organization (CANfit), the USDA and the CDCD’s Division of Nutrition and Physician Activity. CANfit, which is responsible for the development and delivery of the strategy, is designing a physical activity and diet curriculum consistent with the mentoring program of 100 Black Men.” (Dietz, 2000) This approach is one which teaches individuals how to implement an analysis within the community of “nutrition and physical activity resources.” (Dietz, 2000) the results of the examination are that which the strategy and design of the program is based in addressing what is a community problem. Dietz reports that community interventions have only recently been focused upon in studies and none of these programs are fully developed. It is important to understand that African-Americans do not link body weight to health outcomes. Community development programs have, according to Dietz (2000), provided both “insights and lessons learned” that will serve to “guide the development of future activities.” (Dietz, 2000) the work entitled: “Being Overweight is a Matter of Independent Preference and Environment for Female African-American Adolescents” states that 23.6 of African-American females ages twelve to nineteen years of age are overweight.” (the Center for Health and Health Care in Schools, 2007) Additionally stated is the fact that along with being overweight comes a “sedentary lifestyle and poor nutrition.” (Ibid, 2007)

It is reported that the researchers at the Centers for Disease Control and Prevention (CDC) conducted a multiple institutions study and used a sample of 12 adolescents and their mother and interviewed the subjects relating to “attitudes and perceptions toward body image, food and physical activity.” (the Center for Health and Health Care in Schools, 2007) Findings of the research include those as follows:

The individual’s immediate social and familial circle largely influenced body size and weight, not her peers;

Close friends around the teenagers are more accepting of being overweight and there is little social pressure for the teens to alter their habits;

Nutrition was not a factor in choosing what to eat; texture, taste, appearance and “context” were more important;

Physical activity was limited by time constraints, access to exercise opportunities, and by neighborhood safety;

Structured exercise was limited by its cost and because of the time involved in maintaining personal aesthetics, such as tending to their hair and nails; and Celebrities were not perceived as role models for diet and physical activity habits. (the Center for Health and Health Care in Schools, 2007

The work of Hughes, Areghan, Knight and Oyebola states that current trends in obesity among African-American adolescents in the State of Mississippi especially in the Delta remains alarming and disheartening. According to the Mississippi 1999 Youth Risk Behavior Survey (YRBS), 1 out of 3 African-American adolescent is obese with higher ratios for those living in the Delta. Several factors have been attributed to this observed trend. The Delta is probably the most undeserved region in the state with African-Americans being the major ethnic group. Accessibility and availability of medical care is also a problem. It is estimated that over 60% of residents live below the poverty level. Most schools do not have a physical education curriculum. Even more so, nutrition education is not emphasized. Efforts made by public health officials and researchers by the way of intervention have had little success on affecting positively on this issue. The point being raised now is whether these strategies are culturally sensitive and at the same time practicable. Since obesity starts in early childhood extending into the adolescent years and then possibly into adulthood, behavior modification is key to preventing the onset of obesity in this population group altogether. Community development is crucial to the success of any weight control program. The poverty level in this part of the state needs to be addressed in the way of providing jobs for locals and bringing in expatriates. For adolescents living in the Delta, health education on modifiable risk factors is mandatory if any change is to be seen.

FINDINGS of the REVIEW of LITERATURE

Findings of the literature reviewed in this study include the key roles of mothers, cafeterias in schools, physical education teachers and food accessibility in overweight African-Americans. Community initiatives which are combined and integrated with school and home initiatives focused toward healthier eating have been found to be effective in educating and treating African-Americans who are suffering from obesity. Sedentary lifestyles and poor eating habits coupled result in not only obesity but also oftentimes more serious diseases and complications such as experienced by those with diabetes mellitus, which is a common complication of obesity among African-American individuals.

RECOMMENDATIONS for PROGRAM DESIGN

Because there are cultural factors that greatly impact the rate of obesity among African-American individuals it is necessary that these types of programs and initiatives involve the family, school, and community at large in addressing this health problem if proper and effective programs are to be developed, designed and implemented in the African-American community. The perspective of African-Americans must be altered and furthermore the African-American community education concerning healthy eating habits and proper exercise is critically important towards this end.

Bibliography

Environmental Influences on Physical Activity and Obesity in African-American Adolescents – a Multilevel Perspective. (2008) Active Living Research. Online available at http://www.activelivingresearch.org/node/11623

Dietz, William, (2000) Focus Group Data Pertinent to the Prevention of Obesity in African-Americans. From the Division of Nutrition and Physical Activity. U.S. Centers for Disease Control and Prevention, Atlanta GA. The American Journal of the Medical Sciences.

Cultural Attitudes Toward Weight, Diet, and Physical Activity Among Overweight African-American Girls” by Josephine E.A. Boyington and colleagues is found at http://www.cdc.gov/pcd/issues/2008/apr/07_0056.htm?s_cid=pcd52a36_e.

Hughes, Gail D. (2002) Obesity and the African-American Adolescent, the Mississippi Delta Report. 130th Annual Meeting of APHA. 11 Nov. 2002. Board 8. Online available at http://apha.confex.com/apha/130am/techprogram/paper_46137.htm