Obesity Disparities, Prevention and Control in Underserved Urban Communities

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Obesity Disparities, Prevention and Control in
Underserved Urban Communities

• Antronette K (Toni) Yancey, MD, MPH, FACPM
• Professor of Health Services,
• Co-Director, Center to Eliminate Health
  Disparities
• UCLA School of Public Health
• www.ph.ucla.edu/cehd www.toniyancey.com

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Adult Obesity 1988-94 to 1999-2000
Race/Ethnicity
Target
1988-94
Total
White Female Male Black Female Male Mexican
American Female Male

0 10 20
30 40 50
Percent
Note Data are for ages 20 years and over, age
adjusted to the 2000 standard population. Obesity
is defined as BMI gt 30.0. Black and white
exclude persons of Hispanic origin. Persons of
Mexican-American origin may be any race. Source
National Health and Nutrition Examination Survey,
NCHS, CDC.
Obj. 19-2
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Prevalence of Obesity among LAC Adults by
Ethnicity, 1997-2005
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Growth in Childhood Obesity Disparities 1984-88
(bottom) to 2003-04 (top)
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Type 2 Diabetes Incidence Among Adolescents

• 1982 0.7 / 100,000 per year
• 1994 7.2 / 100,000 per year
• 2004 13.9-16.0 / 100,000 per year

gt20-fold increase
Sources Pinhas-Hamiel O et al. J Pediatr
1996128608-15 Daniels et al, Circulat
20051111999-2012
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?Influence on Life Expectancy

• For the first time in thousands of years, this
  generation of children may live shorter lives
  than their parents
• Chances of developing diabetes at birth for
  African-American and Latino children is about
  twice that of white children (1 in 2 vs. 1 in
  4)
• Olshansky et al., NEJM 2005352(11)1138-45
• Daniels et al, Circulat 20051111999-2012

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Staying healthy is easier for some than for
others

• UPPER SES LOWER SES
• Education College GED or HS
• Housing Own / Safe Rent / Safe?
• Physical activity Gyms /Parks Parks?,
  move insecure
• Advertising Sparse Pervasive
• Neighborhood stores Fruit/Veg, food
  secure Drugs/Alcohol, food insecure
• Police Helpful Abusive
• Healthcare Private Doc
  ER, VA
• Sick leave Accrued
  None
• Leisure priority Exercise Rest
• Work conditions Safe, hi decis. lat., Hazardous,
  lo decis. lat., no flex time no flex time
• Child care Nanny/hi-qual facil. Family/neigh
  bor, lo-qual facil.
• Elder/disabled care HHW/hi-qual
  facil. Family/neighbor, lo-qual facil.
• Criminal just. sys. Little contact Much contact
• Premature MM Low High

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Years of Potential Life Lostby Ethnicity (per
100,000)
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Excess physical environmental risk in underserved
communities

• targeted/exploitative marketing
• excess fast food outlets
• few supermarkets
• limited healthful shelf choices poorer quality
  produce
• highly-processed food culturally embraced (home,
  church)
• poorer public/less private transportation

• distance to private fitness facilities
• few worksite fitness opportunities
• few/poor neighborhood recreation facilities
• lesser neighborhood safety
• poorer public/less private transportation
• Adapted from Kumanyika S. Obesity in Minority
  Populations. In Fairburn G Brownell K, Eating
  Disorders and Obesity. A Comprehensive Handbook,
  2002.

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Media Content Analysis Project Findings
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Excess economic environmental risk in underserved
communities

• limited investment in parks/rec. facilities
• fitness facility fees
• cost of exercise equipment
• less stable employment patterns
• fewer trained PE instructors
• large, overcrowded PE classes
• poorly equipped facilities

• low neighborhood demand for healthy food choices
• low family incomes
• other household expenses
• little homegrown food, nor yard space for gardens
• financial incentives for under-resourced schools
  by commercial vendors, e.g., pouring rights
  soda contracts

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PE Quality by SES and School District FitnessGRAM
scores
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Excess sociocultural environmental risk in
underserved communities

• cultural attitudes about PA, rest
• fears about safety
• female roles
• cultural reverence for cars, esp. among upwardly
  mobile
• hairstyle-related concerns about sweating, esp.
  teens
• higher levels of TV viewing

• traditional cuisine
• fasting-feasting
• prevalent obesity? higher norms
• body image
• female roles
• (perceived) food insecurity

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Cultural reverence for SUVs?
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Shift in health promotion field (Spectrum of
Prevention)

• The most effective and sustainable public health
  approaches of the past 2 decades are the more
  upstream ones (structural/environmental vs.
  individual-level), involving social norm change
• Tobacco control
• Alcohol consumption and driving
• Littering recycling
• Seat belt child safety seat usage

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Population Obesity Control Environmental Change
Policy Early stage in development

• Strategically, why shift focus to PA promotion?
• Less controversy, conflict, stigma than
  surrounding diet/nutrition
• Deep pocket business interests, e.g., Nike
  24-Hour Fitness, stand to benefit from success of
  efforts (vs. Big Food losing because cant as
  readily induce over-consumption of H2O, whole
  grains, legumes, FV)
• Cheaper easier10 min. supply 1/3 of PA RDA
• May positively influence food preferences

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Physical Activity Levels, L.A. County Adults,
1999
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Build on Cultural Assets

• Integrating 10- PA into organizational routine
• Movement to music integral to many
  culturesdancing normative for adults
• Short bouts minimize perspiration hairstyle
  disturbanceenjoyable by unfit to very fit folks
• Social support conformity desires drive
  participation (collectivist vs. indiv.
  orientation)
• Addresses less activity conducive outdoor
  environments (safety, utility, aesthetics)
• Designed for organizational settings for work,
  worship, etc.-- folks have less disposable time,
  

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Lift Offs Work! the Rapidly Growing Evidence
Base

• Documented individual and organizational
  receptivity to integrating PA on paid work time
• Contribute meaningfully to daily accumulation of
  MVPA
• Motivational teachable moment linking
  sedentariness to health status for inactive folks
• Improvements in clinical outcomes from as little
  as one 10-min. break/dayBP, BMI, waist circ.,
  mood, attention span, cumulative trauma disorders
• Spill-over or generalization to inc. active
  leisure
• Favorable cost-benefit ratio, eg, L.L. Bean mfg
  plant

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Pausa para tu salud
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Recapturing RecessA model for physical
activity promotion in diverse communities

• Lessons from recess apply to PA promotion
• Institutionalizedpart of the structure of the
  organization
• Social event/social support/peer modeling/ peer
  pressure/social sanctions
• Fun!
• Facilities providedconvenient, accessible
• Carry-over to other venues
• Cultural congruence of activities
• Yancey, Am J Prev Med 199815(4)iv.