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Preventing Childhood Obesity: Health in the Balance
trajectories of these social and politically defined groups are associated with some differences in gene frequencies that may be linked with obesity development. Regardless, as discussed earlier in this chapter, the predominant factors responsible for the expression of obesity as a general population phenomenon are the linked behavioral and environmental factors outlined in the framework in Figure 3-2.
Many factors that potentially mediate racial and ethnic differences and predispose minority children and youth to high obesity risks can be postulated across physical, economic, sociocultural, and policy/political environments (Tables 3-1 and 3-2). Socioeconomic inequities are disproportionately common in minority populations and some of the excess risk may be mediated through economic and physical environmental factors related to low income or living in low-income communities. Other factors may affect individuals and communities on the basis of sociocultural factors that are not dependent upon socioeconomic status. Eating and physical activity patterns in some minority communities are less favorable to weight control than those in the general population, and these differences are observed within socioeconomic strata (Kumanyika and Krebs-Smith, 2001). For example, targeted marketing of high-calorie, low-nutrient-dense foods on black-oriented television has been reported (Tirodkar and Jain, 2003). Less access to supermarkets or to good quality food in supermarkets has been associated with black neighborhoods (Morland et al., 2002a) (see Chapter 6).
Sociocultural variables that need to be considered when approaching obesity prevention to reduce racial and ethnic disparities include traditional cuisines and any aspect of the attitudes, beliefs, and values (referred to in Tables 3-1 and Table 3-2 as the ethos or climate) that may facilitate or inhibit the promotion of healthful eating, physical activity, and weight control patterns in children and youth in these communities (Kumanyika and Morssink, 1997; Kumanyika, 2002, 2004). This ethos may include cultural values of responsiveness to or harmonization with the existing environmental context, as opposed to assumptions that the context can (or should) necessarily be changed. Included in the sociocultural environment are the high prevalence of obesity (e.g., the normative presence of the problem) as well as high levels of obesity-related health problems. In addition, to the extent that a history of discrimination or marginalization based on race or ethnicity becomes intertwined with other sociocultural factors, a certain level of skepticism or distrust relative to mainstream information and initiatives, including health information, may influence the receptivity to obesity prevention messages—particularly when these messages seem to conflict with pre-existing attitudes and beliefs.