A Health Equity Approach
to Obesity Efforts
PROCEEDINGS OF A WORKSHOP
Emily A. Callahan, Rapporteur
Roundtable on Obesity Solutions
Food and Nutrition Board
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This workshop was supported in part by the Academy of Nutrition and Dietetics; Alliance for a Healthier Generation; American Academy of Pediatrics; American College of Sports Medicine; American Council on Exercise; American Society for Nutrition; Bipartisan Policy Center; Blue Cross Blue Shield of North Carolina Foundation; The California Endowment; ChildObesity180/Tufts University; Chobani; Edelman; General Mills, Inc.; Greater Rochester Health Foundation; HealthPartners, Inc.; The JPB Foundation; Kaiser Permanente; The Kresge Foundation; Mars, Inc.; National Recreation and Park Association; Nemours; Nestlé Nutrition Institute; Novo Nordisk; Obesity Action Coalition; The Obesity Society; Partnership for a Healthier America; Reebok International; Reinvestment Fund; Robert Wood Johnson Foundation; WW International, Inc.; and YMCA of the USA. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-49106-8
International Standard Book Number-10: 0-309-49106-1
Digital Object Identifier: https://doi.org/10.17226/25409
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Copyright 2019 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. A health equity approach to obesity efforts: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25409.
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PLANNING COMMITTEE ON A HEALTH EQUITY APPROACH TO OBESITY EFFORTS1
SHIRIKI KUMANYIKA (Chair), Emeritus Professor of Epidemiology, University of Pennsylvania Perelman School of Medicine; Research Professor, Department of Community Health & Prevention, Dornsife School of Public Health, Drexel University
SHAVON L. ARLINE-BRADLEY, Founding Principal, R.E.A.C.H. Beyond Solutions, LLC; Co-Founder, Health Equity Cypher Group
CARLOS J. CRESPO, Professor, Oregon Health & Science University and Portland State University School of Public Health; Vice Provost for Undergraduate Training in Biomedical Research, Portland State University
JENNIFER FASSBENDER, Director of Program Initiatives, Reinvestment Fund
DAVID D. FUKUZAWA, Managing Director, Kresge Health Program, The Kresge Foundation
VANESSA NORTHINGTON GAMBLE, University Professor of Medical Humanities and Professor of Health Policy and American Studies, The George Washington University
VALARIE BLUE BIRD JERNIGAN, Professor of Rural Health and Director of the Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences
THOMAS LAVEIST, Dean and Professor, School of Public Health and Tropical Medicine, Tulane University
MELISSA SIMON, George H. Gardner Professor of Clinical Gynecology and Vice Chair of Clinical Research, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine; Founder and Director, Center for Health Equity Transformation and the Chicago Cancer Health Equity Collaborative
Health and Medicine Division Staff
LESLIE J. SIM, Roundtable Director
HEATHER DEL VALLE COOK, Senior Program Officer
ELLE ALEXANDER, Associate Program Officer (until June 2019)
AMANDA NGUYEN, Associate Program Officer
MEREDITH YOUNG, Research Associate
CYPRESS LYNX, Senior Program Assistant
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
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ROUNDTABLE ON OBESITY SOLUTIONS1
BILL PURCELL III (Chair), Farmer Purcell White & Lassiter, PLLC, Nashville, Tennessee
RUSSELL R. PATE (Vice Chair), University of South Carolina, Columbia
MARY T. STORY (Vice Chair), Duke University, Durham, North Carolina
SHARON ADAMS-TAYLOR, The School Superintendents Association, Alexandria, Virginia
KATIE ADAMSON, YMCA of the USA, Washington, DC
JAMY D. ARD, Wake Forest University, Winston-Salem, North Carolina
ANDREA M. AZUMA, Kaiser Permanente, Oakland, California
ROBIN P. BLACKSTONE, University of Arizona, Phoenix
CAPT HEIDI MICHELS BLANCK, Centers for Disease Control and Prevention, Atlanta, Georgia
JEANNE BLANKENSHIP, Academy of Nutrition and Dietetics, Washington, DC
DON W. BRADLEY, Duke University, Durham, North Carolina
CEDRIC X. BRYANT, American Council on Exercise, San Diego, California
HEIDI F. BURKE, Greater Rochester Health Foundation, Rochester, New York
DEBBIE I. CHANG, Nemours, Newark, Delaware
ANNE DATTILO, Nestlé Nutrition Institute, Vevey, Switzerland
MERRY DAVIS, Blue Cross and Blue Shield of North Carolina Foundation, Durham
CHRISTINA ECONOMOS, Tufts University, Boston, Massachusetts
IHUOMA ENELI, American Academy of Pediatrics, Columbus, Ohio
JENNIFER FASSBENDER, Reinvestment Fund, Philadelphia, Pennsylvania
ADELAIDE (GEIK) FEUER, Edelman, Indianapolis, Indiana
GARY FOSTER, WW International, Inc., New York, New York
DAVID D. FUKUZAWA, The Kresge Foundation, Troy, Michigan
MARJORIE INNOCENT, National Association for the Advancement of Colored People, Baltimore, Maryland
SCOTT I. KAHAN, The George Washington University, Washington, DC
SONIA KIM, Alliance for a Healthier Generation, New York, New York
SHIRIKI KUMANYIKA, Drexel University, Philadelphia, Pennsylvania
CATHERINE KWIK-URIBE, Mars, Inc., Germantown, Maryland
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
THEODORE KYLE, The Obesity Society, Pittsburgh, Pennsylvania
LISEL LOY, Bipartisan Policy Center, Washington, DC
KELLIE MAY, National Recreation and Park Association, Ashburn, Virginia
MYETA M. MOON, United Way Worldwide, Alexandria, Virginia
JOSEPH NADGLOWSKI, Obesity Action Coalition, Tampa, Florida
MEGAN NECHANICKY, General Mills, Inc., Minneapolis, Minnesota
SARAH OHLHORST, American Society for Nutrition, Rockville, MD
BARBARA PICOWER, The JPB Foundation, New York, New York
SUE PECHILIO POLIS, National League of Cities, Washington, DC
AMELIE G. RAMIREZ, Salud America!, San Antonio, Texas
OLIVIA ROANHORSE, Notah Begay III Foundation, Santa Ana Pueblo, New Mexico
NANCY ROMAN, Partnership for a Healthier America, Washington, DC
KEVIN R. RONNEBERG, HealthPartners, Inc., Minneapolis, Minnesota
SYLVIA ROWE, S.R. Strategy, LLC, Washington, DC
JAMES F. SALLIS, University of California, San Diego
MARION STANDISH, The California Endowment, Oakland, California
KATHLEEN TULLIE, Reebok International, Canton, Massachusetts
MONICA HOBBS VINLUAN, Robert Wood Johnson Foundation, Princeton, New Jersey
JAMES R. WHITEHEAD, American College of Sports Medicine, Indianapolis, Indiana
SUSAN Z. YANOVSKI, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
TRACY ZVENYACH, Novo Nordisk, Washington, DC
Health and Medicine Division Staff
LESLIE J. SIM, Roundtable Director
HEATHER DEL VALLE COOK, Senior Program Officer
ELLE ALEXANDER, Associate Program Officer (until June 2019)
AMANDA NGUYEN, Associate Program Officer
MEREDITH YOUNG, Research Associate
CYPRESS LYNX, Senior Program Assistant
ANN L. YAKTINE, Food and Nutrition Board Director
Consultant
WILLIAM (BILL) H. DIETZ, The George Washington University, Washington, DC
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
MELISSA A. SIMON, Northwestern University
MARION STANDISH, The California Endowment
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings, nor did they see the final draft before its release. The review of this proceedings was overseen by RAFAEL PEREZ-ESCAMILLA, Yale University. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.
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Contents
Organization of This Proceedings
2 SETTING THE STAGE: KEY DEFINITIONS AND CONTEXTS
Contextual Influences on Obesity
3 DISPARITIES IN THE PREVALENCE OF OBESITY
Obesity in Various Demographic and Geographic Groups
Obesity in American Indian and Alaska Native People
Obesity Among Asian and Pacific Islander Americans
4 SOCIAL DETERMINANTS OF HEALTH INEQUITIES IN OBESITY PREVENTION AND CONTROL
Civil Rights Laws and Policies
An African American Perspective
Building Thriving Communities Through Community Health Initiatives
Approaches in Native American Communities
Culturally Responsive Obesity and Diabetes Intervention Research in Native Hawaiians
6 LESSONS FROM THE FIELD: ACHIEVING EQUITY IN OBESITY TREATMENT IN HEALTH CARE SETTINGS
Lessons for Achieving Equity in Health Care Settings from Nonobesity Fields
Stakeholder Reflections and Perspectives
D SELECTED U.S. LAWS AND OPINIONS THAT IMPACT CIVIL RIGHTS
E BIOGRAPHICAL SKETCHES OF WORKSHOP SPEAKERS AND PLANNING COMMITTEE MEMBERS
Boxes, Figures, and Table
BOXES
1-1 Workshop Statement of Task
2-2 Intermediate Variables That Influence Weight-Related Behaviors and Outcomes
2-3 Contextual Influences on Weight Control and Related Behaviors
FIGURES
2-1 Contextual influences on obesity
3-1 Prevalence of obesity in U.S. adults, by race
3-3 Patterns in the prevalence of adult obesity as income increases, by race/Hispanic origin
3-4 Patterns in the prevalence of youth obesity as income increases, by race/Hispanic origin
3-6 Age-adjusted prevalence of obesity among adults (≥18 years), single race, United States, 2014
4-2 Key time periods in the history of tribal nations and American governments
5-2 Social and cultural determinants of Native Hawaiian health
6-1 Multiple levels for clinical and policy actions to reduce health disparities
6-2 Conceptual model for achieving health equity
7-1 Equity-oriented obesity prevention action framework
TABLE
4-1 Sociodemographic Data for the Six Largest Hispanic/Latino Groups in the United States, 2010