Articles, Blog

Obesity Epidemic | Tasia Smith | WINGS

December 7, 2019


What if everyone in this room had obesity. We’re not that far off from that being our
reality. Obesity rates have doubled amongst adults
and more than tripled amongst children since the 1980s. Therefore obesity is a serious public health
concern and considered an epidemic in the United States. Before we talk a little bit more about why
it’s an epidemic in the United States it’s really important that we understand what it
is that I’m talking about whenever I say obesity. In terms of adults it includes their height
and weight. And there are these classifications that range
from underweight to obese which is a body mass index of 30 or more. So I know there might be some side thoughts
around is body mass index really the best indicator of obesity. What about individuals who have more muscle
mass. Well that’s only a small part of the population. OK. So when the general population body mass index
is a good measure of obesity. So whenever I say obesity is an epidemic currently
one in three U.S. adults have a body mass index of 30 or more. Also I consider obesity to be like a gateway
disease. It’s associated with increased risk of other
health conditions such as type 2 diabetes, hypertension also known as high blood pressure,
and heart disease which is the number one cause of death in the United States. So aside from these alarming statistics there
is another reason why I stand before you today really passionate about the study of obesity. And this one is a bit more personal. When I was 20 years old college student, went
and formed my normative preventative care, my doctor said to me that I was overweight
and I was shocked. I was like I don’t think I look overweight
but OK. And also my blood pressure was high. Again in the back of my mind I’m thinking
like I’m a college student I’m probably just stressed about exams that’s coming up. Well I continue to monitor my blood pressure
over time and it remained high. So here I was, 20 years old and diagnosed
with hypertension. I was also headed down the road to being another
statistic. Do you know who has the highest rates of obesity. It’s black women. And guess what. I’m a black woman. So I kept thinking to myself, what would lead
a 20 year old to be diagnosed with hypertension. I wanted to know. Was it my weight. I mean my doctor did tell me I was overweight. Was it my diet. I was a college student I lived off of ramen
and pizza. Or was it genetics. Both of my parents have hypertension. The reality is that it’s complicated because
all of those factors could have contributed to my diagnosis of hypertension. That same complexity is what I face in terms
of trying to figure out how do we prevent obesity. Thankfully the donors and the University of
Oregon thought it was an awesome idea for us to have an obesity prevention cluster. And so I get to share this journey with five
amazing colleagues and we each take a piece of this pie in terms of obesity. And so we look at multiple factors ranging
from emotion and self-regulation to disinhibited eating to genetics and then at the top there’s
me. I look at health disparities and culture. And for me thinking about my 20 year old self
and knowing where I could have been in terms of still taking meds today and recognizing
the importance of prevention. I’m very committed to making sure that we
can prevent disparities among diverse populations. In terms of health disparities, I’m talking
about the preventable occurance of obesity that happens based on factors such as race,
ethnicit,y gender, and socioeconomic status and so much more. And in my particular work I’ve chosen to focus
on three different groups who are most impacted by health disparities. There are blacks, Latinx (which is a more
inclusive term for Latinos), and rural communities are the three populations that I study. So if we take a closer peek at these three
groups one thing we’ll see is for example if we look at racial ethnic disparities we
know that black and latin next adults have higher rates of obesity than their white adult
counterparts. There’s also the most interesting race by
gender by income dynamic that goes on. And what we see is that for black and Mexican
American men they who have higher income they have higher rates of obesity than those with
lower income but we don’t see this same trend for women. For women what we see is women in general
women with lower income tend to have higher rates of obesity than those with higher income. Yet those racial disparities still exist. For example black women with lower income
have higher rates of obesity than white women with lower income. Also in terms of geographic location, we know
that individuals who reside in rural communities have higher rates of obesity. And this graph demonstrates in terms of if
we look at self report reported body mass index which we use to measure obesity as well
as measured that we still see that trend. But that’s not the shocking part about this. Only 19.3 percent of the population live in
rural communities. So this is a significant disparity in terms
of obesity. So I think everybody in the room knows these
disparities exist now. Do we believe in it. Now the bigger question is how do we eliminate
those disparities. Well that’s the piece that we’re working on. So as researchers there’s a couple of things
that were really clear about. One, we know that it’s much harder to intervene
once individuals are already are diagnosed with obesity and other chronic conditions
such as hypertension. Therefore we really try and focus on prevention
efforts. The second thing we know as researchers is
that we cannot take a one size fits all approach to identifying solutions for obesity. Let me give you example, let’s say I had a
weight loss program and I implemented my weight loss program and a sample of white adults
and I might see on average throughout the course of this program ten pound weight loss. Well I take this exact same weight loss program
and now I implemented in a sample of Latinx adults I might see on average a five pound
weight loss throughout the course of this program. So what accounts for these differences. It’s culture. So I really want to point out that culture
is all-encompassing. It includes things like language, religion,
food preferences, social habits and so much more. So as researchers we kind of have gotten that
culture matters but things get a little sticky right here. So in my research what I’ve noticed is whenever
it comes to culture there are two big mistakes that researchers are made when they are trying
to adequately account for in prevention efforts with culturally diverse groups. So the first mistake, it’s around lack of
clarity or misinterpretation of culture. So in terms of lack of clarity, I can’t tell
you how many research articles I’ve read where people say this is a culturally tailored intervention
it’s culturally sensitive etc. But guess what, nobody defines culture. The second mistake related to this is the
misinterpretation of culture. Somehow people also decided that culture is
synonymous with race ethnicity but only for racial ethnic minorities. I mean we just saw that it’s so much more
than that. Right. So we’re missing a lot. The second mistake is assumptions. I hate to say that as a researcher but there
are so many assumptions that are made. I don’t know about you but I learned a long
time ago that if you make assumptions and makes a bad word out of you and me. But here we are. So in terms of those types of assumptions
that happened. The first one is in terms of who’s running
the program. So we should say all right we’ve gotten there
so we’re going to have to facilitators who are of the same race ethnicity as our participants. We have to make sure we don’t stop there. Let’s say for example we have a facilitator
who’s from Spain and participants who are from Mexico. Guess what both of these countries have very
different histories and individuals are perceived very differently in the context of the U.S.. So these are two unique cultures even though
they both identify as Latinx. The second assumption is a round what’s important. What should we be talking about in terms of
these prevention programs. And one of the things I noticed is that food
somehow there’s this misconception that food is universal and we know that’s not the case. For example I’m from the small rural town
in North Carolina. And one thing that my aunt and uncle make
is crackling cornbread. Anybody know? OK alright alright OK. For the people who don’t know what cracklin
cornbread is, it’s basically like pork skins and cornbread. So basically everything is made with pork. Yes. So that’s something that was unique for my
cultural experience. So it’s important that we think about these
particular meanings and what way we can get a better understanding of what’s going on. So if we just ask people. So what I did was I have focus group of Latinx
used here in Oregon and I asked them what’s important for them. And just a sneak peek of what they told me
was in terms of things related to their family values. So our first participant talked about how
they were trying to be vegetarian and their parents put them down. I think that’s a really important context
to have. If we’re wanting to prevent obesity within
this particular group. The second one, religion is also important. And so this participant pointed out that during
a time of year, Easter, that they don’t eat certain foods. So as a researcher I’m working really hard
to make sure I don’t make those same mistakes. And one thing I want to leave you all with
is talk a little bit about what some work I’m doing in a unique culture that has some
specific challenges that has contributed to higher rates of obesity within this particular
group. And this group is predominantly white rural
Oregon community here in Oregon. Some of you like culture, but I think we got
it by now. Right. That’s just because they’re are a white population
doesn’t mean they don’t have culture. Because I’m pretty sure that life in a rural
Oregon community is very different than what it is right here in Portland, Oregon. And one of the distinctions that I notice
with this particular community that I’m working with versus somewhere like Portland is grocery
store access. So actually this map is deceiving because
it seems like there might be four or five grocery stores in that community. There’s actually one grocery store the other
ones are convenience stores. And so for me I want to know a little bit
more about this community. They have one grocery store. So are they having access to fresh fruits
and vegetables. Well the first thing that I found out from
this community was a bit surprising. I learned that about 70 percent of the population
were traveling 88 miles round trip to purchase their food. Yes. So only 26 percent. That first Green were actually purchasing
food within the community. And so I want to know what was that about. And they told me because that the that the
food at this particular store was more expensive than the produce only expired after a couple
of days and that a lot of other foods were also expired. So now we’re thinking about access at the
community delivery. Now the other thing I wanted to know was well
what do people have in their homes in terms of fruits and vegetables. So here’s an example of fruits in people’s
home and what we see is that the most common fruits represented are things like bananas,
apples, oranges. The other fruits are much lower. Another thing about this community that I
see there there’s a higher frequency of raisins and dried fruit. Sugar. Exactly. And so we also wanted to know at the individual
level what might be contributing to this. And one thing I learned with lack of exposure. One of the community members talked about
how shocked he was that some of the children hadn’t experienced different fruit. He said they didn’t know what a Kiwi was. A Kiwi. And so I think that really contributes. So in this particular community that I’ve
shown this is just one unique issue that they’re facing. There are so many other issues. And one way I’m working to address this particular
access issue is that I’m working with a local startup company to bring in fruits and vegetables
within this particular community. However for me it’s not just getting that
one piece of the puzzle. It’s really important for me to learn what
else is going on for this community. What other challenges they’re having and with
that information then I can create a more enhanced program that is useful to their specific
needs as they are working as we’re working to reduce obesity within this community and
then eventually we will tailor this program for other rural communities. Now tailor is the key word. Remember what we learned earlier assumptions
we don’t do that. So I can’t just take the same program and
put it into that community. I have to talk to this new community as well
and see, do you have the same issues. Are there other issues as well that we need
to address. So overall my hopes are that my research will
show that in order for us to effectively prevent obesity and associated diseases among culturally
diverse populations that one we need to consider multiple factors that I have demonstrated
today that we can’t just look at the individual level in terms of exposure, family, e saw
what people had within their homes, community, access to grocery stores, society, There’s
a lot there are around perceptions of obesity and so much more – all contribute to our understanding
of obesity. And of course we can’t forget the other pieces
that I’ve highlighted. So I believe that once we’re able to do that
then we’ll be one step closer to solving the obesity epidemic.

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