Understanding the sociocultural roots of childhood obesity: Food practices among Latino families of Bushwick, Brooklyn
Introduction
Childhood obesity has reached unprecedented levels in the United States. In the last 30 years, rates have tripled to 15% (Ogden, Flegal, Carroll, & Johnson, 2002).1 Those numbers are even higher among poor children (Kumanyika & Grier, 2006). The childhood obesity epidemic is a public health crisis deeply connected to poverty. On the surface, stemming the tide of childhood obesity appears a straightforward task: with proper exercise and diet, obesity can be dramatically reduced. In practice, however, obesity prevention presents a conundrum to public health professionals in the United States. The complex realities of obesity pose challenges, and few successful models of prevention exist (Dietz & Gortmaker, 2001; Kaur, Hyder, & Poston, 2003; Summerbell et al., 2005).
Historically, childhood obesity programs have relied on two models for intervention: an individual-child model and a dyadic approach. The individual child model focuses on changing children's behaviors, and the dyadic approach looks to the child/parent pair as the lever for altering behaviors. Neither model has yielded significant long-term results (Caballero, 2004; Summerbell et al., 2005; Swinburn, 2003). Both are reflected in the design of childhood obesity research, which has primarily focused on the individual child or the parent/child dyad (e.g., Crawford et al., 2004; Datar, Sturm, & Magnabosco, 2004).
To enhance the efficacy of prevention programs, public health practitioners have called for more comprehensive understandings of family dynamics, sociocultural practices, and the local food environment in the context of local and national political economies (Birch & Davison, 2001; Dietz & Gortmaker, 2001; Drewnowski & Darmon, 2005; Fitzgibbon & Stolley, 2004). Each of those issues—taken on its own—serves to expand our understanding of childhood obesity. Taken together, however, they offer a holistic framework for examining the problem of childhood obesity in the context of the everyday realities that poor families face and the larger structural and political issues that affect their lives. This anthropological study explores that intersection by probing the sociocultural roots of childhood obesity.
Within the literature on childhood obesity, approaches that examine the social determinants of the epidemic range from epidemiologic to sociological. Epidemiologic research focuses on prevalence, predictors, and associated factors of obesity, identifying “at risk” groups based on age, gender, ethnic/racial categories, class, and other factors that serve to guide prevention efforts (e.g., Crawford, Story, Wang, Ritchie, & Sabry, 2001; Flegal, 1993; Spruijt-Matz, Lindquist, Birch, Fisher, & Goran, 2002). By contrast, sociological research has focused mainly on parent–child practices and perceptions regarding food and obesity, to inform medical and programmatic settings (e.g., Baughcum, Burklow, Deeks, Powers, & Whitaker, 1998; Jackson, Mannix, Faga, & McDonald, 2005; Sherry et al., 2004). This literature, however, pays relatively little attention to how practices and perceptions develop and circulate. Researchers have suggested that the structure of families’ economic resources and local food environments are embedded in a sociocultural context and broader national economies that should be taken into consideration when examining food consumption and obesity (Drewnowski & Darmon, 2005; Drewnowski & Specter, 2004; Fitchen, 1997). In the context of poor neighborhoods, examining those issues offers the opportunity for a greater understanding of the experience of poverty, as well as the effects of food insecurity and government assistance on families’ food practices and children's obesity.
While public health practitioners have called for family- and neighborhood-based interventions to enhance individual-based models addressing the childhood obesity epidemic (Birch & Davison, 2001; Cousins et al., 1992; Dietz & Gortmaker, 2001), the prevailing research strategy for examining perceptions and practices associated with childhood obesity has concentrated on mothers in focus group settings. From conceptual and methodological perspectives, this strategy limits its scope to mothers and children, despite the fact that the more meaningful unit of analysis includes other kin and non-kin, often key actors in children's everyday lives.
In more recent studies, researchers have incorporated in-context research, using interviews and focus groups, and expanded the scope to include close kin as well as community-based workers who serve families (Chatterjee, Blakely, & Barton, 2005; Green et al., 2003).
This article builds on previous research, and addresses a gap in the literature by combining interviewing techniques with systematic observation in the context of people's homes. Methodologically, it does so through ethnographic methods based on the anthropological principles of holism and comparison, embracing the practitioners’ call to examine the sociocultural, political, and economic contexts that create conditions for childhood obesity (Drewnowski & Darmon, 2005; Fitchen, 1997). Research participants include not only parents and grandparents, but those individuals who routinely interact with children: extended kin and friends. Conducted in participants’ homes, the research offers a systematic analysis emphasizing the approaches of interpretivism, which focuses on interpreting people's multiple and complex perceptions and practices as shared systems of meaning, and political economy, which concentrates on understanding social relations in the context of local and national political, economic, and ideological structures. This article explores how adults and children participate in and perceive food acquisition, exchange, and eating amidst fluctuating and often scarce resources. It examines how families generate meaning about food, well-being and obesity, and parental identity, and how these beliefs figure in practices that can ultimately affect weight and overall health. They constitute the sociocultural roots of obesity.
In poor neighborhoods across the United States, residents experience far higher rates of adult and childhood obesity than those in more affluent neighborhoods (Drewnowski & Specter, 2004). They suffer greater rates of illness—often sequelae of obesity—including diabetes and heart disease. To complicate matters, residents of poor neighborhoods also suffer greater barriers to quality medical care and access to goods and services. Among those hardest hit by childhood obesity are Latinos (Flores et al., 2002; Strauss & Pollack, 2001). The rate of childhood obesity is 15% nationwide (Ogden et al., 2002). In New York City, it is 24%—a number heavily weighted by Latino children who suffer an obesity rate of 31%, compared with a rate of 23% for Black children and 15% for White and Asian children (Thorpe et al., 2004). Given these disproportionate rates, this study focuses on Latino families, recognizing the health, social, and economic challenges this group experiences as well as its ethnic and sociocultural heterogeneity (e.g., Davila, 2001; Zsembik & Fennell, 2005). The majority of New York City Latinos are Puerto Rican, Dominican, and Mexican, followed by Ecuadorian, Columbian, and Cuban (New York City Department of City Planning, 2004a). Despite the diversity that the term Latino encompasses, the research goal was to generate a deeper understanding of the childhood obesity epidemic among group most deeply affected in New York City, to inform the New York City Department of Health and Mental Hygiene's (NYC DOHMH) neighborhood-targeted obesity prevention programs.
Section snippets
Study site
The study site of Bushwick, Brooklyn represents a predominantly Latino, low-income neighborhood, whose residents experience some of the highest rates of disease and mortality in New York City (Karpati, Lu, Mostashari, Thorpe, & Frieden, 2003). Bushwick has a population of 104,358, of which 67% is Latino and 24% is Black/African American (New York City Department of City Planning, 2004a). Those figures, however, do not include its undocumented Latino population. The mean household income of
“Ain’t nothing wrong with Maria”: food practices, prevention programs, and childhood obesity
Twenty-three-year-old Yolanda is a stay-at-home Puerto Rican mother, who lives with her two daughters and Ramon, the father of her second daughter.3 Ramon works construction jobs intermittently to support their family, but they have struggled to ‘get by.’ Because of their low income, Yolanda has received benefits from a government program called The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC),
Conclusion
This study has examined the sociocultural roots of childhood obesity by exploring low-income Latino families’ food practices, embedded in their everyday lives, their urban neighborhood context, and the larger political and economic processes that affect them. The study underscored how poor Latino families’ fluctuating economic resources and their strategies to cope with resultant instability—‘taking credit’ and food sharing—create a monthly food cycle that shapes their patterns of food
Acknowledgments
We extend our deep gratitude to the Bushwick residents who participated in this study. The funding for the study was provided by the New York City Department of Health and Mental Hygiene (NYC DOHMH). We are grateful to our colleagues from NYC DOHMH and Mount Sinai School of Medicine for their assistance on the project and helpful comments on earlier drafts, including Kelly Cantor, Kesha Critchlow, Kitty Clarke, Debbie Deitcher, Delia Easton, Karen Florez, Estela Gonzalez, Cindy Gordon, Regina
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