1. What role can culture play? Shiriki Kumanyika, Ph.D., M.P.H. University of Pennsylvania School of Medicine CCEB

2. Three Themes Body Image Body Image Ethnic Minority Populations Ethnic Minority Populations Cultural Change Cultural Change

3. Body Image Concern about eating disorders Concern about eating disorders Stigmatization of obese people Stigmatization of obese people Ethnic or socio- economic differences Ethnic or socio- economic differences

4. Focus Group Findings – Girls Health Enrichment Multisite Studies (GEMS), Memphis, TN Dual meaning of the word healthy Dual meaning of the word healthy Relate hairstyles and clothing to looking good; not size Relate hairstyles and clothing to looking good; not size Changing your body is not necessary – Make the best of what you have Changing your body is not necessary – Make the best of what you have Source: Beech B et al, presented at the American Public Health Association

5. Ethnic Minority Populations Highest risk groups in the U.S. for childhood obesity include ethnic minority populations Highest risk groups in the U.S. for childhood obesity include ethnic minority populations –African Americans –Hispanic or Latino Americans –Native Americans –Pacific Islanders Increasing % of population Increasing % of population

6. Percent of population *BMI at or above the sex and age-specific 95th percentile BMI cutoff points **age-adjusted Source: Health United States, 1998 and Ogden JAMA Oct 9 2002 Overweight Children: Boys 6-11

7. Overweight children Girls 6-11

8. Ethnic differences in factors that promote excess weight gain during children? Mothers weight status and pregnancy weight gain Mothers weight status and pregnancy weight gain Breastfeeding Breastfeeding Infant feeding practices Infant feeding practices Foods at home and parenting style Foods at home and parenting style Eating while watching TV Eating while watching TV Community norms Community norms

9. Cultural Changes

10. Cultural Change Definition of a healthy diet Definition of a healthy diet Media Media Communication patterns Communication patterns Womens roles Womens roles Parenting styles Parenting styles Population diversity Population diversity Globalization of markets Globalization of markets

11. If culture is part of the problem, then it must also be part of the solution

12. Culturally positive obesity prevention strategies Do not focus on obesity as such Do not focus on obesity as such Increase awareness of changes while they are happening Increase awareness of changes while they are happening Demand healthier mix of foods Demand healthier mix of foods Leverage diversity in food cultures Leverage diversity in food cultures Create positive, psychologically and socially meaningful experiences with healthy foods Create positive, psychologically and socially meaningful experiences with healthy foods Empower parents Empower parents

13. National Heart Lung and Blood Institute, NIH