1. By: Amanda Krato Nicole Rosebrock Michelle Robinson Derrek Staley HEALTH PROMOTION FOR OBESITY IN NON- HISPANIC AFRICAN AMERICANS

2. INTRODUCTION Obesity in the United States (U.S.) has risen significantly in the recent decades, with the current rate of 35% adult Americans are obese (Center of Disease Control, 2014a). Minority groups have a higher incidence of obesity with African American being the highest at 47.8% (Center of Disease Control, 2014b). Following Healthy People 2020, the goal is to develop effective health promotions for increasing awareness of obesity within the African American, non-Hispanic black community and reduce obesity and its associated risk factors.

3. LITERATURE REVIEW Obesity in America Obesity is an ongoing and growing issue for the residents of Michigan especially the African American population. In a recent study 39.9% of African American Michigan residents were obese (Robert Wood Johnson Foundation, 2014). Some of the negative health effects caused by obesity are: heart disease, hypertension, stroke, sleep apnea, and diabetes. In this review we will examine a few journal articles that will address these issues. In a study published by Preventing Chronic Diseases, it was found that 80% of Michigan residents ate at a fast food restaurant at least once a month and 28% went more than twice a week (2011). The main reason for visiting a fast food restaurant was the convenience. The poor food choices that are high in calories and fat have contributed to the obesity issue within the state. The article recommended that the restaurants offer healthier and lower calorie options and have the nutritional facts easily available. An article in American Journal of Hypertension, the relationship between weight gain and hypertension, stating that 60-70% of adults have hypertension due to obesity. “Mechanisms of obesity-related hypertension include insulin resistance, sodium retention, increased sympathetic nervous system activity, activation of renin–angiotensin–aldosterone, and altered vascular function”(Kotchen, 2010, p. 1170). The article states that the easiest way to reverse these issues is to lose weight and suggest that “community-based programs” both in schools and places of employment will help with prevention and education (Kotchen, 2010). JAMA (Journal of the American Medical Association, 2012), did a study on obesity and BMI (body mass index) trends in US adults. It was found that the median BMI was 28.7 and the median rate of obesity was 35.5%, for both men and women. The research did find that the rates of both BMI and obesity had leveled off and there was no significant change over the last 12 years.

4. LITERATURE REVIEW CONT. In conclusion with all of the research out there showing us the terrible effects of obesity we Americans still have an impressive rate of it. From these articles we have learned that by simply losing some weight we can decrease our risk of many of the subsequent diseases (hypertension, diabetes etc.). By education for both adults and children and making healthier foods available at fast food restaurants. On a positive note the JAMA did find that there was no increase of obesity rates over the past decade but there was also no decline. So, we seem to have stopped the increase, we just now need to continue with education and maybe in the next decade we can start to see a reduction and more healthy Americans.

5. HEALTH RISKS Many factors increase the risk of obesity in the African American population ▪Genetic predisposition ▪Cultural and religious impact ▪Socioeconomic status Obesity increases the risk of: ▪Heart Disease ▪Type II diabetes ▪Hypertension ▪Stroke ▪Sleep Apnea

6. CULTURAL FACTOR Decreased physical activity Highly religious culture Mistrust of health care Body type ideals Food culture

7. ENVIRONMENTAL/COMMUNITY RISK FACTORS ●Walkability o Limited/lack of sidewalks o No/non-functioning street lights ●Environments that promote sedentary life styles o No access to Fitness centers/community centers o No access to parks/walking trails ●Available food sources oLimited access to supermarkets oEasy access to fast food chains ●Neighborhood safety oCrime

8. CDC (2013) Prevalence of Self-Reported Obesity Among US Adults Prevalence of Self-Reported Obesity Among Non-Hispanic Black Adults CDC Data on Obesity

9. OBESITY IN THE STATE OF MICHIGAN Rank Among US States (2013): 11/ 51 tal) Current Rate of Obesity (Total) 31.5%2013 Men31.5%2012 Women30.7% White30.1%2013 Black39.3% Latino35.4% www.stateofobesity.orgwww.stateofobesity.org (2014)

10. OBESITY RATES IN MICHIGAN CITIES ▪ Flint 32.3% ▪ Kalamazoo 31.3% ▪ Lansing 28.3% ▪ Detroit 27% ▪ Grand Rapids 24.6% ▪ Ann Arbor 20% ▪ (Most Obese city in the US McAllen, TX- 38.8%, least obese city Boulder, CO -12.1%) (Bryner, 2012)

11. OVERWEIGHT AND OBESITY RATES FOR ADULTS BY RACE/ETHNICITY Kaiser Family Foundation (2012) LocationWhiteBlackHispanic United States62.5%71.7%68.2% Michigan65.3%69.3%68.6%

12. OBJECTIVES OF HEALTH PROMOTION Increase health awareness in the African American community by providing health screenings, materials and local resources. To improve the health status of the community by decreasing the prevalence of obesity through healthy diet and physical activity. The promotion of healthy diet and exercise is consistent with the mission and goals of Healthy People 2020.

13. HEALTHY PEOPLE 2020 A main goal of Healthy People 2020 is “To promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights” (Office of Disease and Prevention and Health Promotion, 2014). Incorporating an annual health promotion fair to assess and educate the the members of the community in healthy behaviors can play a pivotal role in achieving Healthy People 2020 goals.

14. SETTING Health Promotion Fair at the Perani Event Center in Flint Michigan ▪ Health Professionals (dieticians, nurses and fitness instructors) ▪ Healthy foods and beverages ▪ Health screenings ▪ Interactive displays ▪ Games and Prizes

15. PLAN OF ACTION Creating an awareness of the health fair through the following: Flyers to be sent home with children from the surrounding school district. Flyers distributed to patrons of local healthcare agencies. Utilization of local television and radio stations.

16. PLAN OF ACTION CONT. Health screening: The assessment of age, weight, BMI, body fat %, blood pressure, and glucose. Dietary education: Registered Dieticians available to provide individualized dietary education, as well as online and community resources that promote healthy eating habits. Physical therapists and fitness instructors: Available to provide guidance in creating a plan to increase physical activity in the home or community based on individual’s physical abilities.

17. CONCLUSION The African American community poses a higher risk for obesity than any other ethnic group. There are health, environmental, and community risks that contribute to elevated obesity rates. A health fair is a great way to reach out to an entire community. Providing medical screenings and health and nutrition education can raise awareness and ultimately decrease the obesity rates in the African American community. Promoting health and decreasing obesity is consistent with the goals of Healthy People 2020. Flint michigan has one of the highest rates of obesity. African Americans make up over half of the population of Flint. This is the reason that a health fair in Flint would benefit the African American community.

18. REFERENCES Anderson, B., Lyon-Callo, S., Fussman, C., Imes, G., & Rafferty, A. P. (2011). Peer Reviewed: Fast-Food Consumption and Obesity Among Michigan Adults. Preventing chronic disease, 8(4) Bryner, J. (2012). The skinniest and fattest U.S. cities revealed. Live Science Retrieved from: http://www.livescience.com/18889-cities-obesity-rates.html Center of Disease Control. (2014a). Adult Obesity Facts. Retrieved from http://www.cdc.gov/obesity/data/adult.htmlhttp://www.cdc.gov/obesity/data/adult.html Center of Disease Control. (2014b). Black or African American Populations. Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/black.htmlhttp://www.cdc.gov/minorityhealth/populations/REMP/black.html Center for Disease Control. (2014c). Obesity Prevalence Maps. Retrieved fom http://www.cdc.gov/obesity/data/prevalence-maps.html Center for Disease Control. (2011). Physical Activity and Health. Retrieved from http://www.cdc.gov/physicalactivity/everyone/health/index.html http://www.cdc.gov/physicalactivity/everyone/health/index.html Casagrande, S.S., Whitt-Glover, M.C., Lancaster, K.J., Odoms-Young, A.M., Gary, T.L. (2009). Built environment and health behaviors among African Americans: a systematic review. American Journal of Preventive Medicine. 36(2), 174-181. Dodor, B. (2012). The impact of religiosity on health behaviors and obesity among African Americans. Journal of Human Behavior in the Social Environment, 22(4), 451-462. Escoffery, C., Rodgers, K.C., Kegler, M.C., Haardörfer, R.,Howard, D.H., Liang,S.,…Coronado, G.D. (2014). A systematic review of special events to promote breast, cervical and colorectal cancer screenings in the United States. BMC Public Health. 14, 274.

19. REFERENCES CONT. Flegal, K., Carroll, M., Kit, B., & Ogden, C. (2012). Prevalence of obesity and trends in the distribution of body mass index among US Adults, 1999-2010. The Journal of the American Medical Association (JAMA). 307(5): 491-497. doi: 10.1001/jama.2012.39. Grier, S. A., & Kumanyika, S. K. (2008). The context for choice: health implications of targeted food and beverage marketing to African Americans. Journal Information, 98(9), 1616-1629 Healthy People 2020. (2014). Nutrition and weight status. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-statushttps://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status Henry J. Kaiser Family Foundation. (2014). Overweight and Obesity Rates for Adults by Race/Ethnicity. Retrieved from: http://kff.org/other/state-indicator/adult- overweightobesity-rate-by-re/http://kff.org/other/state-indicator/adult- overweightobesity-rate-by-re/ James, D. (2004). Factors influencing food choices, dietary intake, and nutrition-related attitudes among African Americans: application of a culturally sensitive model. Ethnicity and Health, 9(4), 349-367. Kotchen, T. (2010). Obesity-related hypertension: Epidemiology, pathophysiology, and clinical management. American Journal of Hypertension. 23(11): 1170-1178. doi: 10.1038/ajh.2010.172. Kennedy, B. R., Mathis, C. C., & Woods, A. K. (2006). African Americans and their distrust of the health care system: healthcare for diverse populations.Journal of cultural diversity, 14(2), 56-60. Layton KL. (2008). Socioecological factors affecting overweight and obesity in African American, Native American and white limited income women.Oklahoma State University Thesis. Retrieved from: http://digital.library.okstate.edu/etd/umi-okstate-2818.pdf.http://digital.library.okstate.edu/etd/umi-okstate-2818.pdf Office of Disease Prevention and Health Promotion. (2014). Nutrition and weight status. Retrieved from http://www.healthypeople.gov/2020/topics- objectives/topics/nutrition-and-weight-statushttp://www.healthypeople.gov/2020/topics- objectives/topics/nutrition-and-weight-status

20. REFERENCES CONT. Office of Minority Health. (2014). Obesity and African Americans. Retrieved from http://minorityhealth.hhs.gov/omh/browse.aspx?lvlid=25http://minorityhealth.hhs.gov/omh/browse.aspx?lvlid=25 Pender, N., Murdaugh, C., & Parsons, M. A. (2014). Health Promotion in Nursing Practice (7th ed.). Upper Saddle River, NJ: Pearson. Sullivan, S.M., Brashear, M.M., Broyles, S.T., Rung, A.L. (2014). Neighborhood environments and obesity among Afro-Caribbean, African American, and non-Hispanic white adults in the United States: Results from the National Survey of American Life. Preventive Medicine. 61(1), 1-5. The, N.S., Richardson, A. S., & Gordon-Larsen, P. (2013). Timing and duration of obesity in relation to diabetes findings from an ethnically diverse, nationally representative sample. Diabetes care, 36(4), 865-872. Trust for America’s Health and the Robert Wood Johnson Foundation. (2014). The State of Obesity in Michigan. Retrieved from: http://stateofobesity.org/states/mi/ http://stateofobesity.org/states/mi/ United States Census Bureau. (2014). State & county quick facts. Retrieved form http://quickfacts.census.gov/qfd/states/26/2629000.html U.S. Department of Health and Human Services. (2012). Information on Poverty and Income Statistics:A Summary of 2012 Current Population Survey Data. Retrieved from http://aspe.hhs.gov/hsp/12/PovertyAndIncomeEst/ib.cfmhttp://aspe.hhs.gov/hsp/12/PovertyAndIncomeEst/ib.cfm