Diversity or Division?
Race, Class and America at the Millennium
New York University
The United States is facing a new epidemic. More than half of all Americans are overweight or obese and the percentages are most shocking for women of color.African-American, American Indian and Hispanic-American women have the highest risk of becoming overweight, according to the Centers for Disease Control. Only one minority group, Asian Americans, has a lower rate of obesity than the general population.
In fact, the results of a national study released in 1996 show that more than half of all African-American and Hispanic women in the United States are already above what is considered a healthy body weight.
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Why does weight matter? Because overweight and physical inactivity now account for more than 300,000 premature deaths each year, according to Jeffrey P. Koplan, director of the CDC. "Obesity is an epidemic and it should be taken as seriously as any infectious disease epidemic," he said in a recent press release.
37% of African-American women are obese; 33% of Mexican-American Women are obese; 24% of Caucasian women are obeseThe statistics are startling. Sixty-six percent of African-American women are overweight and 37 percent are technically obese, meaning that they are 30 percent above ideal body weight. The figures for Mexican-American women are similar: 66 percent overweight and 33 percent obese. For Caucasian women, the figures are slightly lower with 49 percent considered overweight and 24 percent, obese.
And why the prevalence of obesity among minority women? In the past, researchers have focused on health differences between African Americans and Caucasians using race as the major determinant. But as the rate of obesity has skyrocketed in women of all races, scientists began to realize that they had to look at other factors, such as education and socioeconomic level, to determine the cause and develop intervention plans.
"People don't like to think about the idea that one is identified by social class or social stratification," Dr. Nancy Adler explained. Adler is the director of the John T. and Catherine D. MacArthur Foundation Research Network on Socioeconomic Status and Health, which was formed in 1997 to study the connection between health and socioeconomic status.
Recent research shows that social class measured by income and education can be more powerful than genetics in predicting future health problems, including obesity."It's tied more to general economic disparities," Dr. James Hill said when asked about the differences in overweight between African-American and Caucasian women. Hill, one of the country's leading authorities on obesity, pointed to the similarity in the obesity rate of African-American and Caucasian men.
While researchers have studied combinations of all of these factors, statistics for the number of lower class, lower educational level white women that are affected by obesity are hard to find. Despite the recent flurry of published articles on obesity, Tim Hensley, a health communications specialist with the CDC, said that not all of the angles have been covered yet. The poor, uneducated white women seem to be an ignored group when it comes to obesity research.
Race, gender and socioeconomic status all play a part in the genetics versus environment debate. It is too complicated to say it is just one cause. The Journal of the American Medical Association devoted its entire Oct. 27 issue to the subject of obesity in the United States. One article stated that heritability studies have shown that 70 percent of body weight can be tied to genetics.
Recent research shows that social class measured by income and education can be more powerful than genetics in predicting future health problems, including obesity.
However, genetics alone cannot account for the 50 percent increase in the percentage of Americans that are obese and the doubling of the number of overweight children in the past two decades.
"Genes don't make us obese. They allow us to be obese," said Hill, who also is director of the Center of Human Nutrition at Colorado Health Sciences University. It is the lifestyle that an individual who is susceptible to obesity chooses that will most affect her propensity to becoming overweight.Dr. Elissa Epel of the University of California at San Francisco has noticed that scientists are "recognizing the importance of uncoupling race and social class" in their research.
Epel studies the correlation between stress and fat distribution determined by the presence of growth hormone and has found that individuals with the lowest levels of education have the lowest levels of growth hormone making them more likely to gain weight.
"The more growth hormone you have, the less you tend to be obese," she said. While genetics play some part in the amount of growth hormone that one's body produces, Epel has found that stress is a major factor.
"Being of low social status can put someone under chronic stress," she said. "People with less education tend to have jobs with a lot of responsibility and less control." She explained that a head of a company may experience a high level of job related stress but would have more choices and control over the situation and that, in turn, alleviates stress overall. A day laborer, however, has little control over the stress of daily life.
Epel said that the stress of life at low educational and socioeconomic levels is a direct cause of obesity.
Once labeled an epidemic, obesity must be dealt with on an individual as well as a societal level. Education, prevention and methods of controlling body weight must all be targeted to the specific populations involved.
Hill blames the American environment for the alarming rates of obesity. "Everywhere we go, it encourages people to eat," Hill exclaimed disgustedly during a telephone interview. "We are the most sedentary generation ever. We don't get a lot of physical activity. Our physiology isn't set up to maintain a normal weight under these circumstances."A controlled body weight is a matter of balancing the energy that is taken into the body, food or drink, with the level of energy expended by the body in the form of physical activity or exercise. This seemingly simple equation is complicated by the fact that more than 25 percent of women are not active at all. African Americans and Hispanics are more likely than whites to be physically inactive, and people at a lower socioeconomic level exercise less than wealthier individuals.
More than a third of African-American women report no leisure-time physical activity.
"A lot of minority women can't relate to the word 'leisure-time,'" Dr. Amy Eyler, a researcher at the School of Public Health in St. Louis, Mo., said in an interview with Reuters. "And when you ask them about it they say, 'I don't have any.'"
Eyler found that physical activity was less common among women across the racial lines who live in rural areas, smoked and had lower levels of education.
Some researchers also point a finger at the profitable fast food restaurants that tend to target minority consumers.
"Fast foods can be singled out as a villain because they're an obvious villain. What they're doing is giving us food, which is generally low in energy and high in fat, and they're giving it to us in these huge portions," Hill exclaimed, but he stressed that they were not the only culprits in the fattening of Americans.
The hurdles for minorities and especially the poor are enormous. They are more likely to have limited access to health care and insurance coverage, and often suffer from poor nutrition. Some recent immigrants have the added burden of language barriers that make negotiating the U.S. health system impossible.In addition, African-American women report less pressure to be thin than their white counterparts and tend to be less self-conscious about how much they weigh.
Koplan of the CDC suggests that the entire community must play a role to help the increasing number of overweight Americans. He recommends that doctors counsel patients at annual exams, workplaces offer healthy meals, companies install on-site gyms, schools improve their physical education classes, and cities create safe public spaces for walking. Also, parents should encourage their children to play outdoors instead of spending time in front of the television or computer.
"We may be too late to do anything about it. The question we need to ask ourselves is can we turn it around before everyone susceptible is obese."
In one effort at obesity prevention, the National Heart, Lung, and Blood Institute has selected four centers across the United States to test and develop programs to help African-American girls, ages 8 to 10, to catch them before they form bad food and exercise habits.
Celeste Durant has found a way to reach African-American and Hispanic women in the Denver area. She successfully marketed her idea for a show on health for minorities to a new cable station, Colours- Television for All People. The first half-hour segment of "Being Well" will air in May addressing the connection between nutrition, stress, weight and overall health.
"The purpose is to help our viewers lead a more healthy lifestyle," Durant explained. "We're trying to do another approach that makes it more human."
On the first show a nutritionist will suggest ways to make the traditional African-American diet- heavy in fat and salt- healthier.
"All of us begin to go back to the foods that we were raised with," Durant, who is African-American, said.
Durant has pitched her idea for a health show targeting African Americans for years to networks including BET with no success. Because of the small black population in Denver, she changed the format to include both Hispanics and African Americans. She noted that the two minority groups have a number of the same health problems like heart disease, high blood pressure, diabetes, and breast cancer.
Congress provided $5 million in funding to the CDC to research the alarming increases in obesity in 2000. A CDC report released in March confirmed that overall, African Americans and Hispanics, as well as most minority groups, engage in more health-risk behaviors and take fewer preventive health care measures than whites.
The report breaks down health behaviors of racial or ethnic groups by state but not by gender. Interestingly, the figures vary widely within racial groups depending on state of residence, socioeconomic class and education level.
But Hill emphasized that the problem of obesity affects everyone.
"There is such a high prevalence that we have obesity in every group," he said of the numbers that are predicted to keep growing. "This is not something that just affects the poor."
"We may be too late to do anything about it," Hill said. "The question we need to ask ourselves is can we turn it around before everyone susceptible is obese." Unlike the campaigns against smoking, public health campaigns about obesity are much more complicated.
When it comes to changing behaviors, Hill said, "It's easier to do it or not to do it-not to modify it."
Women currently represent 51 percent of the U.S. population. According to the National Women's Health Information Center, they make the majority of the health care decisions and are more likely to provide care for their own families.
There are more than 36 million women of racial or ethnic minority backgrounds in the United States, a number which is expected to increase dramatically by 2050, when racial minorities will account for almost half of the U.S. population.
Obesity, second only to tobacco as the leading cause of premature deaths, disproportionally affects women of color and women of lower socioeconomic classes.
While efforts have begun to prevent obesity and deal with the rapidly increasing cases of obesity-related diseases, the results for this mounting health crisis for women are still a long way off.
"It's late in the game," Hill warned, "and we don't have a game plan."
