Social Justice and the Urban Obesity Crisis

Implications for Social Work

Melvin Delgado

• Publisher: Columbia University Press
• Year: 2013
• ISBN:
  9780231534253
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

A number of economic, cultural, and contextual factors are driving urban America's obesity crisis, which can create chronic health conditions for those least able to manage them. Considering urban obesity through a social justice lens, this book is the first to help social workers and others develop targeted interventions for effective outcomes.

The text dissects the problem of urban obesity in populations of color from individual, family, group, community, and policy perspectives. Beginning with a historical survey of urban obesity in communities of color, anti-obesity policies and programs, and the role of social work in addressing this threat, the volume follows with an analysis of the social, ecological, environmental, and spatial aggravators of urban obesity, such as the food industry's advertising strategies, which promote unhealthy choices; the failure of local markets to provide good food options; the lack of safe exercise spaces; and the paucity of heath education. Melvin Delgado reviews recent national obesity statistics; explores the connection between food stamps and obesity; and reveals the financial and social consequences of the epidemic for society as a whole. He concludes with recommendations for effective health promotion programs, such as youth-focused interventions, community gardens, and community-based food initiatives, and a unique consideration of urban obesity in relation to acts of genocide and national defense.

1

Setting the Context

1

Introduction

America is fat. For some, the evidence is readily apparent: a cavernous dent in the once-sturdy couch, the belt which grows like kudzu, the cruel reminders in the eyes of strangers. For others, though, the obesity epidemic is something troubling but external, alien even, like the neighbors two streets over who leave old car parts in their yard—best kept away from, or at the very least, complained about in the safety of similarly tasteful friends; a sign of personal collapse and failure best glowered over as a Washington Post editorial or chuckled at as a New Yorker cartoon.

(BENFORADO, HANSON, AND YOSIFON, 2006, P. 1645)

The opening quote captures a multitude of perspectives on the social phenomenon that we call obesity, a much-talked-about condition, judging by the amount of publicity and scholarly attention it has generated in recent decades. Is there a need for an entire book on overweight and obesity—specifically one premised on a social justice paradigm and aimed at the social work profession? I hope that this book will prove the answer to be a resounding yes.

At the outset it is important to define the terms overweight and obesity and to consider whether there truly is an obesity “epidemic.” A look at media and scholarly treatments of the issue and a brief history of our changing attitudes toward weight will offer a context that will be useful. Other aspects of the inquiry will examine individual and environmental factors related to obesity, provide an overview of programs intended to combat this condition, discuss obesity’s particular impact on urban communities of color, and explore the potential of social work for addressing this complicated health issue.

The subject of obesity will only increase in significance nationally and internationally in the immediate future (M. C. Smith, 2009). Social workers are in a unique position to make a significant contribution to the ongoing discourse (in research, scholarship, and practice) because of our embrace of social justice, our history of community practice, and our use of multi-intervention methods.

The World Health Organization’s Commission on the Social Determinants of Health advocates for a policy agenda rooted in social epidemiology and human rights with direct relevance to overweight and obesity (Burris and Anderson, 2010). A social justice perspective represents a lens through which we can examine interventions that target obesity, while understanding the political reasons why certain population groups of this nation have a disproportionate chance of gaining excessive weight and are at higher risk for the many health conditions and complications that result.

Defining Overweight and Obesity

Defining what constitutes overweight and obese can be difficult, and some critics argue that any result of such an effort is socially constructed and highly politicized.

The standard measurement for excessive weight is determined by calculating the body mass index (BMI). This figure is determined by multiplying a person’s weight in pounds by 703, and then dividing the resulting number by the square of the person’s height in inches (Mantel, 2010). According to the National Institutes of Health, to be classified as overweight, women must have a BMI of 27.3 or higher, and men a BMI of 27.8 or higher. An individual is considered obese if he or she has a BMI of 30 or higher.

A 1999–2004 study of overweight and obesity in the United States found significant increases over the past several decades, and an alarming rate of increase (Ogden et al., 2006). Further, Strum (2007) found that between 2000 and 2008 the prevalence of severe obesity (individuals who weigh at least 100 pounds more than their recommended weight) increased two to three times faster than that of moderate obesity.

It should be noted when presenting these statistics that the field of obesity research faces broad challenges, as identified by Canay and Buchan (2007): (1) inaccurate and incomplete assessment of energy balance; (2) unclear implications of long-term excessive weight on health; (3) underestimation of obesity-related burden of disease; (4) poor understanding of childhood obesity; (5) inadequate study of population-level prevention measures and interventions; and (6) narrow scope of policy analysis. These six limitations will be addressed throughout this book.

How did we arrive at a point at which being overweight or obese can be considered normative? The journey took place over an extended period of time. The typical male adolescent in 2012 consumes 2,800 calories per day, an increase of 250 calories since the late 1970s; a typical female adolescent consumes 1,900, or an increase of 120 calories (Finkelstein and Zuckerman, 2008). Such seemingly small increases can add up to significant gains in weight: adding just 100 calories per day can translate into a gain of 10 pounds per year (Finkelstein and Zuckerman, 2008). Couple the increase in calories consumed with a reduction in exercise and take into account genetic factors (it is estimated that 70 percent of a person’s body weight is the result of biological factors), and it becomes clear that it is a real challenge not to gain weight!

The prevalence of overweight and obesity is not confined to the United States; it is particularly evident among children living in urban centers of economically developed countries (Seidell, 2000; Wang and Lobstein, 2006; Waters et al., 2008). Bulgaria (Ivanova, Dimitrov, Dellava, and Hoffman, 2008), Canada (Elliott, 2010; Harrington and Elliott, 2009), Sweden (Neovius, Janson, and Rossner, 2006), China (Reynolds et al., 2007; Wu, 2006; Zhai et al., 2009), Latin America, and the Caribbean (Rueda-Clausen, Silva, and Lopez-Jaramillo, 2007), for example, report alarming trends of overweight and obesity. Developing countries, too, are coping with the paradox of obesity and malnutrition (Prentice, 2006).

By these definitions, the World Health Organization (2011) estimates that globally there are more than 1.5 billion overweight adults, at least 500 million of whom are obese (200 million men and 300 million women). This is more than every woman, man, and child in the United States being obese!

In discussing conditions of being obese, overweight, or, more commonly, fat, commentators in the media often use terms that Klein (2006) considers “biblical in their moral disapprobation.” Kuczmarski (2007) notes that the term obesity is bound to elicit a wide range of reactions, depending upon a host of factors (including the knowledge base, experience, and background of the individual responding). Further compounding the confusion, the terms overweight and obese are often used interchangeably. The social consequences of these conditions can be quite distressing: being “fat” influences self-image, increases the likelihood of discrimination, and is also linked to lower economic status and poorer health outcomes.

Society often does not represent or seek the perspective of those who are overweight. Cooper (2009a) counteracts this omission by addressing the importance of upending society’s tendency to stigmatize or demonize those who are overweight or obese. Fat acceptance or “Fat-Lib” efforts serve to empower those who are overweight or obese (Cooper, 2010).

Pomeranz (2008, p. S93) addresses the importance of legislation against weight bias but acknowledges the challenges in bringing such policies to fruition:

History teaches that discrimination against socially undesirable groups leads to societal and governmental neglect of the stigmatized group’s health problem. [Viewing] weight discrimination in a historical context . . . demonstrates that legislation specifically aimed at rectifying obesity is less likely while weight bias is socially acceptable. Beyond obesity legislation, public health professionals may consider advocating for legislation directly targeting discrimination based on weight.

Hopkins (2011) discusses how body size and shape (specifically overweight or obesity) negatively influence identity, the way individuals navigate through society, and the inequalities that they encounter. Sweeting (2011) comments on recent highly publicized actions that single out those who are obese, such as efforts to require that airline passengers who are obese pay for two seats rather than one seat.

Nevertheless, as Cooper (2009b, p. 1) notes, our bias toward “fat” people may even prevent us from recognizing the significance of an activist movement led by these individuals:

In 21st century Western civilization, obesity is such a maligned state of being that the notion of fat activism is unthinkable within dominant obesity discourse. The lead of “activist” suggests a dynamic engagement with public life . . . that would not be further from couch potato stereotypes associated with fat people, or popular discourses which typify “the obese” through moral narratives as innately unwholesome, passive recipients of pity and intervention. Yet activism exists, has a complex history and offers new ways of conceptualizing “obesity.”

Is There an Obesity “Epidemic”?

The term epidemic has been used countless times to describe the problem of overweight and obesity (Gilman, 2008). A 2007 Surgeon General’s report, for example, officially labeled the problem an “epidemic.” Some scholars question this usage, however. See, for example, Flegal (2006, p. 77): “The word ‘epidemic’ has some drawbacks as a descriptor. Because it has no quantitative definition, there is no precise way to determine whether something is an epidemic or not, and opinions may differ.”

The term epidemic has a way of being used to draw attention to a particular situation or condition (Gilman, 2008). An article in the Washington Times (Duke, 2010) titled “‘Epidemic’ growth of the Net porn cited” is such an example. Another is Taylor (2009), “Fear of Failure: A Childhood Epidemic.” A search of the literature will find the term associated with “crime,” “sexual abuse,” “autism,” “depression,” “sexually transmitted diseases,” and “substance abuse.” Klein (2006), as well as others, wonders why other widespread phenomena—automobile accidents or pollution, for example—are not considered epidemics? It seems as though there is no social condition or problem that cannot benefit from the label. However, there are economic and political forces at work that influence its use as a designation. Some question whether the term is overused by industries (such as the food, exercise, and diet industries) and interest groups (such as some in the scientific industry) that financially benefit directly from the “epidemic” label (Campos, 2004; Campos, Saguy, Ernsberger, Oliver, and Gaesser, 2006; Gibbs, 2005; Oliver, 2006). “Obesity Inc.” has been the label assigned to these interests (Mundy, 2002).

Oliver (2006, p. 5) blames the usage on the scientific community:

What I came to discover was that, contrary to the conventional wisdom, the primary source of America’s obesity epidemic is not to be found at McDonald’s, Burger King, or Krispy Kreme Donuts . . . or any of the other theories that are often used to explain our rising weights. Rather, America’s obesity epidemic originates in far less conspicuous sources. The most important of these is America’s public health establishments. Over the past two decades, a handful of scientists, doctors, and health officials have actively campaigned to define our growing weight as an “obesity epidemic.”

Flegal (2006), however, argues that there is no escaping the high prevalence and rapid increase of overweight and obesity. McKinnon (2010, p. 309), sums up the gravity of this phenomenon: “Certain aspects of the obesity epidemic in the United States are not in question. We know, for instance, that rates of obesity (defined as BMI equal to or greater than 30) for all sociodemographic groups have risen to a startling degree in the past 50 years, and that 33.8 percent of U.S. adults are classified as obese, as are 16.9 percent of children.”

Media and Scholarly Attention

The labeling of obesity as an epidemic has benefited from significant media and scholarly attention. Hardly a day goes by without a story in the national media about how Americans have progressively gotten heavier and as a result, unhealthier (Hill, Wyatt, Reed, and Peters, 2003; Kolata, 2011; Parikh et al., 2008). Kumanyika and Brownson (2007) discuss how media coverage of obesity conveys a perpetual national crisis, with dire predictions about the future of overweight individuals. Boero (2007) analyzed the New York Times between 1990 and 2001 and found 751 articles on obesity, many of which focused on individual instead of macro-level forces, making it more of a medicalized, or pathologized, phenomenon. Ten Eyck (2007) studied national newspaper sections devoted to food and fitness during a one-month period (August 2005) and found that the topic of obesity appeared in 592 articles.

Saguy (2005) found that from 1994 to 2004, the number of scholarly medical articles on obesity tripled, while those in the popular press quadrupled. In 2001, the number of media articles on obesity surpassed those on hunger, even though the World Health Organization labeled hunger as the primary cause of death in the world!

Saguy and Almeling (2008) concluded that the media exhibit a propensity to report more heavily on the most alarmist scientific studies, as well as on those that blame individual factors, to the exclusion of those that offer alternative explanations. (It should be noted that alternative theories are much more complex to report, and much more politically charged. An article that implicates food industry practices as an underlying cause of obesity, for example, may have ramifications for advertising revenues. After all, individuals rarely advertise in the media, but corporations do.)

The scientific community, not surprisingly, has also published extensively on the topic. For example, the journals Future of Children (Spring, 2006), Science (February, 2003), Health Affairs (March, 2010), and International Journal of Epidemiology (February, 2006) devoted special issues to obesity, and at least four scholarly journals are devoted solely to obesity (International Journal of Pediatric Obesity; Obesity; Obesity Research; and Obesity Reviews).This trend reveals the significant foothold that issues of overweight and obesity have gained among scholars.

Changing Attitudes Toward Weight: A Brief History

Gilman (2010), a social-cultural historian, shows how the meaning attached to the condition of obesity has evolved, from ancient Greece to the present day. His book Fat: A Cultural History of Obesity (2008) posits that our national obsession with “fat” is not new and can be traced back to the mid-nineteenth century.

Interestingly, the term diet has its roots in the Greek word dioeta. However, the original meaning, “a prescribed course of life,” did not necessarily indicate an exclusive focus on food (Oliver, 2006). Gilman (2010) traces obesity as a pathological condition back to ancient Greece and Hippocrates (ca. 440–370 BCE).

Obesity in the eighteenth century was considered a condition of the wealthy (Gilman, 2010). It acquired a stigma only after it became associated with the lower classes. In the 1860s, William Banting, a formerly obese Englishman, published a pamphlet titled Letter on Corpulence, Addressed to the Public, which described the success of his diet and is considered the first publication on dieting (Greenblatt, 2003). Wolin and Petrelli (2009) note that by the turn of the nineteenth century, many Americans began to view excessive weight as socially undesirable. New inventions, such as portable scales (1891) and the first bathroom scale, the “Health-O-Meter” (1919), made it easier to keep track of weight gain. Levenstein (2003) discusses how from 1880 to 1930, new nutritional science theories and the rise of labor-saving food and devices radically altered the American diet.

Around this time, LuLu Hunt Peters published Dieting and Health, with Key to the Calories (1918), widely considered to be the first best-selling diet book in the United States (Gilman, 2010). Peters targeted women and framed obesity as a condition resulting from overindulgence, highlighting personal factors (such as a genetic resistance to gaining weight, or not having the skills to resist temptation) as the primary issues related to weight. The evolution of the diet industry from these humble beginnings to a $35 billion a year industry is history, so to speak. Stewart and Korol (2009) note that the recognition of obesity as a serious health issue in the United States began around this time, when future president Herbert Hoover, then head of the U. S. Food Administration, introduced calorie counting. By the 1920s dieting was becoming an obsession among adolescent girls.

Sadly, the targeting of women by the diet industry has continued to evolve since then. In The Female Eunuch (1971), Germaine Greer highlighted how society has demanded that women be thin, often to the point that they become susceptible to eating disorders. Wiseman, Gray, Mosimann, and Aherns (1992) reported an overemphasis on diet and exercise articles in women’s magazines during the period 1959–1988. More recently, a meta-analysis of 77 studies found that exposure to media images emphasizing thinness is positively associated with body image concerns among women (Grabe, Ward, and Hyde, 2008). The goal of achieving thinness is a critical element in bulimia nervosa among women (Chernyak and Lowe, 2010), resulting in a lucrative market of products and services addressing eating disorders (Hesse-Biber, Leavy, Quinn, and Zoino, 2006).

In the 1960s, weight and beauty ideals shifted once again: “Yet for reasons that are still unclear, in the early 1960s the beauty and fashion pendulum began...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• Acknowledgments
• Part 1: Setting the Context
• Part 2: Community-Led Health Promotion Approaches
• Epilogue
• References
• Index