Cultural Considerations in the Development of Pediatric Weight Management Interventions

Over the last 20 years, the prevalence of overweight and obesity have increased dramatically in U.S. adults across racial/ethnic groups, and in both males and females of all age groups (Agudo & Pera, 1999; Center for Disease Control, 1997; Eberhardt et al., 2001; Kuczmarski & Flegal, 2000; Mokad et al., 1999; Ogden et al., 2006). Youth of diverse ethnic backgrounds, in particular, have been negatively impacted by the increasing rate of obesity. For example, national statistics indicate that 31.4 percent of African-American male adolescents, and 42.1 percent of African-American female adolescents are currently overweight (Ogden et al.).

There is a growing interest in the application of ecological models in understanding obesity-related factors and in developing effective interventions. Although a number of different ecological models exist, all share the core belief that behavior is influenced by multiple levels of environmental subsystems (Bronfenbrenner, 1979; Kazak, Rourke, & Crump, 2003; McLeroy, Bibeau, Steckler, & Glanz, 1988; Power, DuPaul, Shapiro, & Kazak, 2003; Sallis, Bauman, & Pratt, 1998). This approach, as outlined by Bronfenbrenner assumes that health and health behaviors are shaped by environmental subsystems that include the integration of intrapersonal factors (characteristics of the individual), microsystemic factors (families and institutions), mesosystemic factors (interactions between family and institutions), exosystemic factors (communities, policies) and macrosystemic effects (all systems—micro-, meso-, exo-, etc.—related to a culture or subculture). Figure 18.1 presents an ecological model for understanding cultural issues in relation to the prevention and treatment of obesity among minority youth. In this model, concentric circles are used to conceptualize behavioral levels of influence, with the psychobiologic core as the central circle, and distal leverage points as the broadest, outermost circle. Factors such as family and parenting variables are examples of proximal levels of influence. Institutional supports (schools, churches) and policy are distal levels of influence. Specifically, this chapter will provide an integrated review of cultural issues related to obesity prevention and treatment from an ecological perspective. In this chapter, we highlight factors using an ecological approach that are particularly relevant for understanding obesity-related factors (including diet and physical activity) in ethnically diverse pediatric populations. In addition, we provide a summary of the key obesity prevention and intervention studies that have been implemented for minority children and adolescents, and we propose key priorities for future research.