Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 17
The s ocio - c ultural e nvironment
The socio-cultural environment influences body - size
preferences, as well as eating and activity patterns. 21,32
This environment comprises structural characteristics
and the dominant ethos, as well as culturally - shaped
31 – 33
values, beliefs, attitudes and expectations.
The structure of a cultural group impacts on food -
related practices in families, households and wider
communities, thus impacting on the body size of
group members. 32 The hierarchical structure of a
group is defined by the relative rank and status of
individuals and/or families. Status is determined by a
range of variables, including gender, seniority, life
stage, education, employment and wealth. Body size,
eating and activity patterns are often associated with
the relative status of group members. For example,
older Fijian men are given more prestigious and
greater quantities of food than women and younger
men. 34 A large body size characterizes social rank,
status and power for sub - Saharan Africans. 35 In any
group, high - status family members are likely to make
key decisions about the nurturing of children and the
acquisition, preparation and distribution of food. For
example, grandmothers in intergenerational African
American households often influence infant feeding
36
practices.
The prevailing ethos or world - view within an ethnic
group also influences body-size preferences and eating
and activity patterns. 32 A collective ethos is characterized
by expectations of interdependence, awareness of
others, a sense of duty and cooperation. 37 – 39 The family
is the most fundamental social unit. 32 There is often
greater connectedness with extended family members
and elders are more directly involved in child - rearing
among Fijian families, 40,41 ethnic minority groups
in the USA 21,42,43 and Africans 44 compared to white
families.
Values, beliefs, attitudes and expected behaviors
also impact on body size and eating and activity patterns.
21,32 While socio - cultural influences on body size
are universal, their expressions differ among populations,
classes and ethnic groups. 21 For example, ideas
about what constitutes a well - nurtured or healthy
body are culturally shaped. The WHO ’ s definition of
an optimal body mass index (18.5– 25 kg/m 2 ) does not
necessarily concur with the views of all ethnic groups.
6,32 21
Fijians, African Americans and sub-Saharan
Africans 35 prefer larger body sizes than Europeans,
although emerging evidence suggests that Fijian preferences
are shifting toward Western ideals. 5,45
Although attitudes may coexist among cultural
groups sharing the same environment over time, the
persistence of different body ideals is evident in data
for African Americans vs US whites. Several qualitative
studies report that African Americans tolerate
large body sizes and view the meaning of large body
size differently from health professionals. 21 A study of
low - income mothers of preschool children, the majority
of whom were African American, indicated that
having a larger body size than the growth charts was
acceptable, providing children were healthy, active
and had good self - esteem. 46 A study of 9 –10-year-old
white and African American girls reported that African
American girls with a “ normal ” weight were more
likely to receive maternal messages that they were
underweight than white girls. 47 Similarly, African
migrant adults may have maintained their preference
for a large body size after migration to Australia, continuing
to view a robust body as beautiful and as an
expression of a family ’ s wealth. 35 However, it is not yet
clear whether African migrants ’ body - size ideals will
persist in Australia, given the increasing prevalence of
obesity and awareness of obesity - related diseases.
Parents and/or primary caregivers have a major
influence on their children ’ s eating and activity patterns
via their ideals about a healthy body, knowledge
about healthy eating and exercise, food available
at home, structuring of family meals, shaping of
opportunities for physical activity and modeling of
acceptable behaviors and body sizes. 48 Eating and
activity patterns that result in a large body size may
be considered acceptable, or even desirable, to achieve
a “ healthy looking ” child. A well - nurtured body may
indicate high status and good health, as well as
being associated with fertility in environments where
people have been undernourished, for example, in
some parts of Africa. 49 These associations between a
robust body, social status and health are reflected in
the post - migration eating patterns of African migrants
in Australia, with reduced consumption of foods
that are considered less desirable and seen as survival
food for poor people, for example, vegetables and
35
fruit.
Parents ’ and children ’ s respective roles are culturally
influenced and are likely to differ across ethnic
140