Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 32
inclusion and exclusion criteria for participation. For
example, if the intention is to recruit people from
specific countries such as Pakistan, Iraq and Lebanon
and the community is being accessed through an
Arabic cultural support organization, it is possible
that people from other countries such as Saudi Arabia,
Egypt, Syria, or from Palestinian territories may also
be interested in participating, especially if they are part
of a cultural social network that is participating as a
group. It is important to be aware that if they have
migrated, owing to persecution in their home country,
excluding them from participation due to “ research
rigor ” would be inappropriate and could create
further feelings of exclusion.
Similarly, any research or community program targeting
families needs to first understand the concept
of family for the minority groups in question. In many
cases, gender roles, intergenerational and community
responsibilities in child rearing need to be understood
with regard to their role in influencing eating and
physical activity behaviors and choices. For example,
decisions about food choices may be driven by the
mother as the person responsible for preparing food,
or grandparents who are responsible for child care, or
fathers ensuring cultural practices are maintained.
Cultural identification may also shift as a result of
marriage. For example, a woman may describe herself
as belonging to the cultural group of her husband
rather than her own cultural background.
Appropriate c ommunity s ettings
When approaching minority groups it is most valuable
to operate via the community settings they are
currently utilizing, such as cultural or religious
meeting places. 4,16,18,19 However, this is not always possible
if minority groups are part of a wider community
study. Schools are currently being widely used as a
community - based setting for obesity prevention. The
level of involvement family members of minority
groups have with the school will obviously greatly
impact on the effectiveness of school - community
based initiatives. The level of interaction between
families and schools varies considerably in migrant
home countries. In many African countries, for
example, the whole family visits the school only once
a year for Parents ’ Day. Other than that, they would
normally only attend if there for the recognition of a
child ’ s achievement or if the child were in trouble.
Engagement of families directly in community -
based initiatives needs to accommodate not just cultural
considerations in intergenerational and gender
roles in decision making and child care. The impact
of migration and differing levels of acculturation can
also dramatically affect decision - making roles within
the family. As the child is often the first member of
the family to master the language of the host country
and to gain some understanding of mainstream
culture and systems, parents have to defer to their
knowledge and in doing so can lose power in decision
making. Children thereby become the power brokers
in the family, driving food purchasing and activity
decisions without the constraint of the disempowered
adults. For example, children may perceive fast food
and soft drinks as accepted diet in their host country
and refuse to eat healthy traditional foods. The challenge
in the development of obesity prevention programs
is to engage parents and support their role as
guardians of their children ’ s health and/or to engage
children as the drivers of changed behaviors.
What m essages and s trategies
to u se?
Effective health promotion/social marketing uses
messages that have relevance and importance to the
target community. 20 This is particularly relevant in
obesity prevention because of the range of cultural
values and beliefs in relation to food and physical
activity, health and weight, as described in Chapter 17
and illustrated in Box 32.2 .
In particular, the community program strategies
need to accommodate different cultural frameworks
which will impact directly on the relevance of the
message. For example, for many families from developing
countries obesity prevention messages will
create confusion because:
• Overweight and obesity are perceived as a sign of
health and wealth 21 (represented by the tie resting
on the belly) in the home country and are seen as a
sign of laziness and poor health in developed host
countries.
• It is often difficult to maintain healthy traditional
diets with unfamiliar food products in the host
country.
• Foods high in fat that are seen as healthy and desirable
in famine - affected countries are seen as
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