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Sunday, September 13, 2009

Hispanics struggle with obesity

Outside the Superstar Spotlight, Minorities Struggle With Obesity
By Lenny Bernstein, Washington Post, September 15, 2009

As any sports fan knows, Labor Day weekend is like Christmas in September. The NFL season is about to start, and the speed, power and grace of Minnesota Vikings running back Adrian Peterson is on display. The U.S. Open is in full swing, with Serena Williams tearing through the field as usual. Baseball is heading toward the playoffs; the superhuman Albert Pujols has a shot at the Triple Crown. The majestic Michael Jordan has been inducted into the NBA Hall of Fame and it won't be long before Kobe and LeBron are back on the floor.

Yet here is the irony I couldn't escape as I sat in front of my television, taking it all in: The overall fitness level of the minority groups those superstars represent is appalling. By any measure that matters, blacks and Hispanics are in worse shape than whites -- who, of course, are firmly in the grip of the obesity epidemic themselves.

According to the Centers for Disease Control and Prevention, 38.2 percent of whites over the age of 18 did no physical exercise (outside of work) in 2006. For blacks, the figure was 48.9 percent and for Hispanics it was an astonishing 53.4 percent.

The result of these disparities is sadly easy to predict. Fully 54 percent of African American women older than 20 are obese -- not overweight, obese -- by CDC standards. For Hispanics, the proportion is 42 percent, and for whites it is 32 percent. In combination with generally poorer diets and less access to medical care, that level of physical inactivity helps explain why minorities suffer proportionately more hypertension, Type 2 diabetes and heart disease. Their life expectancies also are shorter.

A larger percentage of African American and Hispanic children ages 6 to 19 are overweight than their white counterparts.
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The reasons for this state of affairs are controversial and -- as with all matters of race, income and personal motivation -- a difficult subject. We'll get to them in a moment. But I bring this up now for a number of reasons.

On Wednesday night, President Obama, a fitness freak, delivered his long-awaited address on overhauling the U.S. health-care system, an effort that all sides agree must place greater emphasis on preventive measures such as improved diet and more exercise. And with summer ending, we'll all soon be spending a lot more time indoors. If you're like me, you'll be packing on the winter pounds.

Yet the approach of autumn also brings us the first annual (and possibly the first-ever) "walk-off" against obesity. On Saturday, Sept. 12, thousands of people in more than 50 cities are scheduled to assemble against this killer.

The event is organized by Ian Smith, who launched the "50 Million Pound Challenge" in 2007. If you don't watch VH1's "Celebrity Fit Club" or read diet books, you may not recognize "Dr. Ian," as his fans know him. (I'd never heard of him until a colleague mentioned his name.) But among African Americans, the slim, Dartmouth-educated physician is well-known for creating a national organization that has confronted their health problems and enlisted tens of thousands in a bid to lose weight. The group has since branched out and is trying to appeal to all races.

"Listen, the swine flu isn't going to kill a tenth of the people that obesity kills on an annual basis," Smith said in an interview. "This is one of the biggest health concerns for America, and we can't get people to talk about it. . . . The sense of urgency isn't there."

One of the walk sites is in Alexandria, where Mayor William D. Euille will lead a team of about 150 people for a 1.5-mile walk. Over the past four years, Euille, an African American, has lost 60 pounds from his 5-foot-9 frame and kept it off.

"I got tired of hearing and reading and seeing obese kids and watching primarily African Americans suffer diabetes and high blood pressure," he said. "My role, being African American, and being leader of this city, [is that] I'm the best person to deliver that message.

"No more excuses," Euille said. "It is as simple as just walking."

Or is it? Here is where experts disagree, and close examination of cultural and environmental factors makes solutions more elusive than they first appear.

Yes, obesity is a problem for all races and ethnic groups in this country and, generally speaking, affects people of all income levels. But higher proportions of the poor, minorities and the less educated tend to be obese, research shows.

Start with the traditional African American diet, Smith said, one rich in salty, fried food, a menu that has been handed down over generations. Add a greater acceptance of plus-size bodies by both African American men and women, along with some women's disdain for exercise, and the cultural factors are stacked against blacks, he said.

If you're poor, you may be sacrificing leisure time and exercise to make ends meet. Your grocery store may be stocked with cheaper, less healthful food. You probably have less access to fitness facilities, your neighborhood may not have sidewalks, and the local park may be the place where gangs hang out or drugs are sold, rather than a safe haven for an evening jog.

If you think this is a bunch of liberal excuses, you should know that it is supported by research. David Marquez, an assistant professor in the Department of Kinesiology at the University of Illinois at Chicago, who studies the physical activity levels of Hispanics, said in a CDC survey of more than 20,000 of them, many Hispanic women feel that working, caring for their families and running their homes leaves them no leisure time at all.

Older Latinas also suggest that the only appropriate exercise for women is walking or dancing, Marquez said. Which is why he is trying to launch programs that center on dance as the primary form of physical activity.

NiCole Keith, an associate professor of physiology at Indiana University-Purdue University Indianapolis, participated in one of the few studies of exercise that controlled for income. Researchers gave poor and moderate-income blacks equal access to fitness resources and -- surprise! -- they exercised at the same rates. Keith says poverty and environmental factors are unquestionably part of the equation.

"If you live in a dangerous area, you cannot get out and walk and run," she said. "If you say, 'You can walk on your lunch hour,' you're making the assumption that you have a job with a lunch hour. And you're assuming everybody can walk when many morbidly obese individuals simply cannot."

In recent years, Keith has had some success persuading Indianapolis principals to open school facilities after hours in inner-city neighborhoods so that adults and kids can exercise. She and colleagues have led videoconference exercise routines for people too infirm or too large to get outside for a walk. They also have tried adding exercise rooms to public housing projects. Urban planners are being educated on the importance of sidewalks. And the American College of Sports Medicine's Exercise Medicine Campaign calls on policymakers to require doctors to counsel patients on physical activity during primary care visits.

"If facilities are available and affordable or free, people will go," Keith said.

Comments: misfits@washpost.com.

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