You’ve Improved!

There was a time in my childhood when I had gained a bit of weight. Yesterday, browsing through the faded photographs, I tried to imagine how today’s American pediatricians might respond upon seeing my own heavier image as a child. Most would almost certainly find me overweight, perhaps counsel my parents about exercise and healthier eating. The way it was, my pediatrician back then – in mid-1970s Former Yugoslavia – playfully pinched my cheek and exclaimed, “You’ve improved!” She was not joking. She really meant I looked better, healthier.

I reveal this personal story to point out how our values about body image, including obesity, are socially defined. Throughout much of human history, and certainly still in many cultures and countries of the world today, being “over”weight is actually preferred to being skinny. Many people don’t view extra weight as a health concern – just the opposite! For example, in a place where hunger has been omnipresent in the recent past, a larger body may still be viewed as a sign of good health, good fortune, strength and attractiveness.

When it comes to body size, large or small, poverty has always been a defining factor. Historically, having a lower income often meant you suffered food deprivation and malnourishment. If you were poor throughout much of human history, chances are you were engaged in hard physical labor, all the while experiencing a shortage of food.

In recent times, a counterintuitive reversal of that historical pattern has occurred, particularly in societies such as ours where food has become plentiful and cheap. The “new” pattern is that poverty actually leads to obesity. Studies show that the likelihood of being overweight in the poorest 25% of the population is twice that of people in the wealthiest 25% of the population. Children living in poverty have limited access to healthy foods and greater exposure to high-calorie and fatty “junk” food. Supermarkets are scarce in poor areas and the gap is usually filled with fast food restaurants and convenience stores.

If I were poor, I might also have a harder time being physically active. I might not have discretionary income to join a health club. My neighborhood may not be safe or otherwise conducive to exercise, or I may have to hold two or even three low-wage jobs to support my family, leaving me with little or no leisure time. My child’s school may lack the necessary facilities and have fewer organized sports. Neighborhood safety issues might prevent students from walking or biking to school.

In sum, there are many social and economic conditions that play a defining role in children’s health, including childhood obesity.

Trying to change the behavior and choices at the level of an individual child and family is certainly necessary. However, solutions to such intractable socioeconomic problems as overweight in children must go beyond that. They must include interventions at the level of these same social and economic conditions that are the root causes of poor health.

Children’s healthcare organizations such as Children’s Hospitals and Clinics of Minnesota are uniquely positioned as leaders of multilevel changes necessary to achieve health in children. Our substantial clinical expertise is at its highest impact when it’s leveraged through community partnerships and positive influence on policy and systems change.

A creative recent example of community partnership that comes to mind is a small urban garden program that Children’s TAMS ran last summer.  Six young people worked with a Latino Health Educator to plan, plant, tend, harvest, cook and enjoy the fresh food that they grew themselves in a community garden plot in our neighborhood.  It engaged these youth in healthy physical activity and community connectedness, while teaching them life-long skills that promote healthy behavior.   The program was based on the innovative local Youth Farm and Market Project.

Boris Kalanj is the Director of Health Care Equity and Cultural Competence at Children’s Hospitals and Clinics of Minnesota. Read his bio.

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