Lately I have been consumed with ideas around knowing and not knowing, particularly with regard to health issues such as obesity. I think I always assumed that someone knew if their child was overweight or obese. But research shows that knowing whether or not your child is overweight or obese is not that simple, in particular for immigrants to this country. In this article, UCSF's Linda Rosas (2010) and her colleagues decided to assess the maternal weight perception of mothers in Mexican immigrant communities in California against those of mothers in high emigration areas of Mexico. Basically, the researchers wanted to see whether these mothers could identify the ideal size (not weight) of a child as well as whether they could identify the accurate size of their own child. And so the researchers showed them the Collins Scale . . .
I had this study in mind when I read a short article by Katherine Hobson (2014) on WFYI's Sound Medicine website that synthesized data from a CDC report that came out in this summer. In the report, the CDC shows that 30% of kids in America misperceive their weight. 76% of the kids who were designated as overweight thought they were "about right" and 42% of those who were obese though they were "about right." Sound Medicine doesn't indicate which percentage of participants in the CDC study were Latino/a, but does mention that boys, younger children, and poor children were more likely to misperceive their weight.
There's so much to unpack here. First, the model itself:
- I realize that these figures are based on representations of BMI, but when looking at the scale, I wasn't sure where I fit, either. Female body image in the US is a tricky thing. The scale doesn't account for muscle definition, and some folks just aren't as well-balanced as the Collins figures. So I conducted my own little study using my partner (dangerous, I know). I chose my Collins image, and then asked him to as well, without sharing my answer. We were pretty much spot on, within .25 of each other. So knowing is possible, but it took a long time for me to decide on a figure.
- There's something about moving to the United States that makes people think that they (or their children) are of a more ideal size than they actually are. In both Rosas and the CDC study we can see that even when kids are overweight, both kids and parents consistently rate kids as ideal- or average-sized. This is despite the fact that folks in the United States know what an ideal-sized person looks like. This has huge implications for my work in campaigns, as both articles recommend positively framed education as a way to change childhood eating and exercise behaviors as opposed to fat-shaming negative frames.
These articles introduce some of the ways in which ideas of knowing and not knowing need to be navigated in order to create successful anti-obesity campaigns. Throughout this blog, I will continue to address issues of obesity, particularly amongst children and particularly in immigrant communities where issues of language and culture intersect with health practices.
Hobson, Katherine. "Many Kids Who Are Obese Or Overweight Don't Know It."Sound Medicine. N.p., 23 July 2014. Web. 29 Aug. 2014. <http://soundmedicine.org/post/many-kids-who-are-obese-or-overweight-dont-know-it>.
Rosas, Lisa G., Kim G. Harley, Sylvia Guendelman, Lia Ch Fernald, Fabiola Mejia, and Brenda Eskenazi. "Maternal perception of child weight among Mexicans in California and Mexico." Maternal and Child Health Journal 14.6 (2010): 886-894. Print.
What an interesting perspective Jill! I have never thought of obesity as a ‘knowing or not knowing’ issue. With a background in nutrition science and a passion for issues affecting children, I am intrigued by this approach to raising awareness. Living in the United States where over 1/3 of the population is obese/overweight can only complicate the process of ‘knowing or not knowing.’ Would you know that you were overweight if you grew up in a household of overweight individuals? Would you know your weight was a health risk if the majority of people in your community were overweight, even your doctors? This approach may be beneficial as a obesity awareness campaign. If people don’t know, then they can’t or don’t know to change. However, if they knew individuals could be more likely to change.
ReplyDeletevery interesting post Jill and lots of insights. Well, how would the study fare with South Asians; say Indians like me and how would it compare with the South east Asians. Further, what is the normative body size in these countries. When I read your post and the study and Collins scale, I went back to my rural forays in India. Sharing a thought:- When you travel in rural India, in villages, you chance upon a lot of bare bodied men, bare waist up and you see many sculpted bodies (how I earn for one!!). And then you realize that each of them is a farmer or a field hand and is either walking or on a bullock cart or on a bicycle pedaling away. But in urban India, it will be hard to find such figures..but each community must have its perception of what is ideal. Further, if you compare south Indian population, with North Indian population, "ideal" "attractive" bodies' definitions undergo a huge change. And then you bring up the point of being an immigrant in this country and if it has a measurable effect!! This is so interesting particularly in anti-obesity campaigns....
ReplyDeleteI thought that this study was very insightful and showed one of the big problems that we have when dealing with obesity. Over the past few years, there has been an increasing interest in obesity, body image, etc. in young adults and teenagers. As Hannah mentioned above, would a person even know if they are overweight or obese if all of the people they have grown up around are the same way? Perception is everything in this case. It really goes to show that although some of us think that we can clearly see when a person is overweight, we could be very far off. Obviously, in different cultures there are different perceptions of what the "ideal" body image is. It is even more interesting that the study showed the difference in those perceptions when Latino people came to the United States. By knowing that these perceptions can be far from what we consider "normal", I am sure it would help in identifying more effective obesity campaigns.
ReplyDeleteLala, I considered doing my next post on international definitions of obesity, particularly with reference to the relativity you mention above. But both the CDC and WHO have definitions that include similar BMI standards (>30) and a consideration of other health factors related to fat accumulation (i.e., does excess fat put the individual at risk for obesity-related diseases) that I find satisfactory. I think it's important to distinguish ideal from actual predictors of health. While in rural India we see little occurrence of overweight or obesity, the obesity in urban areas causes unsatisfactory health outcomes regardless of its relationship to rural areas. And correlations between increase in overweight and increase in health outcomes don't change depending on perception.
ReplyDeleteI think what I mean to say here is, we have discrete issues of image (what Shelby mentions above) and health. It's important to not let image override our ability to gauge healthiness, just as it's important not to let our gauging of healthiness (or lack thereof) affect the way we see (and treat) people.
That is precisely what I am aiming to problematize Jill! Who are we to gauge healthiness of communities with our fancy BMI calculations? And what about these standards? Who establishes them? Do they change across time? Is Obesity a social construction mostly invented in the west? Going further, is the meaning of health a social construction? So, in light of this, how do we practice evidence based health?
ReplyDeleteThe social construction of "health" is exactly what I was trying to get at a couple of weeks ago in class when I questioned who we are as academics, public health workers, or westerners to decide that religious perspectives that disallow concern around death and dying are somehow backward. As a critical practitioner, a large part of me is still uncomfortable with telling other people what they need or how they should go about obtaining it. But if someone knows they have disease or illness (dialectally if they know they they are NOT healthy - do not have the absence of disease), they need to have tools for change. One could argue - and I guess I'm arguing - that a lexicon that describes certain diseases or illnesses is necessary to engage in discourse about these diseases or illnesses. If a man in Mumbai is very very heavy, has hypertension and Type II Diabetes, AND wants help ameliorating these diseases, "treating" each of these individually might not be as effective as treating what is assumed to be the root cause of these discrete conditions. The root cause, one could argue, would be excess body weight, or obesity.
ReplyDeleteHonestly I think in the US a lot of times it comes down to "the children." This is why we want scientologists and other westerners to accept western medicine. In the United States there is often a lassie-faire approach to decision-making in adults, i.e. "they can do what they want as long as it's not harming me," but once the health and well-being of children are affected, we are all up in arms.
This is one of the main reasons I've chosen to focus on messages about food habits and eating as opposed to simply "you should lose weight." I'm not incensed that someone would want to remain living with critical health risks, but I AM incensed that the messages people receive about food are often conflicting and often driven by government programs (MyPlate, etc.) that are highly industry-influenced or by industry itself. Take, for example, the newest academic/scientific research out about weight loss: http://www.nytimes.com/2014/09/02/health/low-carb-vs-low-fat-diet.html?_r=0 Basically it states that people who eat high protein diets lose more weight. It's all the rage in the media - the newest knowledge we have about weight loss. But the other day it was "eat breakfast." What the heck is a person who wants to eat better supposed to do when the information is always changing? Either the messages need to be tamed or folks need to be taught to suss out the garbage.
With regard to BMI, I agree completely that it's a western numerical scale that situationally could or could not be effective. I am comfortable using this, however, as my own reference, although I don't believe the absence or presence of these numbers in one's medical chart is enough to necessitate behavior change (not to mention that there are hormonal, evolutionary, economic, and other forces at play in discourses of obesity). What strikes me, and I will offer an oft-quoted article as a reference, is that many, many people would like to complain about BMI and its failings, but I have yet to see even a suggestion for an alternative. In fact, this linked editorial is titled "Why the Body Mass Index Is Pretty Stupid" but offers behavioral, and not theoretical, reasonings for why it is "stupid." The author also offers no alternative. http://www.huffingtonpost.ca/yoni-freedhoff/weight-loss_b_871494.html
*Sigh.* Maybe I will have to come up with the alternative. So much for my career in social scientific, and not critical, research.
This is a very interesting post! In school, we learn that most diseases are either caused or exacerbated by being overweight or obese. The first non-pharmacologic treatment is always to lose weight. However, it is not always so easy to simply tell our patients to lose weight. Some may even be offended because they think that they are not overweight at all! They think that because everyone else looks the same as them, they are normal. Women especially are offended by the mention of being overweight, because they think it is simply society telling them they are ugly. As a healthcare practitioner, I do not care what society says is beautiful. I simply care about how healthy my patients are.
ReplyDeleteMarcel, there's such a huge tension between body image and health. I'm looking forward to investigating this further as I continue my studies. One of the first steps, as the article suggests, might be to frame messages in a way that encourages healthy eating rather than shames people for being overweight. One thing we do know is that shaming has the opposite effects. I really appreciate having your more clinical perspectives in class - they are so valuable.
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