Influence of Race, Ethnicity, and Culture on Childhood Obesity: Implications for Prevention and Treatment

Obesity may be thought of as a body weight that conveys significant risk for adverse health outcomes. In children, obesity is defined as a BMI at or above the 95th percentile for age and sex, based on population data from the 1970s (1,2). The prevalence of obesity has increased markedly in U.S. children and adolescents in the past 30 years. Obesityrelated risk factors and diseases formerly seen only in adults are increasingly being recognized in obese adolescents and even younger children. Race and ethnicity are terms used to categorize populations on the basis of shared characteristics. Race has traditionally been used to categorize populations on the basis of shared biological characteristics such as genes, skin color, and other observable features. Ethnicity is used to categorize on the basis of cultural characteristics such as shared language, ancestry, religious traditions, dietary preferences, and history. Although ethnic groups can share a range of phenotypic characteristics due to their shared ancestry, the term is typically used to highlight cultural and social characteristics instead of biological ones (3). Both race and ethnicity are, in fact, social constructs. The assumption that race reflects only biological distinctions is inaccurate. Categories based on race account for only 3–7% of total human genetic diversity, are not reliably measured, and are not always biologically meaningful (3,4). Furthermore, both race and ethnicity are constantly evolving concepts, making the task of comparing groups or following the same group over time quite challenging. For instance, the increasing proportion of the U.S. population describing their race as “mixed” or “other,” as well as changes in ethnic self-identification across generations and occasionally even within the same generation, makes it difficult to assign individuals to invariant categories of race or ethnicity. Nevertheless, the social importance given to these constructs to describe groups that have been treated in similar ways based on presumed biological characteristics, as well as the acknowledgment that such classifications themselves have contributed to inequalities in health and health care access, necessitates that we continue to use the terms race and ethnicity. Although childhood obesity is increasing in all ethnic and racial groups, its prevalence is higher in nonwhite populations. The reasons for the differences in prevalence of childhood obesity among groups are complex, likely involving genetics, physiology, culture, socioeconomic status (SES), environment, and interactions among these variables as well as others not fully recognized. Understanding the influence of these variables on the patterns of eating and physical activity that lead to obesity will be critical to developing public policies and effective clinical interventions to prevent and treat childhood obesity. To address the evidence base and gaps in knowledge in this area, Shaping America’s Health and the Obesity Society convened a consensus development conference on 9–11 April 2008. Following presentations by invited speakers and in-depth discussions, a seven-member panel of experts in pediatric endocrinology, cardiology, gastroenterology, nutrition, epidemiology, and anthropology developed this consensus statement on the influence of race, ethnicity, and culture on childhood obesity, addressing the following questions: