Addressing Structural Racism,
Bias, and Health Communication as
Foundational Drivers of Obesity
PROCEEDINGS OF A WORKSHOP SERIES
Emily A. Callahan, Rapporteur
Roundtable on Obesity Solutions
Food and Nutrition Board
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This workshop was supported in part by the Academy of Nutrition and Dietetics; Alliance for a Healthier Generation; American Academy of Pediatrics; American Cancer Society; American College of Sports Medicine; American Council on Exercise; American Society for Nutrition; Blue Shield of California Foundation; General Mills, Inc.; Intermountain Healthcare; The JPB Foundation; The Kresge Foundation; Mars, Inc.; National Recreation and Park Association; Nemours Children’s Health; Novo Nordisk; Obesity Action Coalition; The Obesity Society; Partnership for a Healthier America; Reinvestment Fund; Robert Wood Johnson Foundation; SHAPE America; Society of Behavioral Medicine; Stop & Shop; Wake Forest Baptist Medical Center; Walmart; WW International; and YMCA. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-27599-6
International Standard Book Number-10: 0-309-27599-7
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Addressing structural racism, bias, and health communication as foundational drivers of obesity: Proceedings of a workshop series. Washington, DC: The National Academies Press. https://doi.org/10.17226/26437.
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PLANNING COMMITTEE ON ADDRESSING STRUCTUAL RACISM, BIAS, AND HEALTH COMMUNICATION AS FOUNDATIONAL DRIVERS OF OBESITY1
ANGELA M. ODOMS-YOUNG (Co-chair), Associate Professor and Director, Food and Nutrition Education in Communities Program and New York State Expanded Food and Nutrition Education Program, Cornell University
NICOLAAS (NICO) PRONK (Co-chair), President, HealthPartners Institute; Chief Science Officer, HealthPartners, Inc.
JAMY D. ARD, Professor, Department of Epidemiology and Prevention and Department of Medicine, Wake Forest School of Medicine; Co-director, Atrium Health Wake Forest Baptist Weight Management Center
CAROL BYRD-BREDBENNER, Distinguished Professor of Nutritional Sciences and Director, Graduate Program in Nutritional Sciences, Department of Nutritional Sciences, Rutgers University
CARLOS J. CRESPO, Professor, Oregon Health and Science University and Portland State University School of Public Health; Vice Provost, Portland State University
STEPHANIE A. NAVARRO SILVERA, Professor, College of Education and Human Services, Department of Public Health, Montclair State University
MELISSA A. SIMON, Vice Chair for Research, Department of Obstetrics and Gynecology; Director, Center for Health Equity Transformation at the Institute for Public Health and Medicine; and George H. Gardner Professor of Clinical Gynecology, Feinberg School of Medicine, Northwestern University
SUSAN Z. YANVOSKI, Co-director, Office of Obesity Research and Senior Scientific Advisor for Clinical Obesity Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
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1 National Academies of Sciences, Engineering, and Medicine planning committees are solely responsible for organizing the workshop series, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
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ROUNDTABLE ON OBESITY SOLUTIONS2
NICOLAAS (NICO) PRONK (Chair), HealthPartners Institute and HealthPartners, Inc., Bloomington, Minnesota
CHRISTINA ECONOMOS (Vice Chair), Tufts University, Boston, Massachusetts
IHUOMA ENELI (Vice Chair), American Academy of Pediatrics, Columbus, Ohio
SHARON ADAMS-TAYLOR, The School Superintendents Association, Alexandria, Virginia
KATIE ADAMSON, YMCA of the USA, Washington, DC
JAMY D. ARD, Wake Forest University, Winston-Salem, North Carolina
HEIDI MICHELS BLANCK, Centers for Disease Control and Prevention, Atlanta, Georgia
JEANNE BLANKENSHIP, Academy of Nutrition and Dietetics, Washington, DC
DON W. BRADLEY, Duke University, Durham, North Carolina
JAMIE BUSSEL, Robert Wood Johnson Foundation, Princeton, New Jersey
MICHELLE I. CARDEL, WW International, Gainesville, Florida
DEBBIE I. CHANG, Blue Shield of California Foundation, San Francisco, California
JENNIFER FASSBENDER, Reinvestment Fund, Philadelphia, Pennsylvania
AMENDA FISHER, Walmart, Bentonville, Arkansas
TODD GALATI, American Council on Exercise, San Diego, California
ALLISON GERTEL-ROSENBERG, Nemours Children’s Health System, Washington, DC
MARJORIE A. INNOCENT, National Association for the Advancement of Colored People, Baltimore, Maryland
JOHN JAKICIC, University of Pittsburgh, Pittsburgh, Pennsylvania
ELIZABETH A. JOY, Intermountain Healthcare, Salt Lake City, Utah
SCOTT I. KAHAN, The George Washington University, Washington, DC
PETER T. KATZMARZYK, Pennington Biomedical Research Center, Baton Rouge, Louisiana
CATHERINE KWIK-URIBE, Mars, Inc., Germantown, Maryland
THEODORE KYLE, The Obesity Society, Pittsburgh, Pennsylvania
LISEL LOY, Bipartisan Policy Center, Washington, DC
MONICA V. LUPI, The Kresge Foundation, Troy, Michigan
KELLIE MAY, National Recreation and Park Association, Ashburn, Virginia
___________________
2 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
STACY MOLANDER, Partnership for a Healthier America, Washington, DC
MYETA M. MOON, United Way Worldwide, Alexandria, Virginia
STEPHANIE A. MORRIS, SHAPE America, Reston, Virginia
JOSEPH NADGLOWSKI, JR, Obesity Action Coalition, Tampa, Florida
MELISSA NAPOLITANO, The George Washington University, Washington, DC
PATRICIA NECE, Obesity Action Coalition
MEGAN NECHANICKY, General Mills, Inc., Minneapolis, Minnesota
COURTNEY P. PAOLICELLI, Food and Nutrition Service, U.S. Department of Agriculture, Alexandria, Virginia
BARBARA PICOWER, The JPB Foundation, New York, New York
LESLIE PLATT ZOLOV, Novo Nordisk, Plainsboro, New Jersey
SUE P. POLIS, National League of Cities, Washington, DC
AMELIE G. RAMIREZ, Salud America!, San Antonio, Texas
GORDON REID, Stop & Shop, Gordon, Massachusetts
SYLVIA ROWE, SR Strategy, LLC, Washington, DC
LAURIE STRADLEY, Alliance for a Healthier Generation, Asheville, North Carolina
KRISTEN R. SULLIVAN, American Cancer Society, Decatur, Georgia
SUSAN Z. YANOVSKI, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
Health and Medicine Division Staff
HEATHER DEL VALLE COOK, Roundtable Director
MARIAH BRUNS, Senior Program Assistant (starting January 2022)
ZARIA FYFFE, Senior Program Assistant (through July 2021)
CYPRESS LYNX, Research Associate
AMANDA NGUYEN, Program Officer
ANN L. YAKTINE, Food and Nutrition Board Director
MEREDITH YOUNG, Research Associate (through January 2022)
Consultant
WILLIAM (BILL) H. DIETZ, The George Washington University, Washington, DC
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
KIMBERLY GUDZUNE, The Johns Hopkins University
PETER KATZMARZYK, Pennington Biomedical Research Center
STEPHANIE A. NAVARRO SILVERA, Montclair State University
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings, nor did they see the final draft before its release. The review of this proceedings was overseen by MARIAN NEUHOUSER, Fred Hutchinson Cancer Research Center. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. We also thank staff member CONNIE CITRO for reading and providing helpful comments on this manuscript. Responsibility for the final content rests entirely with the rapporteur and the National Academies.
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Contents
Organization of This Proceedings
3 THE INTERSECTION OF STRUCTURAL RACISM AND OBESITY
Housing Discrimination and Disparities
Education, Segregation, and Structural Inequality
4 THE INTERSECTION OF BIASED MENTAL MODELS, STIGMA, WEIGHT BIAS, AND OBESITY
Obesity Stigma at Work: Improving Inclusion and Productivity
6 OPERATIONALIZING HEALTH COMMUNICATION FOR OBESITY SOLUTIONS
What Is Meant by Health Communication?
7 DATA-DRIVEN OBESITY SOLUTIONS AND INNOVATIVE APPROACHES
Innovation in Education: Physical Activity across the Curriculum
A Perspective from the Intertribal Agriculture Council
A Perspective on Innovative Local Government Approaches
9 REFLECTIONS ON EQUITY-CENTERED APPROACHES TO REDUCING THE PREVALENCE OF OBESITY
Reflections on Equity-Centered Approaches to Reducing the Prevalence of Obesity
10 LEVERAGING DATA FOR SYSTEMS CHANGE: CONNECTING OBESITY AND ITS UNDERLYING DETERMINANTS
Mortality Consequences of the U.S. Obesogenic Environment
11 SYSTEMS APPLICATIONS TO ADDRESS STRUCTURAL BARRIERS TO OBESITY SOLUTIONS
A Structural Approach to Population Health Equity
Structural Solutions for Obesity: Addressing Implicit Bias and Stereotype Threat
12 POLICY SOLUTIONS FOR NUTRITION SECURITY AND OBESITY
USDA Priorities for Improving Nutrition Security
Salud America!: Fueling Advocacy for Systems and Policy Change for Latinx Health Equity
13 A MULTISECTOR CONVERSATION ON SYSTEMS-LEVELS CHANGES FOR OBESITY SOLUTIONS
Panel Discussion with Members of the Roundtable on Obesity Solutions
Closing Remarks for Workshop Day One
14 PATIENT–PROVIDER COMMUNICATION AROUND OBESITY TREATMENT AND SOLUTIONS
The Ethical Dilemma of Implementing Recommendations
The Effect of Obesity on Patient–Provider Communication
Identifying Gaps and Next Steps (Panel and Audience Discussion)
C BIOGRAPHICAL SKETCHES OF WORKSHOP SPEAKERS AND PLANNING COMMITTEE MEMBERS
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Box and Figures
BOX
1-1 Workshop Series Statement of Task
FIGURES
1-1 Causal systems map of obesity drivers and solutions
2-1 A cliff analogy to illustrate four types of health support strategies
2-2 A cliff analogy to illustrate three explanations for the existence of health disparities
3-1 Racial/ethnic inequities in SARS-CoV-2 exposure and COVID-19 morbidity and mortality
7-1 Theoretical model for improving health and academic achievement