Читать книгу Clinical Obesity in Adults and Children - Группа авторов - Страница 42

Dimensions of national culture have also been explored in relation to obesity. The most frequently used metric has been the Geert Hofstede dimensions: power distance, individualism, masculinity, uncertainty avoidance, long‐term orientation, and indulgence. Of these, individualism is the most consistently significant dimension, with countries ranking high on individualism having the highest prevalence of obesity [94]. This observation lends support to the idea that putting the onus on individuals to prevent obesity is unlikely to be successful and may simply result in stigmatization, anxiety, and low self‐esteem for individuals experiencing obesity.

Body size perceptions and preferences also play a role [95–98]. For example, several studies support the idea that Latina mothers prefer a heavier child body size – it is considered healthier, cuter, resilient to illness, and a sign of good parenting compared to a leaner child body size [99–102]. In sub‐Saharan Africa, large body sizes are preferred because they are associated with beauty, health, and social status [96,103–108]. This preference for large body sizes is even more vital in places where AIDS is prevalent because being thin is considered a sign of HIV [105,106,109].

Racial and ethnic disparities in obesity persist in the United States, where Blacks and Hispanics are disproportionately affected [4]. Many studies have explored the underlying drivers of these observations and have found that differences in known obesity risk factors explain a small proportion (less than one‐fifth) of these disparities [110]. For example, while poverty plays an underlying role in obesity disparities, income does not explain all of the observed differences [111]. Food environments may partly explain some of the differences. In particular, having limited access to grocery stores (e.g. food deserts) and high levels of unhealthy food outlets like fast‐food restaurants (e.g. food swamps). For example, one analysis of BRFSS found that 14% of the gap in mean age‐adjusted adult obesity prevalence between counties with large black populations and those with small black populations could be explained by disparities in the food environment [112]. Neighborhood walkability has also been identified as a significant driver [113]. However, in all of these studies, a sizable proportion of the disparities could not be explained, suggesting there is still much to be done in terms of research to understand – and intervene to reduce – racial and ethnic disparities in obesity in the United States.