Cultural Issues of Obesity, Food and Nutrition
11 September, 2006
Conference Examines Cultural Issues Relating to Obesity, Food and Nutrition
In the face of the rising obesity epidemic, it is becoming increasingly important to recognise not only the varying cultural context of food and eating, but also the need to culturally tailor programmes aimed at changing dietary behaviours.
The New Zealand Dietetic Association (NZDA) conference, which begins today, hosts a range of esteemed international and local speakers who are experts in the field of the cultural diversity of dietetics and nutrition.
It is frequently reported that the obesity epidemic is a growing concern for many developed countries, particularly in the United States. Keynote speaker Dr Shiriki Kumanyika will present findings on the dietary factors that are involved in the development of obesity in both adults and children belonging to minority groups. Dr Kumanyika’s primary research focus is obesity, both treatment and prevention, in African Americans.
Dr Kumanyika is involved in various studies that are related to the behavioural and environmental strategies that can be employed to reduce obesity and related diseases in minority communities.
On a local level, New Zealand is also faced with a growing number of obese adults and children. Dr Paparangi Reid, Tumuaki (Maori Dean) in the Faculty of Medical and Health Sciences for the University of Auckland, is an expert in public health issues amongst Maori, and will discuss the practical approaches that can be taken when working with the obesity problem within this population.
Whether suffering from obesity or not, weight management is important to all of us. Joining these keynote speakers is Dr Rick Kausman, who is considered the Australian pioneer in regard to the non-diet approach to weight management. Dr Kausman will share his key approaches to developing a positive self-image for individuals wanting to lose weight, looking at what each person can do to take responsibility for their own weight loss.
The NZDA conference ‘Dietetic Worlds: Infusing Cultural Diversity with Practice’ is being held at Te Papa on September 11 – 13. It provides dietitians with the knowledge and skills to provide nutrition advice and guidance to the culturally diverse aspects of New Zealand.
Note: Key conference speakers’ biographies and abstracts attached
About the NZDA
The New Zealand Dietetic Association, founded in 1943, is the professional Association for registered dietitians and associated professionals. New Zealand registered dietitians are registered by the Dietitians’ Board. Members of NZDA work within a professional code of ethics.
For more information visit: www.dietitians.org.nz
INFUSING CULTURAL DIVERSITY WITH PRACTICE
Key speakers bio notes and abstracts
Dr Shiriki Kumanyika, PhD, RD, MPH - Bio
Professor of Epidemiology at the University of Pennsylvania School of Medicine (Philadelphia), USA.
Dr Kumanyika has devoted a substantial part of her research efforts over the past 25 years to studying dietary change and weight management as strategies for control of chronic diseases. She has a special interest in culturally-adapted lifestyle change programmes for African Americans and, with a number of colleagues, has developed and tested several such programs in clinical and community settings.
Shiriki is the Associate Dean for Health Promotion and Disease Prevention at the University of Pennsylvania. There she leads a Center of Excellence that facilitates research on ways to reduce ethnic disparities in obesity and related health problems. Her primary research focus is obesity, both treatment and prevention, in African Americans. Professor Kumanyika chairs the Prevention Group of the International Obesity Task Force (IOTF), the policy and advocacy unit of the International Association for the Study of Obesity. Shiriki is also the Director of the Graduate Program in Public Health Studies at the University of Pennsylvania.
Shiriki is heavily involved in the SHARE study, which stands for ‘Supporting Healthy Activity and Eating Right Everyday’. SHARE is a weight management study designed to help African American men and women lose weight. The study looks at the role of social support, particularly from family members and friends, in helping with weight loss and related dietary and physical activity changes. SHARE does not involve taking any study medication.
In addition to the SHARE study, Dr. Kumanyika is currently involved in a study to prevent weight gain and increase physical activity in African American women, in collaboration with the Black Women's Health Imperative (a Washington, D.C. based organisation formerly known as the National Black Women's Health Project).
Dr Shiriki Kumanyika - Abstract
CULTURAL REALITIES OF OBESITY AND DIETARY
Shiriki Kumanyika, PhD, RD, MPH
University of Pennsylvania School of Medicine and Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania U.S.A.
The increasing prevalence of obesity in societies across the globe reminds us of the ongoing challenges involved in bridging concepts of nutrition and diet to the realities of psychological and social-ecological contexts of food acquisition and eating. Higher than average obesity prevalence in specific ethnic groups suggests culturally-determined risk pathways and the need for culturally-tailored interventions. In general, attitudes and behaviours related to body size and shape have long been understood as culturally defined. Body types that are considered undesirable are opposites from the current ideal, or marked deviations from the acceptable body size norms. The cultural context of food and eating is equally well-established. Types and amounts of food and beverages, flavours, textures, food combinations, and traditional uses and meanings of food mark differences among ethnic groups and societies, convey symbolic meanings, create social interactions, and define pleasure. Individual choice in food selection within a free-market system is also a typical cultural value. Furthermore, in every cultural tradition there are concepts of how food relates to health, which foods are harmful and which are protective. By contrast, “nutrition” and current dietary guidelines are based on scientific evidence about biochemical and physiological needs, processes, and harms in health and illness, and how these are influenced by the chemical properties of foods and beverages consumed. Unfortunately, concordance of nutritional principles and dietary guidelines with psychological and socio-cultural drivers of eating is co-incidental if present, and discordance is common, whereas concordance of food marketing (products, prices, placements, and promotion of foods) with these drivers is high. These realities should influence the design of obesity-related dietary change interventions. Cultural tailoring approaches designed to improve effectiveness of obesity prevention and treatment with ethnic groups cannot compensate for problems with the underlying paradigm.
Dr Rick Kausman - Bio
Award winning author of ‘If Not Dieting, Then What?’
Dr Rick Kausman is a medical doctor who is recognised as the Australian pioneer of the non-dieting approach to healthy weight management. Rick is the author of the award-winning book If Not Dieting, Then What? and is the creator of the healthy eating, healthy weight management web site: www.ifnotdieting.com
Rick has been the Chairperson of Body Image and Health Inc. for three years, and a board member for 12 years; he has been an Executive Council member of the Australasian Society for the Study of Overweight for nine years; and is currently a Board Member of the Butterfly Foundation, a Fellow of the Australian College of Psychological Medicine, and the Australian Medical Association spokesperson on eating behaviour and weight management.
Dr Rick Kausman - Abstract
If not dieting, then what?
There are many different factors that can contribute to any particular person becoming above his or her most healthy weight. The following points include some important strategies to focus and work on so we can help people to achieve and maintain the healthiest weight that is possible.
Achievable, sustainable behavioural
As with many areas of life, having the right goals is essential. If someone is over their most healthy, comfortable weight and one of their goals is to lose weight, it is important to focus on changes in behaviour, and allow the change in weight to come as a result of the behaviour change.
A positive attitude towards food
In spite of popular culture, there is no such thing as ‘good’ food or ‘bad’ food. People do need to know which foods are healthy to eat most of, but putting a moral tag on food, such as calling it ‘junk’ food, or ‘good’ food is of no benefit in developing a healthy eating pattern. We need to look at all food as being ‘morally neutral’.
We can all eat food when we aren’t really feeling physically hungry. This sort of eating can be called non-hungry eating. Non-hungry eating can include things like overeating, grazing, picking, nibbling and bingeing. It’s quite normal to do some non-hungry eating, but when we do too much it can get our eating pattern out of balance. Non-hungry eating is one of the most important factors that needs to be addressed when working on why someone might be having difficulty achieving and maintaining a comfortable weight. If a person is able to decrease the amount of eating they do when they aren’t really physically hungry, most people can still enjoy a wide range of foods of different tastes, textures, fat and sugar content and still reach and maintain a healthy, comfortable weight.
Being physically active
The importance of being active cannot be stressed too highly. Unfortunately, the word ‘exercise’ for many people has been associated with the ‘no pain, no gain’ philosophy. In other words, that is has to hurt to be worthwhile. This is not true. Whatever physical activity we can do is worthwhile.
To achieve our goals - be it to decrease our non-hungry eating, to increase our physical activity, or whatever we decide we would like to work on and change, we need to come from a position of being as self accepting as we can of our body and body image. This is even when we feel that our body is not at the size and shape it can be, and even when we are working on a long term plan to change.
Bob Anderson, PhD, FRACP, Ian Mackay Fellow - Bio
Founder of Australian and New Zealand Coeliac Research Fund; Founder and CSO/CMO NexpepLtd and Nexgrain Ltd.
Dr Bob Anderson was educated at Otago Boys High School, studied medicine and completed a PhD at Otago University before moving to Australia in 1992. He trained in gastroenterology at The Royal Melbourne Hospital where he is now a consultant and runs the Coeliac Clinic. During four years at Oxford University he discovered the components of gluten recognised by the immune system in coeliac disease.
Since returning to Melbourne in 2002 in his current position as Ian Mackay Fellow at the Walter and Eliza Hall Institute, the mapping of toxic gluten peptides has evolved to the design of a prototype vaccine, and modified non-toxic gluten proteins. Bob Anderson founded the Australian and New Zealand Coeliac Research Fund in 2003, and is Chief Scientist and Medical Officer for Nexpep Ltd.
Dr Bob Anderson - Abstract
Dietary management of coeliac disease, its changing culture
Coeliac disease affects 1% of most Caucasian, West Asian, and Middle Eastern communities. However, less than 1/5 of people fulfilling the classical diagnostic criteria for coeliac disease have been diagnosed in New Zealand and Australia, i.e. amongst the 35,000 New Zealanders likely to have coeliac disease no more than 5,000 are likely to have been diagnosed. Conversely, many more people have adopted gluten free diet than have coeliac disease.
Approaches to screening and diagnostic awareness of coeliac disease require review and substantial professional education is needed to “re-learn” coeliac disease to fully utilize emerging serological and genetic tests. Optimal management of coeliac disease is not the norm. There is increasing demand for dietitians specialised in the implementation of gluten free diet whether for coeliac disease or other “indications”. Awareness by dietitians of diverse indications for GF diet will allow the diet to be tailored to individual needs. Understanding the mechanism for gluten-induced toxicity in coeliac disease allows development of non-dietary therapies or adjuncts to diet. The molecular basis of coeliac disease involves two distinct but complementary effects of gluten on the immune system via gluten specific T-cells and the innate immune system.
Although coeliac disease can be diagnosed according to serological and intestinal histological response to gluten, and excluded if genes encoding HLA-DQ2 or DQ8 are absent, “atypical” coeliac disease or gluten sensitivity is being increasingly diagnosed. Caution is needed before imposing life-long gluten free diet for non-traditional indications when classical small intestinal pathology and/or transglutaminase [tTG] antibodies are absent. Dietitans need a clear understanding of the limitations of diagnostics to able to provide useful dietary advice and to avoid unnecessary imposition of gluten free diet.
Dr Patricia McVeagh - Bio
Consultant Paediatrician on the Visiting Medical Staff of Sydney Children’s Hospital, Randwick; and the Tresillian Family Care Centres.
Dr Patricia McVeagh is the Medical Coordinator of the Sydney Children’s Hospital Eating Disorder Unit. From 1998-2002, Dr McVeagh was the Community Representative appointed by the Commonwealth Government to the Advisory Panel on the Marketing in Australia of Infant Formula. She is the Royal Australasian College of Physicians representative on the Administrative Body for the Baby Friendly Hospital Initiative in New South Wales.
Patricia is also a co-author of books on children’s nutrition including, KIDS, FOOD, HEALTH, Volume One: The First Year, Volume Two: Toddlers and Preschoolers and Volume Three: School age and Adolescents. She writes children's health columns for popular magazines and for the website KIDSLIFE.
Dr Patricia McVeagh - Abstract
AND BENEFITS OF BREASTFEEDING
Dr Patricia McVeagh, The Paediatric Practice, Sydney Children’s Hospital, Randwick, Tresillian Family Care Centres
This presentation will review research from the last 18 months that explore the potential negative effects of electing not to breast feed. Because there persists in some quarters a view that the hazards of formula feeding are only relevant to developing countries, the presentation will focus on studies from developed countries and on hazards of relevance to children and their mothers in countries such as New Zealand and Australia.
Research in breast feeding will very rarely provide class I quality evidence. It is inappropriate to randomize infant mother dyads into breast feeding or formula groups, The demographics of those who elect to breast feed suggest that they are likely to be advantaged and to adopt other good health practices. Reverse causality may confound the results. The use of various and often lax definitions of breast feeding; contamination of groups by the occasional use of formula and the reliance in retrospective studies on recall for the age of introduction of other fluids or solids may affect results. Studying total populations may produce different results from studies of those at risk, eg in allergy or obesity and the outcome of interest may change with the duration of follow up. In long term studies, the artificial feed given to non breast fed infants may no longer be relevant today. Not allowing for the variability in human milk samples between individuals, during the feed and with time may lead to spurious results. For these reasons research on the hazards of not breast feeding are always likely to produce conflicting results and to be contestable.
Recent research has examined the effects of not breast feeding on conditions as diverse as bed wetting, celiac disease, schizophrenia, myopia, intimal thickening and premenopausal breast cancer in the child and C reactive protein (a marker of low grade inflammation associated with cardiovascular mortality) hypertension, type two diabetes, breast cancer gene expression and endometrial cancer in the mother. There is even work showing that human milk smells better to the neonate. However, this presentation will focus on areas where not breast feeding is likely to have the biggest impact on the health of our nations children; infections, allergy and obesity. Because it is topical we will also examine recent work on development and intelligence in the child.
Infection: Research published during this period has reinforced the importance of breast feeding in protecting infants and children in developed countries from infection. One study concluded that “After estimating the attributable risk, it was found that 30% of hospital admissions would have been avoided for each additional month of full breastfeeding. Seemingly, 100% of full breastfeeding among 4-month-old infants would avoid 56% of hospital admissions in infants who are younger than I year”. The mechanism of protection is being untangled and attempts to mimic a strand of this by adding individual components to commercial formula has met with mixed success. However recent research confirms that the integrated complexity of human milk interactions with potential pathogens is such that it will never be replicated.
Atopy: There were five studies published in this period involving 18,285 children examining different cohorts and with different outcome measurements of atopic dermatitis or asthma. Two did not show a protective effect and three showed a reduced the risk of atopic dermatitis and/or asthma in the breast fed group.
Overweight and Obesity: A meta analysis of 17 studies reported “One month of breastfeeding was associated with a 4% decrease in risk (OR=0.96/month of breastfeeding, 95% Cl: 0.94, 0.98). The definitions of overweight and age had no influence. These findings strongly support a dose-dependent association between longer duration of breastfeeding and decrease in risk of overweight”. Although one study did not show a difference in fat mass measured by DEXA at 5years of age, during this period seven new studies supported a protective effect of breast feeding on later overweight, although one suggested that it may be attenuated in adult life.
Development and Intelligence: New studies have shown small advantages in development to having been breast fed. This is particularly notable in smaller children. One study showing a positive correlation between breastfeeding and cognitive ability used sibling comparisons to reduce sample selection bias.
On balance, published research over the last 18 months has increased our knowledge of and confirmed the increased risks to children, even in developed countries, of not being breast fed. It behoves us all as health professionals to have the knowledge to support families in making informed choices and the skills to support them should they encounter difficulties in their breast feeding relationship.