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

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

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
Digital Object Identifier: https://doi.org/10.17226/26437

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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.

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

___________________

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:

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

1 INTRODUCTION

Introductory Remarks

Organization of This Proceedings

2 AN INTRODUCTION TO THE INTERSECTION OF STRUCTURAL RACISM, BIASED MENTAL MODELS, STIGMA, WEIGHT BIAS, AND EFFECTIVE HEALTH COMMUNICATION WITH OBESITY SOLUTIONS

3 THE INTERSECTION OF STRUCTURAL RACISM AND OBESITY

Housing Discrimination and Disparities

Education, Segregation, and Structural Inequality

Panel and Audience Discussion

4 THE INTERSECTION OF BIASED MENTAL MODELS, STIGMA, WEIGHT BIAS, AND OBESITY

Obesity Stigma at Work: Improving Inclusion and Productivity

Health Care Systems Perspectives

Panel and Audience Discussion

5 REFLECTIONS ON THE INTERSECTIONS OF STRUCTURAL RACISM, BIASED MENTAL MODELS, STIGMA, AND WEIGHT BIAS WITH OBESITY

Reflections

Panel and Audience Discussion

6 OPERATIONALIZING HEALTH COMMUNICATION FOR OBESITY SOLUTIONS

What Is Meant by Health Communication?

Audience Discussion

7 DATA-DRIVEN OBESITY SOLUTIONS AND INNOVATIVE APPROACHES

Innovation in Education: Physical Activity across the Curriculum

Innovation in Health Care: Using Data to Guide Personalized, Evidence-Based Care for Obesity Using a Clinical Decision Support System

Panel and Audience Discussion

8 INNOVATIVE POLICY SOLUTIONS

A Perspective from the Intertribal Agriculture Council

A Perspective on Innovative Local Government Approaches

Panel and Audience Discussion

9 REFLECTIONS ON EQUITY-CENTERED APPROACHES TO REDUCING THE PREVALENCE OF OBESITY

Reflections on Equity-Centered Approaches to Reducing the Prevalence of Obesity

Panel Discussion

10 LEVERAGING DATA FOR SYSTEMS CHANGE: CONNECTING OBESITY AND ITS UNDERLYING DETERMINANTS

How Data Science, Artificial Intelligence, and Other Technological Approaches Can Help Address the Systems Contributing to Obesity

Mortality Consequences of the U.S. Obesogenic Environment

Panel and Audience Discussion

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

Panel and Audience Discussion

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

Panel and Audience Discussion

13 A MULTISECTOR CONVERSATION ON SYSTEMS-LEVELS CHANGES FOR OBESITY SOLUTIONS

Opening Reflections

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

Audience Discussion

The Effect of Obesity on Patient–Provider Communication

Audience Discussion

Underutilization of Bariatric Surgery: Health Insurance Design, Weight Stigma, and Patient–Provider Communication

Audience Discussion

Identifying Gaps and Next Steps (Panel and Audience Discussion)

REFERENCES

APPENDIXES

A WORKSHOP AGENDAS

B ACRONYMS AND ABBREVIATIONS

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

1-2 Aggregation of Meadows’ system leverage points into four broad types of system characteristics that interventions can target

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

9-1 Fundamental drivers of health inequity

9-2 Interrelationships among core components of sustainable systems-wide strategies for reducing the prevalence of obesity

10-1 Death rates from cardiometabolic diseases in midlife relative to the rates in 1990

10-2 Recent trends in cardiometabolic disease mortality, U.S. and peer country averages

11-1 Well Being in the Nation (WIN) Network’s theory of change

11-2 Pathways to Population Health Equity framework