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Vanderbilt research: Diet and exercise may not be the key to ending childhood obesity

Focusing on diet and exercise to curb childhood obesity may be counterproductive and lead to missing other root causes of becoming overweight, according to a newly released report from Vanderbilt University researchers.

“Reframing Childhood Obesity: Cultural Insights on Nutrition, Weight, and Food Systems,” from the Vanderbilt Cultural Contexts of Health and Wellbeing Initiative, finds that focusing on a child’s individual diet and exercise can unintentionally contribute to weight discrimination and feed into biases that being overweight is the result of a lack of self-discipline or a moral failing.  

“We should understand that eating is about more than nutrition: cultural values, historical legacies, personal tastes and financial constraints frame our food choices,” said Ted Fischer, Cornelius Vanderbilt Professor of Anthropology, professor of health policy and one of the report’s co-authors.  

An emerging consensus in the field of obesity research points to the need to look beyond individual food choices to address cultural, commercial and structural factors that influence weight, the report states. Using examples from around the world, the report offers policy recommendations for the United States to shift the country’s mentality toward acknowledging that food does more than just provide nutrition. The report suggests programs should take into account cultural contexts connected to eating and include the idea of changing food systems in any obesity-related interventions. 

“For too long we have ignored or underestimated the ways our broader culture can contribute to childhood obesity,” said Jamie Bussel, senior program officer at the Robert Wood Johnson Foundation, which funded the production of the new report.  

The World Health Organization estimates that 39 million children under the age of 5 were overweight or obese in 2020. Among people ages 5 to 19, more than 340 million fell into the category in 2016 worldwide—an 18 percent global increase since 1975 in the number of children who are obese. 

Efforts to combat this epidemic have largely focused on diet and exercise, but Vanderbilt’s research suggests that these approaches miss the structural causes of obesity. 

Fischer, along with co-authors Tatiana Paz Lemus, Alexandra Reichert, Mikayla Alsopp and T.S. Harvey, argues in the report that health is about more than weight and that shaming a person about body mass index is ineffective as a public health tool.  

“We need to fight against weight discrimination and create programs that focus on food systems and cultural preferences, and not just individual diet,” said Paz Lemus, co-author and program manager of the project. 

Addressing widespread weight discrimination and the limitations of BMI as a diagnostic measure, the report adopts a justice framework in which all body types are seen as deserving of health and health care. While certain types of fat are associated with risk for type 2 diabetes, overall weight stigma felt by children results in poor health outcomes and lasting psychological trauma.  

“Many other nations have worked to recognize the impacts of food cultures or shift away from a strict diagnostic focus on weight,” Bussel said. “Their efforts must inspire us to reimagine how we talk about and address obesity in the U.S., and more thoughtfully take cultural contexts into account as we work to help every child grow up healthy.” 

The researchers point to Brazil as one model with innovative dietary guidelines based around social values as well as nutrient balances. Brazil’s guidelines follow 10 broad principles that focus on the cultural and commercial aspects of food and eating, depicting plates with food regularly eaten by all social classes. The country’s federal and local laws treat large body size as a category of discrimination and provide public funds for accessibility barriers. 

The report shows that what one eats is about more than individual choice: corporate-driven global food systems are built upon colonial legacies of inequality and continue to supply the market with cheap, convenient and hyper-palatable ultra-processed products that replace local foods and culturally grounded eating practices. The report maps the biological, cultural and commercial systems that frame childhood nutrition and looks to Indigenous foodways for a model to understand the relationships among culture, agriculture, nourishment and well-being. 

The research was developed in collaboration with the World Health Organization/ Europe’s Behavioral and Cultural Insights Unit. It was funded by Robert Wood Johnson Foundation as part of a three-year project with the World Health Organization to develop a model for health care that considers cultural attitudes and practices that affect health in the United States. This project extends a WHO effort already underway in Europe. Fischer, an expert in understandings of well-being across cultures, has consulted with WHO-Europe’s project for the past six years.