Urban schools and communities are obesogenic environments which challenge behavioral approaches to obesity reduction

Assessment of seven middle schools in metropolitan Detroit detected obesity rates among Latino children 1.5 times higher than expected. An environmental assessment of family, school, and social contexts was conducted in preparation for an intervention to reduce metabolic risk in severely obese children. The results of the environmental assessment are reported here. METHODS: Eating and physical activity ‘behavioral contexts' were explored in school, community, and family using focus group, survey, interview and participant observation methodologies. Forty-five adults and children discussed eating and physical activity norms in five focus groups. A survey of interpersonal and situational influences on food and activity behavior was completed by 80 parents and children. More than 25 school and community leaders were interviewed regarding existing resources and patterns of use. Finally, school and community activity settings were directly observed over the course of a year. ANALYSIS: Thematic analysis of notes and transcripts and descriptive statistical analysis of survey responses was performed. FINDINGS: School Environment: Kids commonly skip breakfast and/or lunch but have money to purchase competitive foods at school. Barriers to carrying lunch from home include embarrassment during lunch bag searches by school security guards when entering school and fear of being teased by peers during lunch for eating ‘different' foods. For those who do eat, time urgency is a problem. Street venders are ready to sell snacks to hungry kids after school. Community Environment: Eighty three, primarily convenience food outlets are available within one mile of school. Parents perceive the community as cohesive (80%) but dangerous (63%). Thirty-eight percent think school is unsafe. Parks are places for gang and drugs and violence in community recreation centers is real. Family/Social Environment: Eighty percent of families report three or more televisions and 42% of kids have their own television. Dinner is left on the stove in busy families and kids eat in front of the television. Kids can't identify exercise role models, sources of personal support, or where to go to be physically active. Twenty percent of parents are functionally illiterate in their dominant language. CONCLUSION: Obesogenic environments will extinguish any short term reduction in childhood obesity unless alternative “microclimates” are created where healthy eating and physical activity is modeled and reinforced.