Addressing Obesity in Diverse Communities: An Interview with Milagros C. Rosal
The Society of Behavioral Medicine’s (SBM) Obesity and Eating Disorders SIG recently interviewed Dr. Milagros C. Rosal, Tenured Professor of Medicine in the Division of Preventive & Behavioral Medicine at the University of Massachusetts Medical School (UMMS). Dr. Rosal is a clinical psychologist and nationally and internationally recognized expert in health equity interventions and community-engaged research to reduce health disparities among disadvantaged groups in the population.
OED SIG: What role does culture play in the incidence and prevalence of obesity?
Milagros Rosal: Everything we think and do is colored by culture, which includes inter-generationally transmitted values, expectations and behaviors as well as values, expectations and behaviors that we slowly adopt from exposure to new cultures through a process known as “acculturation.” Perhaps the role of culture is best illustrated by what happens when an individual from a foreign country immigrates to the United States. For example, Ayala and colleagues summarized evidence that as Latino individuals “acculturate” to mainstream American culture they are more likely to engage in less healthy dietary behaviors, including eating more fast food, snacks, added fats, sugar and sugar-sweetened beverages, and less likely to eat more traditional and healthier foods like fruit and beans, compared to less acculturated Latinos.
OED SIG: What are your suggestions for how we can better address obesity in low-income and minority populations?
Milagros Rosal: There are multi-level factors that contribute to the increasing obesity epidemic and these factors need to be taken into consideration in efforts to gain control over this complex problem of obesity. We need to consider from epigenetic factors to individual, family and school influences, to the social and physical environment in the communities we live, to policy. All levels of influence have aligned to create a “perfect storm”. Now, we are faced with the need to address these factors -singly and in a combined fashion- to fight obesity and optimize our health. In addition, because the impact of our approaches depends not only on their effectiveness but also on their potential reach, we need to consider new intervention models and vehicles to maximize the reach to populations in greatest need. There are resources that can be leveraged to engage large groups of individuals and stakeholders, including new technologies and social media platforms. Lastly, I think we need to learn more about the segment of the population that has not been impacted by the obesity epidemic, or at least not yet impacted. We need to understand how these individuals have managed to be resilient despite the multiple factors yielding the rest of the population in a different direction, toward overweight and obesity.
OED SIG: What are your recommendations for developing culturally tailored interventions?
Milagros Rosal: This is a very important question because there are misconceptions as to what makes an intervention culturally appropriate for a particular group. Existing data provides evidence that the greater the cultural tailoring of an intervention, the greater its effectiveness. Broadly speaking, when we talk about cultural tailoring we refer to ways of making an intervention meaningful to a group of individuals who share a common culture. There is general consensus that protocols to adapt or develop culturally tailored interventions should include input from individuals from the targeted cultural groups and sub-groups. Working in partnership with individuals from the targeted communities and including individuals from these communities within the research team are key. Formative qualitative research also is critical for developing and pre-testing intervention protocols for a particular population. In addition to providing in-depth knowledge of critical weight-related experiences, beliefs, behaviors, and needs and preferences of a target group, qualitative methodologies also allow for assessing the linguistic appropriateness of the intervention, its sensitivity to literacy needs, and its overall acceptability and appeal. Cognitive interviews with individuals from the targeted communities can help assess not only whether the forward translation maintains the meaning of the original intervention but also whether the translation is clear and culturally relevant to the targeted group.
OED SIG: What suggestions do you have for early career investigators in this area?
Milagros Rosal: I think that an important quality for early career investigators working in the field of obesity with diverse populations is to have cultural humility. As researchers in the field of health disparities we need to be aware of and curious about our personal pre-conceived ideas and biases about the problems and the health disparity populations we study. This is an ongoing process, not a single event. This awareness can facilitate an open and non-paternalistic approach with the communities whose health we intend to improve. Working collaboratively with community partners that can inform our work is critical, as is being aware of the power dynamics that can influence the effectiveness of our work and our ability to make an impact.