The Need

In the U.S., an astounding two-thirds of the population is overweight. Obesity is closely tied to ethnicity and socioeconomic status. African Americans are 51 percent more likely to be obese than White Americans. Hispanics are 21 percent more likely. Obesity and its complications are killing African Americans and Hispanics disproportionately. The Office on Minority Health reports:

• African American women have the highest prevalence of overweight (78 percent) and obesity (59 percent) compared to other adult ethnic populations.
• Twenty-three percent of African American girls and 20 percent of African American boys are overweight.
• In 2008, 21 percent of American Indian or Alaska Native children were obese.  In that same year, 19 percent of Hispanic children were obese.

Geography, income and ethnicity are all interrelated factors in the obesity epidemic. Low-income neighborhoods abound with fast food restaurants and corner stores that stock mostly canned and prepackaged foods, creating an unhealthy alliance. Unsafe streets make for difficult walking or jogging. In addition, there are a myriad of cultural and ethnic issues to consider when developing mobile solutions that will make a difference in the lives of low-income and low-literacy audiences.

Cultural and Ethnic Considerations

Obesity is deeply rooted in African American culture and growing rapidly in Hispanic and other cultures. Access to food, sedentary lifestyles and the socio-economic constraints and obstacles that impact low-income people are part of the problem. There are also cultural and ethnic considerations that affect how people adapt and respond to nutrition and fitness information.

To improve health and increase longevity in these populations, we must encourage lifestyle and behavioral changes, but also stay mindful of the cultural and socio-economic implications of the recommended solutions. Cheese-laden Mexican dishes and deep-fried American Indian and African American foods are just a few diet items that contribute to the prevalence of obesity in ethnic Americans. Buying healthier (low-fat, high-fiber and low-sodium) foods can be costly. Furthermore, many people believe that healthier choices tend to be bland and uninspired, and that preparation is difficult. Perceptions and misperceptions regarding cost, taste and preparation of food must be addressed.

Modifying culturally-related thinking and eating patterns will be a challenge. Research has shown that there are many variables to consider when discussing cultural and ethnic issues.  For example, there are many reasons why women of color are heavier than Whites, such as increased stress, discrimination and other factors linked to race and culture. The prevalence and acceptance of overweight in the Black community has been well-documented. A shift in thinking as it relates to weight issues in African American, Hispanic and other ethnic communities will require a delicate balancing act to avoid stigmatizing or weakening self-esteem in populations who already face daily acts of prejudice and discrimination.

Food Deserts

In addition to the cultural issues surrounding overweight and obesity, we need to examine the problem of access to fresh food. Many low-income communities cannot find fresh fruit, vegetables or whole grains nearby and have become known as food deserts. Convenience and liquor stores with limited or no fresh meat and produce abound in low-income neighborhoods. Less healthy (and often more expensive) canned and prepackaged foods are the norm in local corner stores. Fast food restaurants, as opposed to healthier eating establishments, dominate these communities.

A study by the Center for Food and Justice at the Urban and Environmental Policy Institute found that middle- and upper-income communities in Los Angeles County have twice as many supermarkets (with healthy food choices) per capita as low-income communities. The same study found that predominantly White communities have three times the supermarkets of predominantly Black communities, and nearly twice those of predominantly Latino communities. Populations of poor tend to have the worst access to supermarkets as shown by this map of food desert areas in Washington from ArcGIS. The orange dots in tan areas are concentrations of people below the poverty level living outside easy walking or driving distance from supermarkets.

Interactive Food Desert Map

Further compounding the lack of healthy food options in low-income, ethnic areas is the lack of exercise options. Parks, low-cost or free indoor exercise/sports facilities, inexpensive fitness classes and even safe streets to jog or walk on may be limited in these neighborhoods.

Civic Engagement

Low-income individuals and groups should be able to influence healthy change in their communities and schools, as well as in their personal lives and homes. A number of nonprofits are currently focusing on education, advocacy and policy work to make more healthy eating options available in public schools, stores and restaurants in low-income areas. Other community groups and individuals are encouraging more farmer’s markets, co-ops and community gardens in these neighborhoods, but more action is needed. Successful apps might help individuals find and join civic action activities and have their own voices heard.

Apps Out There

Increasing numbers of mobile health applications are available for a variety of functions, including medication and appointment reminders, data collection for clinical trials, monitoring of specific health measures such as blood pressure, heart rate and blood glucose monitoring, communication with health professionals, and resources for specific diseases. Many of the monitoring program register personal health data and transmit it back to health providers who then review the data.

Trim the Fat is looking specifically for apps that are patient-centered and that do not need the interpretation or participation of a health professional.  These applications will provide valuable information directly to the user.

We found some interesting recent reviews of diet/nutrition apps at CorePerformance, USPharmD and TheMedifastPlan. Our review of the reviews, found a lot of helpful apps out there for gym users, diet plan fans, athletes, vegans, yogis, bikers, hikers, the general population and even pets! However, we found no apps specifically targeting the diet and exercise needs of low-income ethnic populations.  Foundation HealthCare Network’s Restaurant Nutrition does provide nutrition information for fast food eateries.  And several apps were recommended by BlackVoices, including Lose it!, Google’s Calorie Counter, and Livestrong.com’s Calorie Tracker. Even these recommendations made no specific reference to the cultural and ethnic issues discussed above.

A similar situation exists for exercise apps, where many products are available, but none appear to address specific ethnic or income issues.  For examples, see LifeHacker and this article.

Although it does not focus on ethnic or low-income users, a good example of a creative mobile application that addresses several of the other desired features mentioned above is the mobile game OrderUP! Developed by researchers at the School of Interactive Computing and the School of Literature, Communication and Culture at Georgia Institute of Technology, the game shows promise for changing the eating behaviors of players.

Apps That Should Be

According to American Medical News, there is enormous potential for growth in the development and use of health apps. The opportunities to address the special concerns of low-income ethnic populations are currently being missed. Successful apps might:

• Provide culturally sensitive nutrition education for low-income consumers of all ages in urban and rural areas, including information on food selection, nutrition content, healthy recipes
• Provide information on the location/availability of nutritious food sources (retail outlets, markets, restaurants, etc.)
• Educate residents of low-income communities on the importance of exercise in relationship to weight and health and help them to educate others
• Offer easy and inexpensive localized exercise options
• Provide ways for individuals to measure improvements in diet and weight
• Encourage/enable small grocery store owners in low-income neighborhoods to include more nutritious choices in their inventory using mobile coupons and other techniques
• Encourage the establishment of large groceries stores with healthy food options in low-income neighborhoods
• Promote success of farmers markets and community gardens
• Encourage the presence of more exercise options in low-income communities (parks, community centers, etc.) and educate community members on their existence and use
• Educate people in ways to become more engaged in making healthy changes in their communities and schools
• Provide tools for health professionals to improve nutrition and lower weight in their low-income patients
• Influence legislation for healthier nutrition and exercise options in low-income schools and homes
• Offer ways to celebrate, or provide rewards for better health

References

ArcGIS, Supermarket Access Map, 2009
Belluck, Pam, Obesity Rates Hit Plateau in U.S., Data Suggest, New York Times, January 14, 2010
Centers for Disease Control and Prevention, Trends in Childhood Obesity
Centers for Disease Control and Prevention, U.S. Obesity Trends – Race
Centers for Disease Control and Prevention, Obesity Prevalence Among Low-Income, Preschool-Aged Children, 1998-2008
Center for Food and Justice at the Urban and Environmental Policy Institute, Healthy Foods, Strong Communities
Dolan, Pamela Lewis, http://www.ama-assn.org/amednews/m/2010/11/08/bl21108.htm, amednews.com, Nov. 8, 2010.
Food Environment Atlas
Andrea Grimes, Vasudhara Kantroo & Rebecca E. Grinter, Let’s Play! Mobile Health Games for Adult