Uneven playing field

In a nation of plenty, kids still suffer from malnutrition

Compared to white Americans, African-Americans are more likely to die from heart disease. Hispanic-Americans have higher rates of diabetes. But the explanation of such disparities is not just that certain races are genetically predisposed to disease. Nutritious food and exercise—and access to each—play a role in the unequal health of Americans.

Nutritious food and exercise—and access to each—play a role in the unequal health of Americans. © Jules Frazier/Photodisc

Nutrition researchers took up the discussion of “Health Disparities and Nutrition: From Research to Action” at the Gershoff Symposium hosted this spring by the Friedman School of Nutrition Science and Policy. The annual conference is held in honor of Dean Emeritus Stanley N. Gershoff, the founding dean of the school.

Dr. Deborah Frank, director of the Grow Clinic for Children at Boston Medical Center, presented one of the most painful examples of such disparity: children from low-income homes who are undernourished. She works with children who have significant problems keeping pace with weight or height gain when compared to other children their age.

As American as Coke
Often the problem is not one of neglect. “Most American families stand on their heads so their children do not feel hungry,” she said. Many cheap foods that will keep a child’s stomach full don’t necessarily provide the nutrients they need to grow their bodies and develop their brains. She recalled a baby fed cornstarch and water who “never cried from hunger, but he was malnourished.” She described immigrants who think the way to be American is to feed their children Coca-Cola.

She touched on the paradox that a country in the midst of an obesity epidemic can also struggle with undernourished children.

“You can clearly tie food insecurity to obesity,” she said. “Being thin and stunted as a young child can predispose you to being fat later.”

Not so much advice
One disparity may begin in the doctor’s office, where minorities receive different advice on diet and exercise than their white counterparts, according to a study by Nasar Ahmed, N92, chair and associate professor of epidemiology and biostatistics at Florida International University.

He found that patients whose doctors advise them to exercise are much more likely to exercise regularly than those who received no such recommendations.

Yet compared to the white patients in his study, he said, the black patients were 27 percent less likely to receive advice on exercise, and the Hispanic patients were 25 percent less likely to receive advice on diet.

The neighborhoods people live in can also affect what foods they buy and how much physical activity they get, said Dr. Deborah Cohen, a senior natural scientist at the RAND Corp. In a study she conducted on adolescent girls, she found that girls who had parks in their neighborhood clocked more physical activity. Other studies have shown that grocery stores in lower-income neighborhoods have a higher proportion of shelf space devoted to junk food and soda.

She advocated solutions to the obesity epidemic that would address the entire population, not just those who are overweight.

“Treating all persons equally will bring a small benefit to the average person, but a large benefit to those who are most at risk,” she said.

Julie Flaherty is a senior health sciences writer in Tufts’ Office of Publications. She can be reached at julie.flaherty@tufts.edu.