Cultural Perceptions of a Healthy Diet and Healthy Weight Among Rural Appalachian Youth
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CULTURAL PERCEPTIONS OF A HEALTHY DIET AND HEALTHY WEIGHT AMONG RURAL APPALACHIAN YOUTH DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Kelli J. Williams, MA ***** The Ohio State University 2006 Dissertation Committee: Approved by Professor Robert Lawson, Co-Advisor ______________________________ Professor Christopher Taylor, Co-Advisor ______________________________ Professor Kay Wolf Advisors College of Education ABSTRACT Youth in rural Appalachia are at a disproportionately greater risk for obesity and related health complications than the general population. Inadequate physical activity and poor dietary habits are two primary causes of obesity in West Virginia adolescents. To design and implement regional nutrition interventions combating overweight, adolescent perceptions of a healthy diet and healthy weight needed to be identified in rural Appalachia. Adolescents were recruited in four West Virginia schools from ninth grade health and physical education classes. Sixteen rural Appalachian adolescents, ranging in age from 14-18 years participated in the study. Focus group interviews were conducted with West Virginia adolescents and their caregivers. Grounded theory was used to develop questions addressing specific domains of interest. Verbatim transcripts were analyzed to assess cultural perceptions of a healthy diet and healthy weight. Participants defined healthy diets through statements relating to federal and professional dietary recommendations, including an increased intake of vegetables and fruits while consuming diets low in fat. Specific foods were commonly described to be either healthy or unhealthy. Vegetables and fruits were cited most often as healthy foods, while snack foods, soda, chips, and pizza were not considered to be part of a healthy diet. Portion control and eating three meals daily were also discussed as ii healthy diet components. Knowledge was often attributed to teachings in health classes, through the media, and from family members with chronic diseases. However, knowledge of and adherence to popular fad diets contradicted some of these perceptions, and a number of students reported never considering whether or not foods were healthy prior to consumption. Additionally, many teens had unrealistic and unhealthy perceptions of weight. Female participants were more concerned with weight than males, but both expressed a social stigma associated with overweight. Many perceptions of healthy weight and appropriate body size were shaped by the media and entertainment industry. Additionally, some participants admitted to performing unsafe practices to reduce body mass, such as very low calorie diets or fasting. Identifying perceptions will provide valuable formative data to develop targeted nutrition education and health promotion programming. iii DEDICATION To Mike: Life’s journey is sweeter because of my traveling companion. And to Mallie and Evan, our precious gifts: You can achieve anything; believe it, and follow your dreams. iv ACKNOWLEDGMENTS I have been profoundly affected by this experience. When it began, I could not have imagined the impact it would have on my life or the chaos it would cause. It has been a long road, and so many have offered support, encouragement, and expertise. I am grateful to all of you, but some warrant special mention. Foremost, I am thankful to those students throughout West Virginia who were willing to share their stories, experiences, and insights. Without you, the study would not have been possible. To my co-advisor, Dr. Chris Taylor, words cannot adequately express my appreciation. You took me under your wing, and navigated me expertly through the research process. Thank you for your constant encouragement and for understanding my need to balance professional and family commitments. You are an asset to our profession, and someone I am honored to call friend. I look forward to working with you in the years to come. To my other co-advisor, Dr. Robert Lawson, I offer my gratitude. You were willing to work with me under somewhat unconventional circumstances. Thank you for taking a chance on me; I hope you were not disappointed. I am also grateful to Drs. Kay Wolf and Richard Crespo. Your collaboration on this project from its inception to completion was remarkable. Additionally, I would like v to thank Paula Fields for her tireless commitment. I certainly could not have done it without all of you! Several exceptional educators have touched my life throughout the years; they taught me to push myself, think creatively, write well, and pursue my dreams. You may not be aware of it, but you assisted me in reaching this milestone. Thank you to Dr. Sue Linnenkohl, John Miller, Delma McComis, and Bette Fisher. I am blessed to be surrounded by extraordinary family and friends, and to each of you, I am grateful. Few are so lucky to have such a strong support system. Chris and Anna Beth, thank you for welcoming me in your home during my many visits to Columbus; you certainly made the travel less painful. My dear friends Mary Kathryn and Vanessa also deserve recognition for regularly lending sympathetic ears, even when they did not have the time or energy. Finally, I am most indebted to my family. So many of you altered your lives to assist me in pursuing this dream; I would not have achieved it without you. Coming from a family of educators, I was taught early the importance of formal learning and a sense of respect for those who dedicate their lives to it. I have learned from all of you who taught before me, and I hope that I can inspire my students as you have me. To my parents and grandmother, I cannot begin to thank you for your help and encouragement throughout the years. So much of who and what I am can be attributed to you. Most recently, you have kept my children, traveled to Columbus, and done anything else I have needed, often before I even asked. Also, my in-laws, Larry and Sally, have helped so much; a special thanks to them as well. vi My beautiful children, Mallie and Evan, do not yet realize what they have given up to support Mommy’s educational endeavors. For the playtime lost, the nights I was not there to tuck you in, and the extra hours in childcare, I apologize. I promise to make it up to you! Lastly and most importantly, I owe my heartfelt gratitude to my husband, who has sacrificed more than anyone during my pursuit of this degree. Mike, you are my strongest advocate and dearest friend. Thank you for enduring and embracing the craziness that has consumed my life over the past several years. This accomplishment would not have been possible without your constant love and encouragement. You are a rare jewel; it is a privilege to share my life with you! vii VITA May 5, 1973 ...................................................Born – Muncie, IN 1995................................................................BS Dietetics, Lipscomb University 1995 - 1996 ....................................................Dietetic Internship, Marshall University 1997................................................................MA, Family and Consumer Sciences, Marshall University 1998 – Present ................................................Assistant Professor of Dietetics, Marshall University FIELD OF STUDY Major Field: Education viii TABLE OF CONTENTS Page Abstract ............................................................................................................................... ii Dedication .......................................................................................................................... iv Acknowledgments................................................................................................................v Vita ................................................................................................................................... viii List of Tables .................................................................................................................... xii List of Figures .................................................................................................................. xiii Chapters: 1. Introduction ........................................................................................................1 Background of the Problem .........................................................................1 Significance of the Problem .........................................................................2 Objectives ....................................................................................................4 Research Approach ......................................................................................4 Definitions....................................................................................................5 Abbreviations ...............................................................................................6 2. Review of Literature ..........................................................................................8 Adult Overweight and Obesity ....................................................................9 Definitions of Overweight and Obesity ...........................................9 Etiology ..........................................................................................10 Prevalence and Significance ..........................................................14 Health Consequences of Obesity ...................................................14