by Dr. Jenifer Matthews, a pediatrician at the Teen Clinic at the Children’s Hospital Oakland and a core organizer with Phat Beets Produce.

As a pediatrician, I often find myself discussing weight with my patients and their families. What an important, sensitive subject. Health reasons aside, there is so much pressure to look a certain way, dress a certain way, and of course be a certain weight. I often think about how hard it must be for my patients to come in to talk about their weight – a subject they spend most of their time trying to avoid.  And, they must really have a “problem” if they are in the doctor’s office having to talk about it!  When we are able to get past the formalities, some of the real difficulties are brought to light: teasing, name calling, feelings of guilt about eating the foods that other kids can eat. There is a whispered criticism in our society – to be overweight must be a reflection of some sort of lack of self-control or laziness.  But these are not insignificant messages. These are messages that are shaping kids images of themselves.

When I was a training physician, I counseled my patients on how to “eat better and exercise”. We would spend a good portion of our time together talking about eating more fruits and vegetables, cutting out soda, with the plan to follow up in a month or two to check on their progress. And, guess what? Most of the time, when my patients returned for a follow up, they were heavier.

I started to wonder, what’s going on? I knew my patients were probably dreading their appointments.  I was frustrated, they were frustrated. There were tears, and more guilt. This was not the type of relationship I wanted to have with my families. I began to really think about it. Why were most of my patients still gaining weight? Why were more of my kids heavier even after all of their efforts?

This led me to an even bigger and more complex question.  Why are we struggling with an obesity epidemic? So I started reading more about the subject, and listening to the people who are directly involved with the problem – my patients. Here is what I have figured out so far:

Food we shouldn’t be eating on a regular basis has been normalized!
We have gotten so far away from basic, simple whole foods. While at the grocery store recently, I saw a snickers bar that was advertised to glow in the dark. What, you ask? How is that even possible? What kind of chemicals does it contain? Or perhaps more importantly, why is that possible? Heavily processed foods are everywhere and heavily marketed to our kids. Just spend a Saturday morning watching cartoons with your kids. How can they resist the bombardment of cool ads for sugary cereals, sizzling hot chips, and high-fructose sweetened beverages?

Good food is seen as being more expensive, and for a lot of families, money is a major barrier to eating healthy.
I surveyed a group of my families in clinic and cost was the number one barrier they identified to being able to eat more fruits and vegetables. Organic, fresh produce can be more expensive depending on where you get it, but this does not have to be the case.

Social stratification and poverty lead to an inequitable food system.
Ask yourself, what does my neighborhood look like and how does this affect what I eat?
Think about where you live and where you shop for food.
Think about how your neighborhood affects how you view yourself, how you feel society views your worth.  How does that compare to the other people that live in Oakland? Try this exercise. Imagine yourself as someone who lives in East Oakland. Now put yourself in the shoes of someone who lives in the Oakland Hills, Fruitvale, or Berkeley, near the campus. All of these environments co-exist in the same vicinity, yet depending on where you live, the sources of food are drastically different. And where you can get your food, in the short term, affects what goes into your body, and in the long term affects your weight and overall health status.

Our lower-income neighborhoods, practically devoid of supermarkets, are flush with liquor stores and fast food outlets providing processed foods with long shelf-life and high caloric value, but minimal nutritional value.   Residents in lower-income neighborhoods often rely on public transportation, making it difficult to purchase and transport large quantities of groceries.

Why are supermarkets missing from low-income neighborhoods? Research has shown that the spending power of residents in low-income areas is perceived to be low. There are higher rates of insurance for business owners as areas have perceived or higher rates of crime. And partially due to the historical practice of red-lining, access to financing in these areas proves to be challenging. This often translates to residents shopping at corner convenience stores which typically sell nutritionally lacking foods.

So now what?

As a health provider, I believe that talking about weight and exercise with my families is critical, albeit a potentially difficult discussion to have. But, perhaps, even more importantly, as a community we need to engage in even more difficult dialogue about the root causes of obesity and how we can continue to make positive changes for our children.

A movement is growing.  A collective voice is calling out for change – asking for some water for our food deserts.  Let’s make sure that those voices are heard.

Also posted at The Street Beet Blog.