June 14, 2017

Shiriki Kumanyika, PhD, MPH, joined the Dornsife School faculty as a research professor in the fall of 2015, following her retirement from the University of Pennsylvania where she retains an appointment as an Emeritus professor of Epidemiology. Kumanyika “retired” into a new position determined to lead and nurture the African American Collaborative Obesity Research Network (AACORN), which she founded in 2002. AACORN has its national office at the Dornsife School. The network seeks to advance the health of US black communities through research and research translation on nutrition, physical activity, and body weight. Kumanyika says she created AACORN by accident, when she found herself mentoring African American scholars who felt like they were the only ones concerned about certain issues, and didn’t have a lot of support in their institutions. “I gathered together 10 people – all who happened to be African American and all women – and said, ‘You could benefit from talking to each other as much as talking to me individually,’” she recalls. “The next thing I knew we had a network.”

Q. Why are obesity issues in the African American community different from obesity generally? 

SK: Obesity issues have been relatively more important for black communities since before we had an epidemic, before [obesity] got to be a subject everybody was thinking about. And that’s when I became interested in the issue. When someone made the observation that obesity was more prevalent [among African Americans] but that it was difficult to talk about because it was politically sensitive – I thought, ‘This must be what I’m supposed to be doing with my life because as a black woman, I can address the issue without being accused of stereotyping or having the wrong view’ – so I was an ‘insider’ for the issue. 

I discovered that black women were not the only ethnic minority population that had an obesity problem … it was every other minority group. So it really became interesting from an epidemiologic point of view: what is it that these population groups have in common, given how different they are? Obviously what comes to mind is that they’re all minorities, so it’s more of a socio-political issue. It’s not that they are all from the same gene pool, it’s that they are all living in circumstances of social disadvantage based on their ethnicity. 

I had been in the cardiovascular epidemiology area, but here was a problem that I – with a background in nutrition – could really focus on. So AACORN grew out of something I had already taken on as my life’s work. 

Q. Calling someone “fat” is a negative, but in the African American community being “thick” is okay and in Hispanic culture, the fat baby is the healthy baby. 

SK: Attitudes associated with body attractiveness, or a certain weight level, have cultural roots in all countries and cultures – in relation to fertility, and also as evidence that you have enough food and you’re well taken care of … You can find it in all cultures. The ‘You can never be too rich or too thin’ type of philosophy kicks in as societies become more affluent. … While poor people can get food, it may not be the healthiest food – but lots of calories available, cheap. 

Q. Why were you inspired – and driven – to keep the network going after you retired? 

SK: AACORN was created to bring scholars together and to make a difference on the obesity problem. I had no choice but to continue, because the work is just not finished – in fact it probably has become harder. That’s how I came [to Drexel]. It changed my idea of what retirement meant because I realized that you cannot retire from a mission that you’ve set – especially when … people are still depending on you to keep it going. 

Q. What has AACORN accomplished? 

SK: We set a research agenda based on where we wanted to look at the issues that were most important for addressing the higher rates of obesity in black Americans. Next, we brought together a diverse group of people to decide what had to be done differently, to be true to our sense that as insiders we could bring a special lens to the problem. … We eventually invited other members, whohave a special commitment to working on African American weight issues but are not African Americans. And we have community research partners committed to working with researchers on these issues. We’re not just academics talking about people and communities; we regularly hear from people outside of academic institutions. 

We then developed what we called the AACORN Expanded Research Paradigm. The principle of that paradigm is to turn the issue inside out, to stop looking at people through the lens of the problem – as people who failed to achieve calorie balance – and look at calorie balance as something that people were needing to achieve in a much broader life and social context. We created this paradigm in which social, historical context, psychosocial, collective identity, collective trauma and then the physical and economic environments are considered … and asked, ‘Given the environments people are trying to navigate, where do food, weight, physical activity and nutrition issues fit into people’s lives?’ That paradigm has guided my own work and the work of a lot of members who’ve used it to design studies, or explain why issues should be approached in a different way. … It’s becoming more mainstream now, with the recognition that obesity is not something you can solve by just telling people they should eat less and be more active. 

Q. How does AACORN’s work fit into the broad, national concern about obesity?

SK: When the obesity epidemic was recognized in other countries and the U.S. it changed the whole conversation about what the causes were. 

When the whole population including children began to gain weight it forced people to say, well this can’t be a treatment failure – and I think that’s a big part of the paradigm shift toward the environmental approach to the problem. Because when you have minorities and lower income people who are heavier, people can assume that it is deviant behavior … but it’s very different when the deviant behavior becomes dominant behavior. 

The paradigm put the focus back on the people and their environments – intra-personal and community. The widening obesity epidemic made that a more plausible argument for the mainstream. And then the problem became for AACORN – are we going to get left behind? 

Because now, people in the majority community are fighting for their children not to be obese, affected by diabetes and other problems... So AACORN’s focus has changed somewhat, to making sure that the solutions being applied for the general population reach populations of color, reach black America … and have the desired effect – or even a greater effect, because we’re already behind, so just doing it equally doesn’t cut it. You have to do it better. 

When I say the job has gotten harder – it’s partly gotten harder because you could have black communities being the receivers of the things that are pushed out of other communities. We could become the customer base for soft drink companies, when they are rejected by those who have more means and are more enlightened about health issues and have more choices and less dependency. … I don’t know the extent to which black communities are less enlightened about the issues – or if it’s just they have fewer choices, or if the companies are so much better at convincing them ‘We are really your best friends.’ 

Q. So what’s your take on the Philadelphia soda tax? 

SK: I’m for it. I think that it works, and is consistent with ethical principles on how you approach these sorts of widespread problems. [Soda] is a product that is nutritionally expendable, that affects weight, and – very important in terms of policy design – the tax can be used to bring revenue into communities that need it. 

That’s critical, because we are competing with companies that create deep loyalty with money … so the government has to show it has some interest in the resources available in the community [like funding pre-kindergarten]. It’s a tricky argument, but you are telling us to give up something – when we like these products, and we can also get scholarships for our children – and (health advocates) are not offering anything of that type. 

Q. So food and beverage marketing is part of the challenge? 

SK: The marketing environment is a big issue that hasn’t yet gotten into public health science. AACORN has created a body of evidence that helps with the understanding of consumer issues around food and black Americans – including a brief on sugar sweetened beverages. 

We’ve done a campaign to look at how youth consumers view messaging and the relationship between their own behavior and how companies market products. There really was almost no information in the marketing literature about black Americans as consumers – the literature is about black Americans as patients. 

And we’ve done a peer reviewed supplement, a special issue in the 2014 Obesity Reviews on what works in weight control in black communities. 

Q. What’s your long range goal – and how do you envision achieving it? 

SK: My long range goal is to see a sustainable effort that will ensure that there is a focus on research on health issues in black communities. … We have a traveling exhibit, and on the last panel we say that we have a vision that black people could be exemplars of good health. … Why not dream? Not just to catch up, not just to even things out – but to become exemplars? That’s the vision that I have. I hope when I step away another group of people committed to that vision will carry on.