Cultural Humility Considerations in Health Outreach to Address Obesity and Overweight

Community health educators and outreach staff play an important role in helping to tackle the current obesity and overweight epidemic in the United States. The intention of this article is to provide an introduction on how cultural humility practices can assist outreach staff in accomplishing respectful and effective outreach focused on obesity and overweight prevention, management, and treatment.

The United States is experiencing skyrocketing rates of obesity and overweight; alarmingly, roughly one-third of U.S. adults are obese while approximately 12.5 million children between the ages of 2 and 19 are obese. Dire health consequences correlated with obesity and overweight are also on the rise, including Type 2 diabetes, coronary artery disease, hypertension, and stroke.[i]

A person becomes obese or overweight when he or she consumes more calories than their body uses. Many factors can contribute to obesity and overweight that extend beyond behavior, including genetics, environment, culture, metabolism, and socio-economic status.[ii] It may require a tactful approach to address issues of culture, environment, and socio-economic status to a vulnerable priority population. For example, you may be teaching a lesson about healthy eating to a person whose sole priority is simply to provide food of any kind for their family.  This example illustrates a family’s food insecurity, meaning they may not have the privilege of choosing a mix of quality and healthy food options. 

Here’s another example: an educator must conduct outreach to an overweight immigrant family who prefers to eat high-fat and calorie-dense foods.  Though unhealthy, these meals provide a sense joy and satisfaction that enable people to maintain a connection with their county of origin or family abroad.  As a health educator or outreach worker, you may not always know the entire story behind someone’s struggle with achieving a healthy weight. It is critical to pay attention to the complex and diverse factors that may contribute to someone’s weight status, especially during first-time exchanges and interactions with community members.

Because initial encounters with your outreach target population can lay the foundation for developing trust, respect, and effective communication, it is critical that educators and outreach staff develop the skills necessary to create opportunities for open, honest, and nonjudgmental dialogue. While it can prove challenging to even broker a dialogue about a person’s diet or exercise regimen, family history with obesity/overweight, and financial situation, it is not an insurmountable task.  Outreach workers and health educators can engage in respectful and meaningful health education and promotional activities that improve the knowledge and skills necessary to prevent, manage, or treat obesity and overweight. One primary way to accomplish this goal is to practice cultural humility.

Cultural humility is a life-long commitment to self-reflection for the purpose of developing respectful relationships with diverse individuals, groups, and communities; in other words, you must understand yourself so you can acknowledge and appreciate differences in others. Cultural humility requires you to adhere to specific values, including:

• Openness to new people and new situations
• Appreciation of others and their differences and/or similarities
• Acceptance of the unfamiliar and the unknown  
• Flexibility to adapt to new ways of thinking

These values can help you navigate education and outreach encounters with diverse populations that have differing needs for preventing, managing, and treating obesity and overweight. The truth is that we cannot know everything there is to know about another person and/or community and the challenges with their weight status; as educators we need to be comfortable with the unknown.  For example, you may not know exactly why a person is opposed to exerting any physical activity; perhaps it is due to safety concerns, gender roles, family dynamics, or pure exhaustion from a long day at work. The important thing for you to remember is to withhold assumptions or judgments. Instead, seize the chance to ask questions, listen, empathize, and attempt to understand a person’s situation.

Once you are invited to learn about other’s situations and experiences, reflect on the values, beliefs, and feelings you experience as the conversation flows. This self-reflection process can keep unintentional judgments away and enable you to effectively connect with community members in respectful and meaningful ways. There may be occasions when you do not fully understand why people are engaging in a particular behavior that is detrimental to their health. That is okay; simply by being aware of these feelings, you are more likely to let go of these biases, listen, and appreciate the differences you may encounter.

By practicing cultural humility, outreach staff and educators can enhance the quality of their interactions and connections with priority populations.  Cultural humility is an ongoing process; it takes time, patience, and perseverance to develop cultural understanding.  It is important to remember that adapting to different viewpoints starts with flexibility and self-reflection. To assist you in engaging in self-reflection for practicing cultural humility, consider the following reflection questions:

1. What is my attitude towards those who are similar to me?
2. What is my attitude towards those who are different from me?
3. To what degree does my non-verbal behavior indicate a willingness to work with those around me, particularly those who are different from me?
4. What attitudes am I expressing in my nonverbal behavior?
5. What attitudes am I expressing in my verbal behavior?
6. To what degree does my nonverbal behavior reinforce my internal attitudes?
7. How might I be more effectively present to those around me?
8. How do I show others that I am listening?
9. Am I reflecting on what I am being told in conversations with others?
10. Do I ask questions when I don’t understand what others are saying?
11. What is something I learned about or from someone who is different from me?
12. What am I doing today that will help me better communicate with and help others?
13. What/who am I avoiding or resisting and why?
14. What is my next step towards understanding those who are different from me?

Health Outreach Partners encourages outreach staff to consider practicing cultural humility to improve the quality of obesity and overweight education, management, and prevention efforts. For more information and resources on practicing cultural humility, please contact Health Outreach Partners.