Jeneane Hamideh, Sydney Y.K. Brown, Martha Romero, Kevin Lopez, Paola Hernandez, Vishal Rao, Sanam Ahadi, Laila Cross, Rutha Adhanom, Taylor Mitchell

THE BIG PICTURE

The prevalence of childhood obesity has escalated in the United States, and particularly in children of African American and Latinx descent (Ogden et al., 2022). Nationally, race, birthweight, parental smoking, and not having family meals have been linked with higher rates of obesity (Williams et al., 2018). South Los Angeles (LA) faces a particularly severe burden due to compounding socioeconomic and environmental factors. Communities such as Watts-Willowbrook, located in South LA, with predominantly African American and Latinx populations, experience disproportionately high obesity rates (Lutfiyya et al., 2008). These are driven by structural challenges, such as poverty and lower educational levels, exacerbating the situation for children in these areas (Browne et al., 2021). Compared to other regions in Los Angeles, residents of South LA experience higher obesity rates, also due to practical challenges, including limited access to healthy foods and inadequate spaces for opportunities for physical activity (Tester et al., 2020). This carries profound implications, emphasizing the need for systemic changes to address the social, economic, and environmental factors that contribute to health inequities in South LA.

The consequences of childhood obesity in South LA impact not only the health and well-being of individuals but also the broader community (Balasundaram & Krishna, 2023). Obesity is associated with a range of chronic health conditions, including Type 2 diabetes, cardiovascular disease, and certain cancers (National Institutes of Health, 2019). These conditions can lead to decreased quality of life, increased healthcare costs, and reduced life expectancy. In addition to the physical health impacts (Smith et al., 2020), obesity can affect mental health, contributing to conditions like depression and anxiety (Halfon et al., 2013; Harrist et al., 2016). Through conducting a literature review, statistics, serving the community, and most importantly, coming from a similar upbringing, the team gained further insight into the complex relationships between childhood obesity and the socioeconomic drivers in South LA.

How we came to work with the community of South Los Angeles

Amid the civil unrest of the Watts Rebellion in 1965, a moment of profound racial and social upheaval, the seeds of a new mission emerged. The McCone Report revealed that poor health outcomes and limited access to care were key contributors to the unrest, catalyzing a commitment to address these disparities. Today, Charles R. Drew University (CDU) continues that mission by establishing an independent MD program—the first such Historically Black program in over 40 years and the only one of its kind west of the Mississippi. This milestone affirms our dedication to equity and excellence in healthcare for underserved communities.  Situated in the heart of the Watts-Willowbrook community, CDU remains deeply committed to addressing the health challenges our neighbors face. One such challenge, childhood obesity, disproportionately affects our community, threatening the health and future of our youth. By combining our focus on health equity with innovative research, education, and outreach, CDU is dedicated to empowering the next generation of physicians to confront this epidemic and create healthier futures for the communities we serve.

As medical students at Charles R. Drew University in Watts-Willowbrook, South LA, many of us (the authors) grew up in communities similar to Watts-Willowbrook and have been directly exposed to social and health inequities that have shaped our commitment to addressing health disparities. Childhood obesity is a significant health disparity that we have identified as a dire concern, as evidenced by literature review, quantifiable data, and through first-hand witnessing this health concern when serving the community in medical practice. We also found that childhood obesity in South LA is significantly pronounced when compared to other communities in Los Angeles. To investigate our topic, we engaged with our community physicians, faculty, and mentors to identify and prioritize the leading health challenges for South Los Angeles. These critical discussions further reinforced our decision to pursue childhood obesity as our topic.

At the national level, childhood obesity is a significant public health concern. According to the Centers for Disease Control and Prevention (CDC), approximately 19.7% of children aged 2-19 in the United States are affected by obesity, particularly affecting some groups more than others, including adolescents, Hispanic and non-Hispanic Black children, and children in families with lower incomes (CDC, 2023). Within Los Angeles County, 36.1% of children aged 2-11 in Watts-Willowbrook are overweight for their age, compared to 12.5% in Los Angeles County overall. Additionally, 49.9% of teens aged 12-17 in Watts-Willowbrook are overweight or obese, significantly higher than the 34.4% reported for Los Angeles County (Los Angeles County Department of Public Health 2023).

The magnitude of childhood obesity is a matter of urgent concern in Watts-Willowbrook, South LA. To better understand this deep-seated issue, our project adopted a community-engaged approach, engaging stakeholders, families, the community, and healthcare providers directly to understand the relevant issues and create culturally sensitive, sustainable solutions. Our community-engaged approach was inspired by the model implemented at Charles R. Drew University, which contained the essential elements: mutual respect, shared decision-making, and a focus on measurable changes in the community rather than conducting research solely for hypothesis testing (del Pino et al., 2016).  This approach, as medical students in South LA, allows us to gain a deeper understanding of childhood obesity through the lens of both patients and key stakeholders.

DESCRIPTION OF PROJECT

The study on childhood obesity in Watts-Willowbrook, South Los Angeles, was rooted in a community-engaged approach, emphasizing participatory research that involved various stakeholders, including families, community members, and healthcare providers. Our project specifically aimed to answer the research question: “What are the driving forces of obesity in elementary school-aged children in Watts-Willowbrook, CA?” Through this inquiry, we sought to assess the prevalence and impact of childhood obesity while exploring community perspectives and experiences related to the issue. Partnering with Dr. Angela Venegas-Murillo from the MLK Pediatrics Medical Home Clinic, we conducted a series of interviews with key stakeholders, such as registered dietitian Joselin Berdugo from the Gasol Foundation, family physician Dr. Alexander Rodgers, and pediatrician Dr. Shanika Boyce.

The methodology involved qualitative data collection through semi-structured interviews designed to gather a diverse range of insights. Our initial step was to create a literature review where we outlined a series of five main domains from this review:

• diet and nutrition,
• exercise,
• family and community support,
• healthcare and prevention, and
• environment.

Following this process, we created an interview script that emphasized the five domains and identified key stakeholders to interview. We interviewed two people from the following groups: patients/family members, clinical health care providers, other health care team members (e.g., dieticians), community-based organizations, government organizations, and research/health policy experts. After these interviews, we analyzed the content of our interviews and extrapolated recurrent themes across all stakeholder interviews. This process allowed us to extract quotes that provided a unique and personal basis to highlight the complexity of our domains and how we can create targeted interventions.

Community Needs

Watts-Willowbrook is a vibrant, multicultural community with a variety of unique needs that are influenced by the local socio-cultural environment. Many families and children are living in the area who experience limited access to food, green space, culturally competent medical professionals, and financial resources. It is crucial to address these needs to combat childhood obesity in Watts-Willowbrook and ensure that families can build and maintain healthy lifestyles. A primary challenge in the Watts-Willowbrook community is access to nutritious food at an affordable price. There is a great need for affordable produce, high-quality protein, and other nutrient-dense staples that form the foundation of a healthy diet. Currently, there are some food banks and farmers’ markets that meet this need, but more are needed to provide sufficient food options for the entire population across the entire geographic area.

Opportunities for physical education are another significant need within the Watts-Willowbrook community. Many freeways bisect this area of Los Angeles, vastly limiting residents’ access to green space where they can practice recreation and physical activity. Additionally, Watts-Willowbrook has a noticeable paucity of fields, recreational swimming pools, and similar facilities, which leaves children with limited options for physical activity. There is also a lack of community initiatives promoting healthy lifestyles for youth – presumably due to a lack of funding.

South LA is also an area that has historically had a lack of medical facilities, from primary care to acute care services, and unfortunately, Watts-Willowbrook continues to be a medically underserved area. This leaves residents with limited options if they choose to seek treatment for childhood obesity – particularly if they are requesting the assistance of specialized healthcare professionals whose services are often not covered by Medicaid. The community as a whole could benefit immensely from registered dieticians and mental health counselors as it takes on the epidemic of childhood obesity and the behaviors that perpetuate the cycle of obesity within families. The children affected by childhood obesity in Watts-Willowbrook could significantly benefit from a specialized, multidisciplinary clinic designed to help them achieve a healthy weight by targeting the plethora of physical and psychological factors that contribute to obesity.

Additionally, as a multicultural community with a high proportion of residents who speak English as a second language, Watts-Willowbrook needs all services designed to combat childhood obesity to be provided in multiple languages, particularly Spanish. Furthermore, any healthcare professionals involved in the treatment of patients experiencing childhood obesity should have a high level of cultural competency and be able to meet the language and communication needs of their diverse patient population. Overall, Watts-Willowbrook has a number of needs that require our support in order to continue combatting childhood obesity. This includes improved access to healthy food, more areas for residents to do physical activity, and a need for highly-trained, culturally aware healthcare resources for obese children.

Collaborative Partners

We created questions based on the domains:

• diet/ nutrition (Anderson et al. 2019, Gato-Moreno et al. 2021, Liu et al. 2019),
• exercise (Anderson et al. 2019),
• family (Liu et al 2019, Smith et al. 2020) and community support (Smith et al 2020),
• healthcare and prevention (smith et al 2020), and
• environment (liu et al 2018, Reis et al 2020).

Based on the domains and with guidance from our mentor, we identified partnerships such as pediatric and family medicine doctors, community promotoras, researchers, previous employees at the Los Angeles Public Health Department, and community-based organizations such as the Lundquist WIC program and Gasol Foundation.  Each student was assigned an identified collaborative partner to coordinate and schedule an interview.  Before the interview, a document with background, project information, and interview questions was provided. All interviews were conducted via Zoom or Teams calls, which were recorded. In addition, a verbal agreement was provided during the meeting. No documentation was requested from the representatives of the organizations.  We submitted the recording for transcription using AI Parrot. We summarized the key points for submission to our course directors. In addition, each group member presented a slide that summarized the interview findings to the other group members, which helped capture the major themes and trends that play a role in childhood obesity in Watts-Willowbrook across the various domains.

For nutrition experts, we interviewed Joselin Berdugo, a registered dietitian at the Gasol Foundation. Berdugo focused on delivering culturally sensitive dietary advice that resonated with the community’s cultural practices, making healthier eating more accessible to low-income families.  For healthcare professionals, we interviewed Dr. Shanika Boyce, a pediatrician who played a crucial role in addressing childhood obesity through nutrition education in South Los Angeles. Dr. Alexander Rodgers, a family medicine doctor, emphasized family-centered nutritional practices, such as cooking demonstrations and visual aids like portioned plates, to help families adopt balanced eating habits. Their combined efforts highlight the importance of culturally relevant approaches to promote healthier lifestyles. We had the pleasure of speaking with Michael Prelip, a scientist specializing in health promotion interventions, who stresses the importance of the physical environment in promoting healthy lifestyles.

Community program coordinators and health educators worked on enhancing physical activity in Watts-Willowbrook, addressing barriers such as safety concerns. Nova Green, a High-Risk Program Training Coordinator at the Lundquist WIC program, identified the need for safer environments to encourage outdoor activities. Gigi de La Haza, a Nutrition Education and Training Coordinator, provided practical resources and guidance to families, helping them find local opportunities for physical activity. These partners focused on making physical activity more accessible and safer for the community. Aiziti Magana, formerly of the LA County Health Department, advocated for improved infrastructure, such as shaded areas and hydration stations, to support safe exercise.

Family and community representatives, like Mariela Rodriguez, a local mother, played an essential role in highlighting the social aspects of obesity. Rodriguez shared her personal experiences of modeling healthy behaviors for her daughter, emphasizing the influence of family support on weight management. Community insights from representatives helped tailor interventions to be more relatable and effective, underscoring the importance of family dynamics and community involvement in addressing childhood obesity.

OUTCOMES AND IMPACT

The “Breaking the Cycle” project, led by the authors, aimed to address childhood obesity in the Watts-Willowbrook community through an initial exploratory community-based approach. This exploratory endeavor aimed to tackle the multifaceted nature of childhood obesity by focusing on diet and nutrition, exercise, healthcare experiences, family and community support, and environmental factors. The project aimed to provide a framework to facilitate enhanced nutritional education and resources within the community. By integrating insights from local clinicians, community members, and policymakers, our team proposed actionable strategies.

Strategies included: culturally sensitive programs, including teaching kitchens, dietary counseling, visual aids, and supporting families in making healthier food choices. This effort resulted in a significant increase in awareness about healthy eating practices, particularly through culturally relevant strategies and practical tools like online resources and dietary apps.

In addition to improving nutrition, the project addressed barriers to physical activity. These barriers included safety concerns and a lack of shaded areas, which were mitigated through the promotion of local recreational activities and improved access to physical activity resources. Partnerships with local organizations played a crucial role in overcoming challenges related to transportation and safety, thereby increasing opportunities for physical activity.

The “Breaking the Cycle” project, led by the authors, aimed to address childhood obesity in the Watts-Willowbrook community through a comprehensive, community-based approach. This initiative tackled the multifaceted nature of childhood obesity by focusing on diet and nutrition, exercise, healthcare experiences, family and community support, and environmental factors. By integrating insights from local clinicians, community members, and policymakers, the project developed actionable strategies that led to several key outcomes. The project aimed to provide a framework to facilitate enhanced nutritional education and resources within the community. Culturally sensitive programs, including teaching kitchens, dietary counseling, and visual aids, supported families in making healthier food choices. This effort resulted in a significant increase in awareness about healthy eating practices, particularly through culturally relevant strategies and practical tools like online resources and dietary apps.

In addition to improving nutrition, the project addressed barriers to physical activity. These barriers included safety concerns and a lack of shaded areas, which were mitigated through the promotion of local recreational activities and improved access to physical activity resources. Partnerships with local organizations played a crucial role in overcoming challenges related to transportation and safety, thereby increasing opportunities for physical activity.

LESSONS LEARNED

Through our community-engaged research project (CERP), we have gained a deeper understanding of the complex factors surrounding childhood obesity in the larger South LA area and, more specifically, the Watts-Willowbrook area. Our research team chose this topic because we want to be champions of health in our careers as physicians, and one challenge we have seen impacting our community’s health in many ways is a preventable one – childhood obesity. Many in our team have experienced growing up in low-income, resource-poor areas and know that a disproportionate number of obstacles are impacting access to healthy food and safe environments to exercise in these areas. Powered by Charles R. Drew University’s vision to provide “excellent health and wellness for all in a world without health disparities,” we identified driving forces influencing childhood obesity in ages 5-11. The goal of our project is to provide insight that will inform future interventions to eliminate childhood obesity, especially in underserved communities like Watts-Willowbrook.

We are proud of our work and the valuable tools we have developed that will continue to serve us as we advocate for health equity in our communities as medical students, researchers, and community members. One of the most fulfilling lessons we learned was how to facilitate a culturally informed research project. Too often, researchers may view communities merely as a source of data without inviting them to play a collaborative role in the research. We are proud that our project partnered with community members and stakeholders to give a voice to the Watts-Willowbrook community. This experience taught us that trust, collaboration, and cultural humility are important when addressing health disparities that we have personally experienced and witnessed firsthand. Our project has challenged us to reflect on how we, as future physicians, can make a meaningful impact in our communities through advocating for health equity. By staying actively engaged with the community and prioritizing culturally informed research strategies, we are better equipped to empower communities towards health and wellness in ways that are sustainable and transformative.

LOOKING FORWARD

Looking forward, there is a continued focus on training culturally competent healthcare professionals and leveraging social media as a platform for positive change. Family involvement remains a priority in interventions aimed at breaking the generational cycles of poor health. Addressing environmental determinants of health, such as advocating for improved neighborhood safety, access to fresh foods, and recreational facilities, is essential. Additionally, staying informed about evolving health factors is crucial to ensure that interventions remain relevant and effective. Future initiatives will adopt a comprehensive approach that integrates cultural sensitivity, community empowerment, and systemic change to promote healthier communities.

RECOMMENDATIONS

Addressing childhood obesity in Watts–Willowbrook requires a comprehensive, multi-level approach grounded in Bronfenbrenner’s socioecological model. The socioecological model is a public health framework that examines how multiple levels of influence — individual, interpersonal, community, and policy — interact to shape health outcomes. At the patient level, culturally relevant education is crucial to helping families make healthier food choices while respecting and preserving long-standing eating traditions. Equally important are programs that promote positive body image in children through school and community initiatives, shifting the focus from weight to overall well-being to reduce stigma and empower self-confidence. Engaging parents is another vital component; workshops centered on nutrition education and physical activity can foster sustainable healthy habits within households. To support these efforts, healthcare providers must be trained to deliver culturally and linguistically sensitive care, ensuring that interventions are both respectful of families’ needs and effective in overcoming the unique barriers they face.

At the community level, improving access to affordable, fresh produce is a top priority. Efforts should include collaborating with local stores, farmers’ markets, and urban agriculture programs to address food insecurity while considering the cultural context of the neighborhood. Enhancing safe recreational spaces, such as parks and playgrounds, is also vital to providing children with opportunities for physical activity. Involving community members in these initiatives ensures that solutions are inclusive, practical, and tailored to local needs.

Finally, structural and policy-level changes are essential to sustain progress. Expanding school-based services, such as nutritional guidance and obesity screenings, can help identify at-risk children early and connect them to resources. Advocacy for policies that increase funding for parks, community health programs, and broader infrastructure improvements is critical to creating a supportive environment for long-term health. Together, these strategies offer a comprehensive approach to reducing childhood obesity and promoting health equity in Watts–Willowbrook.

Community psychology in addressing childhood obesity:
weight management, prevention, empowerment, and systems change

Engaging stakeholders in community-based participatory research can aid in creating sustainable interventions to address childhood obesity by offering opinions through lived experiences. Interviews with various stakeholders revealed four common themes: nutrition, community support, environment, and policy change. The first three themes emerge in Samantha’s and Mariela’s story as they overcome obstacles to achieve a healthy lifestyle change. The last theme encompasses suggestions from dieticians, providers, and public health officials with a vested interest in the people.

Nutrition must incorporate culturally and linguistically sensitive instruction and proper food access to extend its reach to diverse populations. Hosting bilingual nutrition classes at community centers, such as schools or churches, can expand access to local families, providing them with an additional resource to aid in their child’s weight management. As shown in Samantha’s and Mariela’s story, engaging entire families in healthy eating practices is essential to creating lasting, multigenerational change.

At the intersection of community support and environment lies the common theme of exercise. In terms of community support, offering free recreational courses for children and their families allows the child to be active while developing healthy exercise habits. Healthcare providers must establish rapport with families to harness trust so patients feel comfortable asking for guidance and confident knowing their doctor will steer them on the right path. For example, Mariela turned to Samantha’s pediatrician to ask for help addressing her child’s weight and was provided with a list of nearby recreational facilities where Samantha could enroll. These classes also offered a safe environment where Samantha could exercise and build community.

An unexpected influence emerged in the social media environment during Samantha’s interview. She shared that she contemplated purchasing weight loss supplements to gain control over her weight. Fortunately, her mother, having gone through a weight loss journey herself, told Samantha that that was an unhealthy approach to losing weight. That’s when Mariela counseled Samantha about establishing healthy eating habits and being more active to aid in her weight loss goal. This provides a great example of how educating parents about proper weight loss and healthy eating trickles down to the next generation, creating healthy multigenerational lifestyles.

When looking at policy, dieticians, providers, and public health officials offered suggestions based on personal experiences with patients. A major suggestion involved the need for a policy that allocates resources toward safe recreational areas in the communities. This includes ensuring proper lighting, maintained walkways, and security patrols or cameras. It is vital to create these spaces where people can be physically active at any time of the day.

Samantha’s and Mariela’s story is a unique example of how addressing nutrition, exercise, community support, environment, and policy can positively impact the lives of children and their families. It shows us how tackling childhood obesity requires a multidisciplinary approach that intersects public health, sociology, and education. Establishing provider trust, offering culturally and linguistically sensitive nutrition classes, and providing access to recreational spaces promote individual and family well-being and improve the broader health of communities.