Barriers to Progress: How We Can Do Better to Help Low-Income Mothers Eat Healthier
by Dr. Mei-Wei Chang
Evidence is clear that obesity is a common, serious and costly disease and disproportionally affects low-income populations. Although numerous intervention studies and initiatives have focused on promoting healthy eating and physical activity to combat obesity, little progress has been made, especially for low-income populations.
There are some potential explanations based on my two decades of experience working with low-income, overweight or obese mothers with young children that we can do better to overcome:
First, researchers and program planners might not design a program that meets the needs of the low-income populations they seek to help. In many cases, we researchers design intervention programs based on literature review and focus group discussions with our target audience and/or stakeholders/decision-makers. In other cases, we design the program based on our best understanding of the needs of the target population. In most cases, we don’t prioritize inviting the target audience to work with us to design the intervention contents. This is a missed opportunity to design an intervention meeting their specific needs.
Second, we frequently design interventions with a focus on telling our target audience what to do instead of helping them build skills on how to make positive change that can fit in their daily lives. Based upon my research, I have learned that most low-income populations are very knowledgeable about what they should do to make positive changes – for example, eat a variety of healthy foods. However, they are not sure how to do it, even if they are highly motivated to make the positive change.
Third, we may not design an intervention that takes into account their life circumstances. For example, when we design an intervention study to help low-income mothers to eat more vegetables, we typically focus solely on moms. Over the years, I have learned the importance of helping these mothers to increase their young children’s vegetable intake as a motivation to also increase the mothers’ vegetable intake. Also, many low-income moms prefer to cook at home, but they do not have proper tools. Their ovens and/or cooking pans may be too old to function properly, or their knives may be too dull to cut vegetables. These are potential barriers to cooking healthy meals at home that must be taken into consideration.
Fourth, many low-income mothers prefer not to buy fresh vegetables because they feel that those vegetables go bad quickly. That may be based on past personal experiences with buying less-high-quality vegetables, and even when they bring high-quality vegetables home – especially leafy vegetables – they don’t cook them until several days later.
Fifth, many women express feelings of hunger often, so they eat. Indeed, they may not be aware that they may experience cravings as a response to negative emotions. I have taught low-income mothers about ways to distinguish the differences between true hunger and cravings (due to negative emotions) and they really appreciated the education. This is because they perceive the awareness as an opportunity to improve healthy behaviors.
Finally, I have heard frequently from low-income mothers, “I know I need to make changes, but I just cannot motivate myself to do it.” Helping them identify their motivation so they can see the program as a doable challenge is crucial to the initiative’s success.
If we seek to help low-income mothers and their children live healthier lives, it is incumbent upon us as researchers, program planners and leaders in our fields to listen to their stories and needs. Also, we need to be empathetic to their life circumstances and help them build skills on how to do it rather than just telling them what to do. Moreover, we must empower low-income mothers to sustain the success they can find through our work together.
Mei-Wei Chang, PhD, RN, FAAN is an associate professor at The Ohio State University College of Nursing.