41– It's not your fault, talking health & obesity, with Medical Sociologist Gabriele Ciciurkaite

November 10, 2020 Utah State University Office of Research Episode 41
41– It's not your fault, talking health & obesity, with Medical Sociologist Gabriele Ciciurkaite
Show Notes Transcript

In this episode, Gabriele Ciciurkaite explains her research into food insecurity, obesity prevention, and mental health. She talks about data sets that represent the entire US, interventions she studied in Appalachia, and she gives Utahn's health a report card.

Wyatt : [00:00:02]
 If you could teach people one thing about obesity and health, what would it be?

Gabriele Ciciurkaite: [00:00:08] 
It's so hard because I feel like everything in medical sociology points to the fact that individual behaviors are in such a small part of what explains our health. I mean, obviously, it matters what we do matters, and it does directly affect our health, but our agency and our choices are so largely influenced by external factors that I guess I would try to teach them that it's it's not your fault sometimes. I don't know.

Wyatt : [00:00:51]
 Today you're going to hear how your health and your weight are affected by the communities that you live in and the culture around you. Let's meet this episode's tour guide.

Gabriele Ciciurkaite: [00:01:01]
 Hi, my name is Gabrielle Ciciurkaite. I am a medical sociologist. So I study the social factors that affect individual, physical and mental health and mortality.

Wyatt : [00:01:15] 
Basically, Gabrielle studies how stuff affects your health. And there's a bunch of stuff.

Gabriele Ciciurkaite: [00:01:21]
The social factors that I'm referring to are your age, your gender, your race, ethnicity, immigration status, your childhood experiences, your education and income level, the neighborhood that you live in, any other kind of factors in your social environment that might have to do anything with health.

Wyatt : [00:01:46]
My name is Wyatt , and you could be pulling out your phone to Google your zip code, but you don't have to because you are listening to this instead.A podcast from Utah State University's Office of Research, in this episode, you'll learn about the mechanisms that turn food insecurity into stress, how those stressful outcomes can be affected by your gender or your age. Doctor Ciciurkaite to explain how the help of Utah stacks up to the rest of the states and how the United States relationship with food compares to where she grew up in Lithuania. Make sure you subscribe to the podcast and followed at instead podcast on Instagram. Today, most of Doctor Ciciurkaite research is done with massive data sets from the USDA or the CDC to help you feel how all the factors in the list you heard earlier can affect people's health. She's going to tell us about some of her early work in Kentucky.

Gabriele Ciciurkaite: [00:02:46]
All of those things affect our life chances in general and how many good things we're going to have in life. And so health is just one of those things that also happens to be affected by where we are placed in these social hierarchies because of the resources that we have access to in terms of like material resources as well as social support.

Wyatt : [00:03:10]
 So you went to the University of Kentucky, right? Correct. Did some projects there. Tell me about what you learned in Appalachia, That was interesting.

Gabriele Ciciurkaite: [00:03:18]
 So Appalachia is an interesting place to people who study health because it's a it's a very poor place. So it faces all the challenges that individuals of lower socioeconomic status would.

Wyatt : [00:03:32]
Most of her work in Appalachia with studying health interventions, a.k.a. ways to improve people's health outcomes.

Gabriele Ciciurkaite: [00:03:39] 
So one of the interventions had to do with diabetes clinic to community navigation. A lot of those people in the poorer regions of Kentucky were not. He did not have enough money to buy insulin. They didn't have the knowledge of how to take care of their feed, you know, the regimens that they needed to follow. They were terrible at keeping their appointments with the physicians. Individuals in those areas just generally tend to have a bit of a mistrust in the medical system, partially, perhaps because of their lower education. Perhaps they don't have the greatest experiences with physicians. Maybe sometimes they don't understand what they're saying. So basically, we trained people from the community to increase their trust and then those people from the community would visit, give them brief little instructions on how to better take care of themselves, like looked at the things they eat to give them advice on what to eat better. And then it would take them to the community clinic to make sure that they don't forget their physician appointments. We did that for a while and then we try to see if their diabetes health outcomes, like their agency BMI and their general health behaviors improved.

Gabriele Ciciurkaite: [00:04:59]
And it was a very small sample and it was a very short intervention. So we did not observe significance, but so it was kind of funny.So we had to have a control group and an experimental group. And so the health advisors felt really bad that they couldn't help the people in the control group enough. So I think they cheated a little bit. So I I'm not exactly sure about our studies design. I think they just really wanted to help those people out. So overall, we know there's some very positive trends.

Wyatt : [00:05:33] 
So now that we've heard how Doctor Ciciukatie studied interventions that could help people in Appalachia, let's move to her work understanding the mechanisms between limited access to food and stress and anxiety.

Gabriele Ciciurkaite: [00:05:45] 
Food insecurity, which is limited access through socially acceptable channels, so like not having to rely on a food bank. And so in my research, I, I conceptualize food insecurity as a chronic stressor, and we have noticed that it actually negatively affects individual well-being. And particularly I'm interested in of what are the mechanisms that lead to these negative mental health outcomes. So I have looked at other chronic strains that individuals who are food insecure might experience, as well as lack of social support, lack of coping mechanisms such as mastery and self efficacy, which are all of those things that are supposed to help us overcome stressful experiences in trying to model and explain these associations.

Wyatt : [00:06:37] 
Tell me more about this USDA survey called NHANES.

Gabriele Ciciurkaite: [00:06:41] 
So it's Nutrition and Health Examination Survey. Every year they interview about ten thousand people. They have trained people who go in and measure people's height and weight, their weight circumference ratios of other body parts. They collect blood samples. They measure blood pressure. So you have like really amazing biomarkers for health indicators that of the questions ask about adult food consumption practices. And then another eight also ask about children, children's food consumption practices. And they start out with things like, I worried that food will run out at the end of the month. The quality of the meals that I have is lower over time or like I had to skip meals because we just didn't have enough food. So it gets kind of like progressively worse and worse. And then the worse questions are where, you know, like my children did not have enough food to eat.

Wyatt : [00:07:41] 
Mm hmm. Yeah. Yeah. Are there any questions you wish they were answering that they're not?

Gabriele Ciciurkaite: [00:07:46] 
Yes, actually, that's an excellent question. So you have really amazing biomarkers for health indicators. Conclusions are generalizable to the entire U.S. So it's great for like establishing associations. But for a sociologist, it doesn't let you really answer the question of like, OK, well, why is it that this variable leads to this outcome? So I wish they asked more questions about chronic stressors and strains and individual lives, personality like self esteem, questions on social support, childhood, stressful experiences like all of these experiences that can either make you more vulnerable to certain health outcomes or like act as a buffer. And the protective effect. I wish it had all of these things.

Wyatt : [00:08:35] 
Yeah. Yeah. So essentially they're put in an exam room and measured and weigh those callipers or maybe take into their love handles or whatever and then and that happens. That's great because it gives you really good data. But you also wish that like been a therapist, like took them into another room and it was like, tell me about. Your childhood. Tell me about your family and your neighborhood and your work.

Gabriele Ciciurkaite: [00:08:54] 
Exactly. OK. Yeah. What neighborhoods you live in. Do you feel safe in that neighborhood? Do you have access to, like, parks and gyms? And they do have really good dietary data because they have people fill out the journals. So they do have that. But these kind of like more like squishy things about your environment and your everyday life. I wish they had those.

Wyatt : [00:09:18] 
Yeah. Yeah. How does food insecurity change between genders?

Gabriele Ciciurkaite: [00:09:25] 
Ok, so so it's so general, it's a household level measure, it's not an individual level measure, but what's gendered about it is the way it affects mental health. And the association is much stronger for women relative to men. And we think that that is partially explained by the fact that women still largely occupy the roles of, like the carers are nurturers and the family. And so a lot of times they like forego their food needs to feed their husbands or their children.So therefore, the stress of not being able to provide for their families seems to be affecting them more negatively than men.

Wyatt : [00:10:05]
What other variations do you look at like age?

Gabriele Ciciurkaite: [00:10:08]
Yeah, so I have one manuscript that is currently under review in that journal. So we looked at the association between food insecurity and anxiety and depressive symptoms and we looked to see if age in general, people who are older report fewer stressors in their life relative to younger individuals.And so we think that's just because they're better able to cope because of all the life experience. So we were trying to see if that vulnerability younger adults. And that is exactly what we found.

Wyatt : [00:10:43] 
What are some of the misconceptions or unknowns about the mechanisms that cause obesity?

Gabriele Ciciurkaite: [00:10:49] 
So I think the biggest misconception is probably that it is a more individual failure, that people are just somehow unable to, like, eat well and they just make very poor choices and do not exercise. And that's why we see increasing rates of obesity, which, of course, is not true. I mean, individual behavior such as diet and exercise does account for a part of it, but that's not where the full answer lies.

Wyatt : [00:11:25] 
What are some of the social causes of obesity that we're aware of?

Gabriele Ciciurkaite: [00:11:30]
Ok, so the neighborhood effect is one area of research where there is more and more studies coming out. So like people who live in food deserts and maybe do not have access to grocery stores or they are exposed to more fast food advertising, or just like having more fast food outlets, per capita neighborhoods not amenable for physical activity. So neighborhood disadvantage is one group of social factors that affect rates of obesity. Social networks is kind of interesting. There was a really famous study that came out in 2007, I believe, by an M.D. and a Ph.D., Nicholas Christakis and his colleague who showed that basically obesity spreads in social networks and that if you have a spouse or a friend who is obese, your risk of obesity increases. I even took notes on this because I was hoping that you would ask me, OK, so a person's chances of becoming obese increase by fifty seven percent if their friend was obese.

Gabriele Ciciurkaite: [00:12:41]
If you had a sibling who was obese, your chance of obesity increased by 40 percent. And then if your spouse became obese, a person's likelihood of obesity increased by thirty seven percent. They did not observe similar effects among neighbors, which only led them to hypothesize that it's the relationships that are closer to us in terms of social proximity and geographic proximity that really mattered for the spread of obesity. And the mechanisms of how social networks affect obesity have not been studied much. But there are like three proposed hypotheses of how that happens, and one of them is shared body norms and ideals. Research shows that those perceptions converge over time. The second one is social control, and we particularly see that among partners and married couples where one partner and that usually tends to be a female or a wife monitors that or controls health behaviors of their partners. And then the third mechanism is behavioral modeling. And that's usually that we tend to adopt the behaviors of people that we hang out with. So if I become friends with a bunch of skiers here in Utah, I am probably going to be more physically active. Whereas if a lot of my grad school friends in Kentucky were huge fans of KFC, I tended to eat more fried chicken.

Wyatt : [00:14:17]
They're going from Kentucky to Utah. What kind of health behaviors do you think are interesting that are different?

Gabriele Ciciurkaite: [00:14:24]
So you think that. Actually, a very healthy state. Well, OK, it depends what health indicator you'll look at. So in terms of obesity, Yuuta is, I believe 40 is fortieth lowest. So that's the obesity prevalence in Utah is lower than the national average in the US. So that's great. And and I don't know if it's just because we live in Logan with people in general seem to be very health conscious here in terms of just physical activity and being outdoorsy. I mean, obviously, because of the religious influence of alcohol consumption is much lower. Similarly with smoking. But then on the other hand, of course, Utah has huge problems with mental health and suicide and opioid abuse. So in terms of physical health indicators, Utah is very healthy.

Wyatt : [00:15:21]
So when we think about like the United States as a country, we kind of all know that we have an obesity problem compared to other countries. Are there any sociological explanations for that, our society, how is it making us fat?

Gabriele Ciciurkaite: [00:15:36] 
Obesity is a global problem. It's affecting largely developed countries everywhere. And I can't remember exactly how the United States compares to other developed countries. I know that the issues here are are prevalent. I think it has largely to do with the organization of social life and the use of the systems of oppression that are at place and also opportunities and resources that some groups have more than others. So and this might sound like a bit naive explanation, but a lot of places in Europe, almost every neighborhood has a little farmers market cities are largely walkable. So there is easier access to fresh food. Fast food is not as popular. It's also more expensive. That is not an option that people of lower classes usually reach out for, which is the opposite in the United States. Another thing, for instance, we know that racial minorities suffer from obesity at higher rates. One of the explanations for that is experiences of institutional and interpersonal discrimination. Some more homogenous countries in Europe do not have those problems to deal with.

Wyatt : [00:17:05] 
How is our relationship with food different than people's relationship with food back in Lithuania?

Gabriele Ciciurkaite: [00:17:11] 
Huh, that's interesting. So, you know, I grew up in an extremely conscious family. My my parents have always been hypersensitive about their level of fitness and appearance. And I'm so glad they cannot understand and hear me say that. And even though this was never explicitly stated, but you could always tell that they sort of perceived higher body weight as an individual failure.There was this aura of moral superiority because of their ability to be really fit and obesity. So I left Lithuania 11 years ago. Obesity was not really a problem. It's becoming more relevant now. And so when I got to the U.S., I became, you know, surrounded by a larger variation of body types and sizes. And so I started thinking, you know, surely it can to be right that something that affects 30 percent of the population is really just a moral failure on the individual part.So that's partially when I started thinking about all of these questions and why what's happening here and what a larger social forces are at play. But. In terms of American relationship with food versus Lithuanian relationship with food, I think we value a European approach to food in general where, you know, we we take our time to eat and it's sort of like a social time together. Family meals are very important. People don't do things on the go as much, which I absolutely loved. When I first came here, one of my favorite things to do was to just get a Starbucks and eat snacks in the car because it just seemed like the most amazing American way to live. You know, you're in a traffic jam and you get your snacks in the car, like, what a dream.

Wyatt : [00:19:09]
I just think that that's a fascinating thing to point out, that I don't think of it because it's usually of like, oh, I'm going somewhere. Like, I might be hungry while I'm there to take a granola bar or we feel like we shouldn't ever be hungry and we always have access to food.

Gabriele Ciciurkaite: [00:19:23] 
Yeah, that's actually that's actually very interesting that you bring that up, because I read somewhere that in America, people, well, excluding those who are suffering from food insecurity issues, people do not allow themselves to have the physical experience of hunger anymore. And that's interesting that you brought that up because I haven't even thought about it.

Wyatt : [00:19:48] 
Oh, I've just been very conscious of it. Working at home like the fridge is just downstairs and I'll be doing something like, oh, I'm hungry. And I'm just like, well, you can't eat every time you feel a tiny bit of hunger by it. So, yes, something I've been trying to pay attention to. OK, those thoughts that your parents have, was that specific to them or is that just more of a general thing that was going throughout the culture there?

Gabriele Ciciurkaite: [00:20:10]
 I think my parents well, my parents in particular were very weight conscious, but it's also kind of a theme in Lithuania, particularly among women. They're extremely weight conscious and everyone wants to have a body of of a model.

Wyatt : [00:20:28]
 How how is this data and information useful could be done with it?

Gabriele Ciciurkaite: [00:20:33] 
I guess so. We demonstrate to policymakers, are health care professionals some sort of mental health interventions would be very useful not only for the most vulnerable social groups, but pretty much for everyone.

Wyatt : [00:20:54] 
These are really vulnerable times in terms of economic insecurity and that addressing some of the issues of economic insecurity, it would also help alleviate the psychological distress in individuals lives.

Wyatt : [00:21:10] 
Ok, I think this is I have a final question for you.  Ok, you were building a city. How would you build that community so that the people would have the best outcomes possible? 

Gabriele Ciciurkaite: [00:21:13]
Oh, my God, I feel like you just have to model it after some tiny Mediterranean village that's like highly walkable, integrated neighborhoods, lots of green space for exercise, intergenerational communities, lots of opportunities for people to get together and engage in social activities together and support each other.

Wyatt : [00:21:53] 
Why is it intergenerational?

Gabriele Ciciurkaite: [00:21:55] 
Oh, just embeddedness in social networks is really important for people's health. This is, I feel like particularly relevant now because we are becoming or people are largely reporting increased social isolation, which we know from research that social isolation increases your risk for mortality and a number of other adverse health outcomes. So I guess I was just thinking for opportunities for social engagement, people of all groups and particularly older adults, because aging, aging and solitude, this is a very dire, dire situation.

Wyatt : [00:22:44]
That was my conversation with Dr Gabrielle Ciciurkaite. Thank you for listening to this episode. This voice over is being recorded on November 10th. And today we don't have a lot of choice but to be physically isolated from one another. But I'm here for you and on Instagram instead podcasts. As we isolate together, please tell a friend to listen to this episode of the Instead podcast. And don't forget to write us and leave us a review. This episode was produced and edited by me, Wyatt Traugber and Nick Vázquez as part of our work in the Office of Research at Utah State University.