Joint U.S.-Mexico Workshop on Preventing Obesity in Children and Youth of Mexican Origin Summary (2007) / Chapter Skim
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Appendix C: Preventing Obesity in Mexican-American Children and Adolescents
Appendix C: Preventing Obesity in Mexican-American Children and Adolescents
Pages 128-186
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From page 128... ...
During the 1960s1970s, the prevalence of obesity in children and adolescents in the United States was relatively stable at about 47 percent. However, during the 1980s the obesity prevalence doubled, with 11 percent of children and adolescents having body mass index (BMI)
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From page 129... ...
The paper then provides an overview of current intervention strategies and programs and proposes actions that may offer the greatest potential for success in preventing and controlling the obesity epidemic. EXTENT AND CONSEQUENCES OF OBESITY IN MEXICAN AMERICAN CHILDREN AND YOUTH Data from national surveys clearly demonstrate a high and increasing prevalence of childhood obesity in the United States (Ogden et al., 2002, 2006; Hedley et al., 2004)
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From page 130... ...
Waist Circumference Waist circumference is a more specific indicator of abdominal fat, and it appears to perform at least as well as BMI in identifying children with a clustering of CVD risk factors (Katzmarzyk et al., 2004)
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From page 131... ...
Descriptive data showing percentile distributions of waist circumference have been developed for 28-year-old AfricanAmerican, European American, and MexicanAmerican children based on data from NHANES III (Fernandez et al., 2004)
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From page 132... ...
White African American Mexican American FIGURE C-1 Obesity prevalence in boys, NHANES 20032004. SOURCE: Ogden et al.
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From page 133... ...
Abdominal Obesity Prevalence Abdominal obesity appears to be a particular concern for Mexican adults, children, and youth. Data from the Mexican National Health Survey conducted in 2000 indicate a high prevalence of abdominal obesity in Mexican adults based on waist circumference measurements, with a reported prevalence of 46.3 percent in men (waist circumference 94 cm)
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From page 134... ...
134 ,2003 Total 12-19 Combined ethnicity ages Americans ,and Girls Mexican Obese + gender Blacks Risk age, 12-19 At ,by ages Whites Boys obesity for Total 95th Ethnicity < risk 6-11 and at Americans BMI ages = or Mexican Sex, Girls obese Blacks percentile Group, e percentile) ar 6-11 (85th Age by who Whites Risk ages At Boys Category Total adolescents 2-5 and Americans percentile)
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From page 135... ...
135 19992000 c National Survey Children: Mexican Health 2000 10.6 9.3 Mexican and b years. National Survey 17 to 2002)
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From page 136... ...
. These findings of increased waist circumference suggest that Mexican American children and youth, and particularly MexicanAmerican boys at all ages, may be at an increased risk of co-morbidities associated with abdominal obesity, including type 2 diabetes.
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From page 137... ...
A review of growth studies on MexicanAmerican children and youth during 19201980 (based primarily on immigrant and low-income Mexican Americans) showed a high prevalence of short stature and low weight that was indicative of undernutrition (Malina et al., 1986)
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From page 138... ...
The upward trend in obesity prevalence in MexicanAmerican children has continued in recent years. Between NHANES III (19881994)
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From page 139... ...
White African American Mexican American FIGURE C-7 Obesity trends in females 1219 years old. NHANES 19881994 versus 20032004.
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From page 140... ...
Trends in waist circumference in children and adolescents also have been observed. In the interval between NHANES III (19881994)
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From page 141... ...
Overall, these data indicate that childhood obesity, and perhaps abdominal obesity in particular, represents a long-term and increasing problem among MexicanAmerican children and adolescents. Health and Economic Impacts of Obesity Impact on Physical Health The relationship between obesity and chronic disease risk in adults has been observed and documented widely.
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From page 142... ...
Sleep apnea is another morbidity related to obesity. It has been suggested that Mexican Americans may have a higher prevalence of sleep apnea than other Hispanic subgroups (Strohl and Redline, 1996)
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From page 143... ...
. The findings of this study showed higher levels of obesity and hyperinsulinemia in MexicanAmerican children and adults compared with non-Hispanic White children and adults and therefore indicated that the Mexican Americans had an increased risk for CVD.
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From page 144... ...
It is important to remember that today's adults were children and adolescents in the 1970s and 1980s when Mexican Americans were first recognized to be at a greater risk for obesity. Consequently, if MexicanAmerican adults currently have some of the highest rates of diabetes in the country, what will this population look like when the current group of children become adults?
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From page 145... ...
for health care, and since many may be underinsured or uninsured, the high prevalence and rapid increase in obesity among Mexican Americans inevitably will place increasing demands on these health care providers and have important implications for the funding needs of these programs (Flores et al., 1998; Burgos et al., 2005)
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From page 146... ...
Transition from traditional Mexican diets to American diets likewise may affect second and later generation families as succeeding generations become more acculturated. The insecure employment settings and the environment of poverty in which many Mexican Americans live also may have effects on energy balance by influencing dietary choices, physical activity opportunities, and access to health care.
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From page 147... ...
Therefore, maintaining a traditional diet seems to be an important factor in preventing obesity in MexicanAmerican children and their families. Physical Activity and Sedentary Behaviors Physical activity is the second part of the obesity equation.
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From page 148... ...
These issues need to be explored with Mexican Americans, because they come from a complex cultural milieu involving both Mexican and American influences. Moreover, with a large proportion of immigrants recently arrived from Mexico and the majority of Mexican Americans maintaining some ties to the Latino culture, perceptions of normal weight for MexicanAmerican
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From page 149... ...
Instead, the greater levels of familism were seen in those with more education, higher income, and bilingual or English-speaking families. Although this study involved a large, mobile immigrant population, it suggests that even with acculturation, Mexican Americans still retain a strong family orientation.
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From page 150... ...
In this study, Mexican Americans were more than 50 percent of the sample and had the highest proportion of obese adults. In a study conducted in Washington State, Mexican immigrants were found to consume fewer fruits and vegetables as they became more acculturated (Neuhouser et al., 2004)
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From page 151... ...
Their jobs often have less security and typically less union protection, particularly for farm workers before their unionization. Thus, although Mexican Americans have high workforce participation, they continue to live in poverty without health insurance and with limited upward mobility.
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From page 152... ...
. The study's investigators were unable to show a direct association with obesity; however, further research may demonstrate a genetic risk for this population that would have significant implications for Mexican Americans who may share the same genotype.
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From page 153... ...
. Although Mexican Americans have substantial media access, the quality of health information disseminated over these channels varies considerably in quality and consistency.
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From page 154... ...
. youthcampaign/ - Includes health promotion research/resources.htm content in Spanish on the http://www.cdc.gov/ CDC website.
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From page 155... ...
org/Obesidad/jsp/ - Content is culturally and intro_fam.jsp linguistically adapted for http://www.todoensalud. use by Mexican Americans.
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From page 156... ...
Because it originates in Mexico, the content is culturally and linguistically adapted for use by Mexican Americans. A related site, Todo en Diabetes, provides information specifically for patients, professionals, and families concerned about or caring for persons with diabetes.
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From page 157... ...
entpartnerships/ - Partners with Univision in Univision-Announces this initiative include the Year-Long-Health Kaiser Family Foundation, Campaign-in the Ad Council, and many Partnership-With-the other health, community, Kaiser-Family and medical organizations. Foundation.cfm Coalition Children, - Involves marketers, media, - Program impact to be for Healthy teens, and nonprofits, foundations, measured by changes in Children parents and government agencies attitudes and behavior to provide consistent, of children and parents.
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From page 158... ...
Coalition for Healthy Children: Combating Childhood Obesity Another initiative to enhance health information for children and youth is the Coalition for Healthy Children, a publicprivate collaboration designed to use the collective strengths of marketers, the media, nonprofits, foundations, and government agencies to address the obesity crisis. With support from the Robert Wood Johnson Foundation and in cooperation with the Advertising Council, the coalition aims to provide consistent, research-based messages targeted at parents and children.
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From page 159... ...
These intervention programs have combined nutrition education and have increased opportunities for physical activity with policy changes with regard to vending and the nutritional quality of school meals. These programs provide examples of promising strategies for school-based intervention that have been successful in schools with a high proportion of MexicanAmerican children.
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From page 160... ...
program in El Paso, Texas, implemented a school-based intervention to increase moderate to vigorous physical activity and to improve the nutritional content of school meals. Evaluation in 24 schools with a high proportion of MexicanAmerican children found that, for most intervention schools, the intervention was associated with significantly increased moderate to vigorous physical activity and decreased fat in school meals.
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From page 161... ...
have - Programs target parents, · Significantly increased school health classes, dietary fiber intake, cafeterias, and after-school · Increased physical activities. fitness levels, and - Primary objectives are to · Decreased fasting decrease dietary fat intake, capillary glucose increase fiber intake, levels.
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From page 162... ...
- Stanford Health Promotion Spanish Resource Center Learning Grades K12 - Posters and teaching aids Contact: Zone Express in Spanish. http://www.learningzone - Online store and resource express.com center.
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From page 163... ...
This program provides an interesting model in which activities potentially contributing to obesity prevention can be integrated into a larger framework of community efforts to promote child health. California Latino 5-a-Day California's Latino 5-a-Day program promotes fruit and vegetable consumption among Spanish-speaking adults.
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From page 164... ...
· Video, in Spanish, htm#Have%20Fun%20 showing families being &%20Be%20Active physically active with Brochure for health fair: children ages 15 years. http://www.cchealth.org/ · Community health espanol/pdf/wic_ promotion fairs for funshops_esp_2005_ Hispanic families.
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From page 165... ...
However, a survey by the Alameda County Community Food Bank estimated that 1.7 million Californians, many of them Latino, are eligible for food stamps but do not participate in the program. These findings suggest that an educational campaign to expand awareness of and participation in the food stamp program by Mexican Americans could help improve access to healthful foods and would be a valuable component of an overall obesity prevention strategy.
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From page 166... ...
access.org/aboutus.shtml - Promotores are skilled at educating and serving as role models for their peers. - The Children and Youth Initiative assists children in high-risk environments to adopt healthful nutrition and physical activity and other positive behaviors that promote good health.
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From page 167... ...
Health Care Interventions Mexican Americans and other Hispanics face a number of barriers in accessing health care, including language barriers, cultural differences, poverty, lack of health insurance, and transportation difficulties. These chal
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From page 168... ...
Funded by CDC, this program offers guidance to health care providers on screening for CVD risk factors, lifestyle counseling to improve diet and physical activity, and clinical referral and follow-up services. The program involves a three-session intervention that emphasizes readiness for change, goal-setting, individual tailoring, self-monitoring, and social support.
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From page 169... ...
The program is now being implemented in both English and Spanish in a clinic in northern California (Contra Costa County) as part of a larger community-based effort to prevent and treat childhood obesity in a population with a high proportion of Mexican Americans.
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From page 170... ...
screening for CVD risk - Counseling is facilitated factors, lifestyle by bilingual community counseling to improve health workers. diet and physical activity, - California is currently and clinical referral and planning to pilot test the follow-up services.
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From page 171... ...
espanol/detalles_sobre_ kidshape.html http://www.kidshape. com/Pages/ programs.htm National-Level Survey and Monitoring Activities At the national level in the United States, the ongoing Health and Nutrition Examination surveys, Behavioral Risk Factor Surveillance surveys, and Youth Risk Behavior surveys provide essential information on obesity prevalence and behavioral trends.
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From page 172... ...
High School - Conducted in 2003. - Public Health Institute, Fast Food - Survey examined school 2003 Survey food service practices in a Contact: sample of California high http://www.phi.org/pdf schools.
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From page 173... ...
These realities underscore the conclusion of the IOM report Preventing Obesity: Health in the Balance that the strategy to address childhood obesity must be to focus on primary prevention (IOM, 2005)
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From page 174... ...
Although policy changes are more likely to meet more resistance than interventions that focus on individual behavior change, a policy change strategy offers the best opportunity to achieve effective and sustained prevention. Behavioral Theory The theoretical framework described in the IOM report Preventing Obesity: Health in the Balance used an ecological systems theory model that depicts the behavioral settings and leverage points that influence food intake and energy expenditure (IOM, 2005)
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From page 175... ...
RECOMMENDATIONS FOR ACTION Overall goals for obesity prevention in MexicanAmerican children parallel those for all children and youth as expressed in IOM's Preventing Obesity, Health in the Balance. In the long term, the overriding goals are to
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From page 176... ...
Achieving policy, environmental, and behavioral goals for obesity prevention for MexicanAmerican children and youth will require interventions at many levels, including television, print, and electronic media; schools; communities; and health care settings. To be successful, these efforts must be supported by ongoing research and monitoring and by effective advocacy.
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From page 177... ...
· Support research to develop and evaluate school-based interventions that are sustainable and effective in promoting increased participation in healthful physical activity. Community-Based Interventions Community-based youth programs and policies that create environments where children, youth, and families can share physical activity are critical components of an obesity prevention strategy.
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From page 178... ...
· Encourage collaboration between medical, public health, and school services to provide consistent and thus reinforcing health promotion messages and support for populations of MexicanAmerican children who are at high risk for childhood obesity, independent of insurance status or ability to pay. Research and Monitoring Expanded research and evaluation efforts are needed to provide the scientific underpinnings for obesity prevention efforts.
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From page 179... ...
· Support research to better understand the attitudes and perceptions of Mexican Americans about the health consequences of obesity and the link between obesity and dietary and physical activity habits. · Support continued monitoring of obesity prevalence and related risk factors at the national level, particularly in high-risk populations such as Mexican Americans.
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From page 180... ...
· Provide awards that recognize significant research and programmatic accomplishments in obesity prevention relating to Mexican and Mexican American children and youth. · Provide training grants and fellowship support to encourage young researchers to enter the field of obesity prevention.
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From page 181... ...
1999. Perception of Latinos, African Americans, and Whites on media as a health information source.
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From page 182... ...
2004. Waist circumference percentiles in nationally representative samples of African American, European American, and Mexi can American children and adolescents.
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From page 183... ...
2004. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents.
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From page 184... ...
1989. Genetic and environmental determinants of growth in Mexican Americans.
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From page 185... ...
1999. Weight, stature, and body mass index data for Mexican Americans from the third national health and nutrition examination survey.
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From page 186... ...
2005. Prevalence of impaired fasting glucose and its relationship with cardiovascular disease risk factors in U.S.
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