Noisy Water Review

Mexican American Youth and the Rising Incidence of Obesity

Michael Cahill

Abstract

The incidence of childhood obesity is rapidly increasing in the US, with the highest rate of growth in the Mexican American population. Ten peer-reviewed nursing and health care journals addressing pediatric obesity in Mexican Americans were selected and analyzed for this study. This qualitative study addresses the growing trend in overweight and obese children in the Mexican American culture based on the findings presented in the chosen nursing and health journals. Factors, such as acculturation, socioeconomics, perception, and depression are examined as possible causes for the high incidence of obesity in Mexican American youth. After identifying some of the possible reasons for the high prevalence of obesity in Mexican Americans, culturally-minded health care interventions are then explored that may help effectively prevent or possibly reverse the growing trend of obesity.

Introduction

In recent months the United States (US) media and government have concentrated its efforts on educating the public about H1N1 and its deleterious effects on young children; however a greater threat to the health of children continues to loom over the US: pediatric obesity. Currently 34% of US children and adolescents, ages 6 to 19 years of age, are classified as overweight and 17% are categorized as obese (Centrella-Nigro, 2009). Excess body weight and obesity predisposes children to chronic adult health conditions, such as type 2 diabetes mellitus, cardiovascular disease, and asthma (Small, Melnyk, Anderson-Gifford, & Hampl, 2009). When this US pediatric population is examined by ethnicity, Mexican American children have the highest rates of childhood obesity (Centrella-Nigro, 2009).

Mexican Americans are a sub-culture of Latino Americans, which consists of American citizens with any background from Cuba, Mexico, Puerto Rico, South America, Central America, or Spain (Centrella-Nigro, 2009). Currently Latino Americans make up 14% of the US population and are expected to rise to 24% by 2050 (May & Rew, 2009) with Mexican Americans accounting for almost two-thirds of the population (Centrella-Nigro, 2009). Research has shown that the prevalence of obesity in Mexican American adolescents from 1998 - 2006 has increased from 9.2% to 19.9% in females and from 14.1% to 22.1% in males (May & Rew, 2009). This rising incidence of obesity calls for immediate action to address ways to improve the health of Mexican Americans. It is the purpose of this paper is to explore the culture and the factors leading to the growing prevalence of obesity in Mexican American youth. The paper will then focus on suggesting ways to help reduce the growing incidence of obesity through culturally-minded interventions.

Method

Online databases hosted by EBSCO, such as Academic Search Premier, Health Source: Nursing/Academic Edition, and CINAHL, were accessed to locate nursing and health journals published between 2005 and 2010, which addressed obesity in Mexican American youth. Phrases, such as Mexican Americans, pediatric obesity, overweight youth, and nursing interventions were used as key word searches. A total of 424 peer-reviewed articles were found using these key word phrases. Abstracts were reviewed and articles relevant to Mexican American youth and obesity were selected for further review. Journal articles were selected for this qualitative review based on their content addressing culturally-specific factors leading to obesity and research studies of successful interventions to prevent and treat obesity in Mexican American youth.

Discussion: Knowledge

Children in the US are considered overweight if their body mass index (BMI) is greater than the 85th percentile (Small et al., 2009) and obese if their BMI is greater than or equal to the 95th percentile (Howell Adams, Carter, Barnett Lammon, Hicks Judd, Leeper, & Wheat, 2008). Several factors have been linked to the high rates of obesity in Mexican American children. Understanding the Mexican American culture is an important first step to make in order to explore ways to reduce their high incidence of obesity. According to Centrella-Nigro (2009), socioeconomics, perception, and acculturation are factors that may lead to excess body weight in Mexican American children. High incidences of depression may also play a role in the rising trend of obesity in Mexican American children as well (Melnyk, Jacobson, Kelly, O’Haver, Small, & Mays, 2009). By exploring these proposed reasons for the rising trend in Mexican American obesity, US health care workers may begin to develop effective interventions to correct this problem.

Low socioeconomic status has been linked to the high levels of overweight and obese Mexican American children. According to Hancock (2005), over the past two decades, the majority of Mexican immigrants have been settling in the southeastern rural regions of the US. Mexicans settling in the rural US typically earn lower wages and lack suitable education. Families with low income typically live in areas that lack access to healthy foods and have been found to spend less on fruits and vegetables when compared to families with higher income (Centrella-Nigro, 2009). A study conducted by Howell Adams et al. (2008) cited that parents with less than a high school degree have children who are 1.65 times more likely to be obese when compared to children of parents with an education beyond high school. The high incidence of low income and education levels among Mexican settlers in the US may be a reason for the rise of excessive body weight in Mexican American children.

According to Small et al. (2009), Mexican American families with higher income still have children at risk for being overweight. Mexican American parents find that they both need to work in order to provide the commodities that their children expect in order to be part of American society, such as fast food, video games, and television. The increased work hours allow children to have more independence in choosing their own foods and spending their leisure time as they see fit. As the parents struggle to provide their children all the American conveniences, they do not have as much time to properly monitor their child’s health habits.

The growing trend of overweight children may also be linked to Mexican Americans’ unique perception of an ideal body weight. Mexican Americans and their Latino American counterparts hold a cultural belief that a healthy baby is an overweight baby (Centrella-Nigro, 2009). A qualitative study by Small et al. (2009), consisting of eleven Mexican American parents, found that parents perceived a solid body, which is a large body weight consisting of muscle, to be healthier than a thick body, which is a body weight consisting of excess body fat. When the examiners asked the parents how they distinguished between a solid and thick body, they almost all answered that they just knew. The parents then shared details of how they assessed their child’s body weight; however almost all parents wanted confirmation from the examiners of whether their methods were efficient. The findings from this study suggest that Mexican American parents feel that a child with a large body weight is healthy; however they lack confidence in their methods to properly distinguish between a muscular and a chubby build.

Acculturation is the process of an immigrant group adapting a new dominant culture’s customs, values, and beliefs to their own culture (Harrington, 2008). Obesity has also been observed to increase in prevalence with each new successive Mexican American generation. Second and third generation Mexican Americans have a higher incidence of obesity when compared to first generation-born family members in the US (Centrella-Nigro, 2009). These findings suggest that as Mexican immigrants become more ingrained in American life, the incidence of Mexican American obesity increases. Several of the eleven parents studied by Small et al., (2009), revealed that they gained over fourteen pounds within the first three weeks of arriving to the US. Some of the reasons for this rapid weight gain, described by the participants, were attributed to longer work days leaving little time for healthy home cooked meals and decreased physical activity due to increased use of cars. The participants also reported that it was unsafe for their children to play outside due to increased traffic; therefore physical activity was limited.

The combination of cultural perception of ideal body weight, low socioeconomic status, and acculturation also showed a strong correlation among Mexican American obesity. Centrella-Nigro (2009) highlighted a study, consisting mostly of immigrant Mexican American mothers from areas of low socioeconomics and education, which showed that they were accurate in assessing their own BMI. When shown images of various bodies, they chose bodies with thinner figures as most desirable for themselves. When these same mothers were asked to assess their children, most identified those children who were in the 50th to 75th percentile BMI as being too thin, whereas children in 97th percentile BMI were identified as being just a little overweight. Mothers in the same study who were more acculturated picked slimmer figures as a more ideal body weight for their daughters.

Depression and excessive body weight also seem to have a strong correlation amongst Mexican Americans. A study conducted by Jaser, Holl, Jefferson, and Grey (2009) found that Latino American adolescents had a higher incidence of depression when compared to non-Latino adolescents. Results of the study also showed that adolescents with high levels of depression were more likely to make poor dietary decisions and less likely to participate in physical activity. These findings indicate that depression can lead to obesity amongst Mexican American adolescents since Mexican Americans make up such a large percentage of Latino Americans. It can also be inferred that early treatment of depressive symptoms can have a profound impact on the prevention of obesity in Mexican Americans.

The experience of the migratory and adaptation process of Mexicans to the US may play a role in the high incidence of Mexican American depression. According to Hancock (2005), the migratory process imposes high levels of stress and can lead to a high incidence of depression among Mexican immigrant families. Some of these stresses include: language disparities, transition from a male dominant family to a more equalitarian family as wives enter the workforce, and increased pressure on older children to take care of their younger siblings. Rapid acculturation to the US lifestyle has also been shown to have deleterious effects on Mexican immigrants predisposing them to a higher incidence of drug use and psychological problems.

Discussion: Application

Socioeconomics, perception, acculturation, and depression have been identified as factors related to the rising incidence of overweight Mexican American children, so how can health care providers work to prevent and decrease this trend? The answer may be to use knowledge of Mexican culture as a guide when developing interventions that encourage physical activity, education of healthy behaviors, and methods to prevent and treat depression. Mexican cultural concepts of familism and personalismo are significant variables that need to be included in health care in order for the interventions to be effective (Vincent, 2008). Familism or family cohesiveness is considered very important in Mexican American culture and has a strong influence on a family member’s decisions. In traditional Mexican culture, family is thought of as a survival net, which holds a strong sense of duty to one another reaching to extended-family members. Personalismo involves establishing and maintaining trusting relationships, which helps encourage people to share their concerns (Hancock, 2005). These concepts suggest that the inclusion of strong family involvement and social relationships may help increase the effectiveness of weight loss and prevention interventions.

In a qualitative study by May and Rew (2009), twenty-one Mexican American mothers and their children were interviewed for their opinions of how healthy eating and physical activity habits could be best promoted. The results of the study showed that the participants felt that nurses and schools could best educate parents and their children about health promotion. These findings suggest that interventions to promote weight loss and weight prevention in Mexican American youth may be best promoted by schools and school nurses. Evidence of a successful obesity intervention using schools to promote health habits was found in a three year study conducted by Jiang, Xia, Greiner, Wu, Lian, and Rosenqvist (2007). Five schools in Beijing participated in this experiment with two schools selected as the focus group who received weight loss interventions. All schools were similar in size and socioeconomic status based on parental educational level, occupation, and income. The results of the study showed that the prevalence of obesity and excess body weight decreased by 26.3% and 32.5% in the two schools who received interventions, where obesity and body weight increased in the control schools, which did not receive the interventions.

The experiment conducted by Jiang et al. (2007) included families in their school-based weight loss prevention by inviting parents to school assemblies. Parents were then distributed educational pamphlets outlining information about childhood obesity prevention, which included weight and height references by age and gender. There was also an extra meeting at the beginning of each semester where parents of already overweight and obese children were given information about healthy foods using a traffic light food list. Traffic food lists categorized unhealthy foods to avoid, high in fat and calories, as red light foods and healthy foods to be encouraged, low in fat and calories, as green light foods. Parents were also given calorie intake tables with traditional Chinese food items that allowed parents to easily calculate the number of calories that their children ate with each meal and compare them to the recommended requirements. Other interventions included the encouragement of increased physical activity, such as taking walks with their children after dinner and allowing their children to stay 20-minutes later after school to participate in a running program.

In the design of a successful and culturally-sensitive weight loss intervention program for Mexican American youth, concepts of familism and personalismo need to be included. In the school-based intervention designed by Jiang et al. (2007), family involvement was pivotal to the success of the program. Parental education in the experiment’s intervention program was designed based on the participants’ socioeconomic status consisting of educational level, occupation, and family income. Designing education materials for Mexican American parents based on a region’s socioeconomic level may involve translating pamphlets into Spanish and using literature that correlates with the region’s parental education level. In addressing the subject of Mexican American perception of obesity and the uncertainty of assessing healthy body weight, parents may find it helpful to receive similar, Spanish-written information pamphlets on weight and height references that the Beijing intervention group received in the experiment.

The Mexican American concepts of familism and personalismo have also proven to be effective when included in body weight control interventions. In an 8-week study by Vincent (2009), weekly 2-hour group sessions were held where Mexican American adults were educated on making low-fat modifications to traditional foods and promoting culturally acceptable exercise programs, such as walking and dance. The control group of the experiment also consisted of Mexican American adults; however they were not involved in group sessions and only received standard health care education from a brief meeting with a physician.

The theme of familism was included in Vincent’s (2009) experiment, by encouraging the participants to bring a family member as a support person to each session. Personalismo was incorporated by using a certified diabetes educator, who was bilingual and knowledgeable of Mexican culture, to conduct the group meetings and establish a relationship with the participants. The certified diabetes educator, known as a promotora, also made weekly phone calls to the intervention participants of the study to answer questions and to remind them of the next session. The results of the study showed a mean weight loss of five pounds and a decrease in BMI in all participants of the intervention group, where members of the control group reported an increase in BMI. These findings suggest that Mexican American families, seeking health promotion interventions, may benefit from follow-up phone calls made by a health care worker familiar with Mexican culture.

The strong correlation between the high prevalence of depression in Mexican American adolescents and obesity is another matter for health care workers to intervene. The study by Jaser et al. (2009) suggests that the higher rate of depression among Latino American youth when compared to African American and Caucasian youth may be related to the stress of acculturation. American culture promotes adolescents to become more autonomous, whereas Mexican American culture emphasizes adolescents to be more involved with their families. The difference between these two cultural expectations may cause Mexican American adolescents to struggle in their mental development. School-sponsored programs to address acculturation issues and other issues specific to Mexican American psychosocial development may be helpful in treating and preventing depression.

Melnyk, Jacobson, Kelly, O’Haver, Small, and Mays (2009) conducted a study on the effectiveness of a mental health promotion program, which educated Latino adolescents on living a healthy lifestyle. Participants in the intervention group were involved in a 9-week program, which included strategies and information on stress management, self-esteem promotion, goal setting, nutrition, and physical activity. The participants in the control group were not involved in the 9-week program. Before the study began, blood samples were drawn from each participant involved in the study. At the end of the study, participants in the program reported less depression, less anxiety, and a stronger commitment to health when compared to the control group. Participants in the intervention program also demonstrated improved physiologic results, such as a decrease in BMI, a decrease in LDL, and an increase in HDL levels. The results of this study indicate that school-supported mental health programs may improve both mental and physical health in Mexican American youth.

Conclusion

A strong familiarity of cultural background is important for nurses and other health care workers to possess before they can offer treatment. The population of Mexican Americans is continuing to grow along with the rising trend of pediatric obesity, indicating a need to address this issue at a young age. Socioeconomics, perception, acculturation, and depression are factors that may be related to the high incidence of obesity in Mexican American youth. By becoming familiar with these factors and how they affect the health of the Mexican American culture, interventions can be designed in order to effectively decrease and eventually prevent the high rate of pediatric obesity in America.

The inclusion of Mexican concepts of familism and personalismo in the promotion of health behaviors directed towards weight loss and prevention has been shown to highly increase the effectiveness of the interventions. If nurses and health care workers have an understanding of these two concepts when working with Mexican Americans, then their interventions may be more efficient. School involvement has also been shown to be a valuable tool in educating Mexican American families and may prove to become a mandatory resource that nurses and health care workers will utilize as further study of treating Mexican American obesity is continued. For future treatment of obesity in Mexican Americans, nurses and health care workers may need to work closely with local schools and begin educating children at an early age about adequate health behaviors in order to prevent excess body weight and eventually reverse the rising incidence of obesity.

References

Centrella-Nigro, A. (2009). Hispanic children and overweight: causes and interventions. Pediatric Nursing, 35(6), 352-356. Retrieved from CINAHL with Full Text database.

Hancock, T. (2005). Cultural Competence in the Assessment of Poor Mexican Families in the Rural Southeastern United States. Child Welfare, 84(5), 689-711. Retrieved from Academic Search Premier database.

Harrington, S. (2008). Overweight in Latino/Hispanic Adolescents: Scope of the Problem and Nursing Implications. Pediatric Nursing, 34(5), 389-394. Retrieved from Academic Search Premier database.

Howell Adams, M., Carter, T., Barnett Lammon, C., Hicks Judd, A., Leeper, J., & Wheat, J. (2008). Obesity and Blood Pressure Trends in Rural Adolescents over a Decade. Pediatric Nursing, 34(5), 381-394. Retrieved from Academic Search Premier database.

Jaser, S., Holl, M., Jefferson, V., & Grey, M. (2009). Correlates of Depressive Symptoms in Urban Youth at Risk for Type 2 Diabetes Mellitus. Journal of School Health, 79(6), 286-292. doi:10.1111/j.1746-1561.2009.00411.x.

Jiang, J., Xia, X., Greiner, T., Wu, G., Lian, G., & Rosenqvist, U. (2007). The effects of a 3-year obesity intervention in schoolchildren in Beijing. Child: Care, Health & Development, 33(5), 641-646. doi:10.1111/j.1365-2214.2007.00738.x.

May, K., & Rew, L. (2010). Mexican American Youths' and Mothers' Explanatory Models of Diabetes Prevention. Journal for Specialists in Pediatric Nursing, 15(1), 6-15. doi:10.1111/j.1744-6155.2009.00207.x.

Melnyk, B., Jacobson, D., Kelly, S., O'Haver, J., Small, L., & Mays, M. (2009). Improving the Mental Health, Healthy Lifestyle Choices, and Physical Health of Hispanic Adolescents: A Randomized Controlled Pilot Study. Journal of School Health, 79(12), 575-584. doi:10.1111/j.1746-1561.2009.00451.x.

Small, L., Melnyk, B., Anderson-Gifford, D., & Hampl, J. (2009). Exploring the Meaning of Excess Child Weight and Health: Shared Viewpoints of Mexican Parents of Preschool Children. Pediatric Nursing, 35(6), 357-368. Retrieved from Academic Search Premier database.

Vincent, D. (2009). Culturally tailored education to promote lifestyle change in Mexican Americans with type 2 diabetes. Journal of the American Academy of Nurse Practitioners, 21(9), 520-527. doi:10.1111/j.1745-7599.2009.00439.x.

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