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Hispanic Childhood Obesity: Kent County
Chris Common, Angela Common, Jill Slade, Crystal Bendele,
Kelly Larr, Heather Metz, Heather Morgan
NURS 340
Ferris State University
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Abstract
“Today, nearly 1 in 3 children in America is overweight or obese” (Childhood obesity, 2010, para 1). Children of all ages are one group of individuals that are affected by being overweight or obese. “In 2007, 28.9% of Michigan youth, grades 9 through 12, were either overweight or obese; 16.5% were overweight and an additional 12.4% were obese” (Overweight and Obesity in Michigan, 2009, pg. 3). Within Kent County, Michigan many different cultural and ethnic groups make up its population. The Hispanic population of Kent County, Grand Rapids continues to be on the rise. “Hispanics comprise the largest ethnic minority group, with 44 million people or 14.8% of the total population within the United States” (Maurer and Smith, 2009, pg. 271). “Hispanic children of both sexes are more likely than their non Hispanic White peers to be overweightor obese at all age groups” (Ryan, 2010, pg. 1).
Hispanic Childhood Obesity
Childhood obesity has increased three fold over the last ten years. Eleven percent of children are overweight, and children with obese parents are seventy percent more likely to be overweight (McKevitt 2003). As weight increases so do the chances of heart disease, diabetes, and breathing difficulties. Childhood obesity is more prevalent in Hispanic children than in any other ethnic group in the United States (Butte 2003). In Kent county seventeen percent of children are Hispanic. In 2005 one in four Hispanic adults was obese with one in six Hispanic children suffering from obesity (AccessKent.com). In Kent county most of the Latino population lives in the inner city. For children in these areas they are not allowed to ride their bicycles or play outside due to safety concerns. These areas usually have a high incidence of crime and violence. Inner city areas do not have access to parks, playgrounds, or gymnasiums. With no physical activity Hispanic children are at an increased risk for weight gain. Activity levels for Hispanic children in Michigan decrease between the ages of nine and twelve (Mckevitt 2003). Along with no activity, twenty-two percent of Hispanic households suffer from food insecurity (Butte 2003). This means that these families do not have access to high quality, nutritious foods, so they consume high calorie, high fat items. The children will follow their parent’s example and eat these unhealthy foods. Healthy eating behaviors need to be taught to both Hispanic parent and child. Children follow their parent’s examples. With the decreased access to quality food and limited opportunity for physical activity, fighting Hispanic childhood obesity will be difficult.
Factors that contribute to Obesity in Hispanic Children
One of the major health concerns facing the nation’s children is childhood obesity. There are common factors for all obese children. An increase in a sedentary lifestyle is one of the factors. With the increase of computer video games and hand held video games, children do not get the exercise recommended. Another contributing factor is a poor diet. Most children live in families where two parents work and fast food frequently becomes the dinner choice. Poor nutrition combined with sedentary lifestyle is a combination for obesity in any race.
Hispanic children in the U.S. are at greater risk for obesity than other ethnic or racial groups. Hispanic children are twice as likely to be obese as white, non-Hispanic children. The prevalence rates have risen rapidly in the previous decades (Obesity Reviews, 2004). The Hispanic population is burdened with additional risk factors for childhood obesity. Common factors for all children in relation to becoming overweight or obese include lack of exercise and nutrition. Hispanics are also burdened with additional risk factors such as parental obesity, low socioeconomic status, recent immigration, acculturation to U.S. diet and lifestyle and limited health insurance coverage (ADA, 2009). As stated above, an additional study published in the Journal of American Dietetics states that factors such as culture, less education, poor nutrition, and a lack of exercise contribute to the greater incidence of Hispanic childhood obesity (Wilson, 2009).
Disparities in health insurance coverage plays a role in the reason Hispanic children may be obese. In 2001, Wallen performed a study regarding uninsured children and found that Hispanic children represent only 4.3% of Michigan’s total child population, yet they compromise 10.3% of all uninsured children statewide. A total of 19.9% of Hispanic children lack health insurance.
According to the CDC, 17% of children ages 2-19 are obese (2010). Contributing factors to childhood obesity include genetic, behavioral, environmental factors. Less time engaged in physical activity during school also contributes to childhood obesity. Over the last 13 years, physical education among adolescents has decreased 14% (CDC, 2009). According to Michigan Department of Education, not one Michigan high school meets the national recommendations of physical activity (2001). Two thirds of Michigan high school students are not enrolled in physical education.
Those who live in low-socioeconomic families are also at risk for obesity. Nutritional foods often are costlier than higher fat foods. The National Center for Children in Poverty found that 70% of Hispanic Children live in low income families (2008). In addition, eating patterns have also shifted in unhealthy directions. Nutrition factors that increase the likelihood of weight gain are increased serving sizes, availability of convenience foods and more meals eaten away from home.
In relation to school related food trends, there is a selection of prepared school meals as well as other competitive foods. Food service programs are now self-supporting, forcing schools to offer items a la carte to meet financial demands. A la carte foods and fast foods offered do not have to comply with national nutritional standards (MDCH, 2001).
Another major factor that contributes to Hispanic childhood obesity includes genetics. According to the VIVA LA Familia study, on average, 91% of parents to obese Hispanic children are also obese (Wilson, 2009). Kids in families with obese parents tend to be obese themselves. If one parent is obese or overweight, their children have an 80% chance of becoming overweight (University of Michigan, 2010).
With these contributing factors common in the Hispanic culture, it is likely that Hispanics are at a disadvantage when it comes to ideal weight. Low socioeconomic status, genetics, and lack of insurance are contributing factors that make Hispanic children at a disadvantage for weight gain. These factors are more common among Hispanic which may contribute to the identified difference.
Genetics
Even though sedentary lifestyles and poor nutrition play a large role in childhood obesity, genetics are also to blame. Hispanics are more likely to be overweight than any other ethnicity. Twenty-two percent of Mexican-American boys are overweight and sixteen percent of Mexican American girls are overweight (Fisler and Warden 2006). Fisler and Warden 2006 conducted a study based on twenty-five hundred children born to seventy-five different hospitals. These children were of different ethnicities and followed until the age of three. The findings showed twenty-five percent of Hispanic children were obese by the age of three. Obesity rates for African Americans and Caucasians were between fourteen and sixteen percent.
Diet
The Hispanic culture eats a diet high in carbohydrates and fats. A normal diet consists of legumes, while milk, red meat, flour, and cooking with lard. Even though the culture does eat fruit, they eat very little vegetables (Aldrich and Variyam, 2000). The foods Hispanic children eat are cooked with lard or heavy oils and many are fried, such as refritos, beans that are mashed and fried twice (2000). Children today also have easy access to sugary foods and drinks. School stores carry candy, soft drinks, and energy drinks that contain more than a daily allowance of sugar and carbohydrates. These items are ingested then children sit through six hours of lectures with no physical activity, increasing weight gain.
Sedentary Lifestyle
Hispanic children living in low income, urban areas do not play outside due to safety concerns. These children are then forced to stay indoors playing video games or watching television. Hispanic children are also less likely to play school sports. Sports team participation may very well be connected to a family's financial circumstances; fees for participation and uniforms or other equipment might very well exclude a child from participating (Garcia 2008). Being overweight is another hindrance for Hispanic children. They are less likely to be picked for a sports team due to their obesity, forcing them to sit on the bench. Poor diet, sedentary lifestyles, and the genetic occurrence of obesity all play roles with Hispanic weight gain.
Childhood obesity in Hispanic culture through out Kent County, Grand Rapids can be better controlled through health promotion. Primary prevention is key in identifying the problem within the community. Health teaching and counseling are two essential nursing activities that may decrease the likelihood of Hispanic childhood obesity (Maurer & Smith, 2009). Poor diet and the lack of exercise are the primary causes for obesity. Teaching children about proper diet and exercise will allow them to understand what is good to eat and what they should avoid. “Today’s environment plays a major role in shaping the habits and perceptions of children and adolescents. The prevalence of television commercials promoting unhealthy foods and eating habits is a large contributor. In addition, children are surrounded by environmental influences that demote the importance of physical activity” (All About Obesity, 2010, para, 13).
Aside from promoting a healthy diet and exercise it is important to provide secondary prevention. Secondary prevention focuses on early detection of a disease and prompt treatment (Maurer & Smith, 2009). Obesity within Hispanic children can be easily detected by obtaining each individuals body mass index (BMI). “Obesity in children is determined by using BMI-for-age percentiles. BMI-for-age percentiles have emerged as the favored method to measure weight status in children” (All About Obesity, 2010). If the individuals BMI states that they are obese it then is important to treat him or her by reflecting back on primary prevention such as diet and exercise. If obesity continues within Hispanic children with Kent County it puts them at risk for developing diseases such as heart disease, sleep apnea, diabetes, cancer, high cholesterol, and high blood pressure (All About Obesity, 2010).
Within the school systems of Kent County all schools offer food programs and physical education classes to all students. According to the Michigan Department of Education there are physical education standards and bench marks that schools must follow (Physical Education, 2007). Each grade or age groups have different benchmarks to meet. With meeting these benchmarks in school these children within Kent County will have a basis of meeting some of the physical education requirements to maintain a healthy weight and to prevent obesity from occurring. “School lunches must meet the applicable recommendations of the Dietary Guidelines for Americans, which recommend that no more than 30 percent of an individual's calories come from fat, and less than 10 percent from saturated fat. Regulations also establish a standard for school lunches to provide one-third of the Recommended Dietary Allowances of protein, Vitamin A, Vitamin C, iron, calcium, and calories. School lunches must meet Federal nutrition requirements, but decisions about what specific foods to serve and how they are prepared are made by local school food authorities” (National School Lunch Program, 2010, pg. 1). With healthier lunches served, children have less of a choice of eating unhealthy. However, at this time we can not control what children bring in their own lunches from home. We can only educate the children that eating healthy will improve their overall health.
Within Kent County, there are adequate resources within the community to carry out the interventions to prevent childhood obesity within the Hispanic culture. As stated above, there are requirements and benchmarks to meet for physical education within schools and proper lunches are to be served. With these two efforts hopefully we can control the obesity level within Kent County. Aside from gym classes and healthy lunches, health classes taught in school should emphasize the importance of both diet and exercise every single day. They too should go over the risk factors that may develop when a child is obese.
Health promotion is a never ending effort to improve the overall health within in a community. Encouraging children to increase there activity at home can sometimes be a challenge. Children in today’s society tend to have more of a sedentary lifestyle. Again, education and encouragement is what should be implemented to increase the activity level to prevent obesity. After school activities such as athletics allow children to engage in more physical activity outside of physical education class.
The many different school districts within Kent County offer a wide variety of extra curricular activities such as athletics, clubs, or debates. “Kentwood believes that Athletics are an integral part of a student’s educational experience. We believe that participation in Athletics provide a wealth of opportunities and experiences that assist students in personal, athletic and academic growth” (Athletics, 2010).
The local health departments in Kent County could work together with nutritionist and school nurses to make a monthly newsletter to send out to all families of school children about diet and nutrition. The newsletter would include the national and state statistics of childhood obesity along with ways to prevent it. Healthy lunch ideas could be implemented in the newsletter along with fun ways to get your child involved in more physical activity. Aside from diet and exercise, risk factors should be included too. With heart disease being one of the five leading causes of death within our nation, parents may have a tighter grip on not only their childs health status, but their own too (CDC, 2010).
Implementing the interventions to improve each and every individuals eating habits and physical activity level do not require permission to be carried out. With state and national requirements for physical education benchmarks and healthier school lunches, these two steps may impact the rising level of childhood obesity within the Hispanic culture of Kent County.
Health Promotion Model
The rise of obese Hispanic children in Kent County is a reflection and a reminder of the current trend of obese children in American. Obesity is fast becoming an epidemic and nurses have an opportunity to educate, raise awareness, and create change. Nola J. Pender published a mid range nursing theory in 1982 titled the Health Promotion Model. This model focuses on the promotion of living a healthy lifestyle and is applicable to all age groups (Tomey & Alligood, 2006, pp. 452-458).
According to Maurer & Smith (2009), “the Health Promotion Model attempts to account for behaviors that improve well-being and develop human potential” (p. 478). Pender’s Health Promotion Model does not include fear or threats as a means of motivation to change health behaviors. The Model defines individual characteristics and experience and maintains that these factors determine health promotion behaviors.
Individual characteristics and experiences include the frequency of the behavior in the past and among family members. Personal factors that lead to the behavior or increase in national and local rates of obesity are biological, psychological, and sociocultural. These factors combined can be predictive of a given behavior and are also shaped by the targeted behaviors (Tomey & Alligood, 2006, p. 456). Biological factors that influence childhood obesity include age, gender, body mass index, pubertal status, and aerobic capacity or physical ability. Psychological factors that play a role in obesity include a child’s sense of self-worth or self-esteem, self-motivation, and ones’ definition of health. Sociocultural variables must be accounted for as well. The children of Kent County’s Hispanic population are affected by socioeconomic status. This fact relates on a National level as well. Children who are of low socioeconomic status face greater challenges and have reduced opportunities for proper nutrition and physical exercise. Race, ethnicity, acculturation, and education level are also important factors to consider in health promotion (Tomey & Alligood, pp. 456-457).
Behavior-specific cognitions and affect are also considered major motivational significance in any health promotion plan. According to Pender, these variables are modifiable through nursing actions (Tomey & Alligood, 2006, pp. 456-457). Perceived benefits of action are anticipated positive outcomes that will occur do to the implemented changes of the plan. Perceived barriers are anticipated by the persons who are planning as well as implementing the change and personal costs are understood. Essential to overcoming the perceived barriers is a high self-efficacy in children. Children who believe that they are capable of the proposed changes will have greater success with fewer actual barriers (Tomey & Alligood, p. 456). “Interpersonal influences are cognitions concerning behaviors, beliefs, or attitudes of others” (Tomey & Alligood, p. 456). Primary sources of interpersonal support for children are peers, families, and health care providers. Children learn through observation and modeling of the behaviors of those around them. “Situational influences are personal perceptions and cognitions of any given situation or context that can facilitate or impede behavior” (Tomey & Alligood, p. 457). These include perceptions of the options available and the features of the environment where the health promotion activities will take place. This is individual to the community where a health promotion plan is being implemented but can be applied on a national scale as well.