Moms bring a heaping portion
of culture to the table
Graciella Contreras takes pride in providing healthy meals for her five children. Guests to her Denver home are offered fresh fruit as snacks and there is not a calorie of junk food to be found in her cupboards.
Contreras, who emigrated from Mexico as a young adult, can’t understand why many Latina mothers in this country let their children get fat. They are lazy, she says. It’s easier for them to reach for a bag of chips or bring home a dinner in a bag than to prepare nutritious food for their babies, she told Lauren Clark, PhD, FAAN, associate dean for research and extramural affairs at the University of Colorado Denver School of Nursing.
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| Graciella Cntreras's children have been the picture of health since they were young. |
Contreras’s success in creating a healthy home environment can be seen in her five healthy, normal-weight children, ranging in age from eight to 17.
Clark wanted to get Contreras’s perspective on healthy eating habits for a study she and her collaborator, Susan Johnson, PhD, are conducting on the obesity epidemic among Hispanic children in the Denver metro area. Their goal is to understand the influence of Hispanic culture on food habits and the role of women in nutrition.
“ Obesity begins early,” said Clark. “There’s been a lot of attention given to overweight adults and older children, but birth to two years of age is such a critical prevention time. If we can prevent kids from battling the problem from the beginning, we might have fewer adults becoming overweight and getting diabetes and heart disease.”
According to national estimates, 40-50 percent of school-age Mexican-American boys and 34-52 percent of school-age Mexican-American girls are overweight or obese, compared to 20-25 percent of non-Hispanic white children. In 2005, Hispanics were 19 percent of Colorado’s population.
Obesity is a complex issue
During key growth periods, such as between four to six months of age, high rates of childhood obesity affect the long-term health potential of children. Since childhood obesity tracks into adulthood, the older the obese child, the greater the likelihood he or she will become an obese adult.
Overweight and obese young children are like the canaries in the coal mine for the health care system, since their expanded girth puts them at greater risk for hypertension, stroke, type 2 diabetes and certain cancers. A report in the August 2004 issue of Pediatrics recommends that children as young as three years of age have their blood pressure checked whenever they visit the doctor. Hispanics have a three-fold increase in the prevalence of diabetes, and a diabetes mortality rate twice that of the white population.
Through their research, Clark and Johnson learned that families with a parent working two jobs or doing shift work tended to substitute snacking in place of regular meals, serving fast food and discouraging boisterous indoor play to keep the kids quiet and content.
“ Studies of Mexican-American childhood nutrition show that as they get older, these children eat increasingly fewer of the recommended servings of fruits and vegetables,” said Clark. “In children aged two and older, most eat more than the recommended daily amount of cholesterol.”
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| Lauren Clark, PhD, FAAN |
Cultural attitudes
The researchers have found that Latina moms frequently have inaccurate perceptions of whether their children have a weight problem. Often, the women believed their children were a normal weight, when they actually were overweight, and sometimes even obese. They have a tendency to believe chubby children are healthier.
Using drawings of infants of varying degrees of heft, researchers sought to assess maternal preferences for infant body type. Their study indicates that mothers perceive overweight infants as being a normal weight.
Some of the comments made during the study indicate how entrenched these views are:
“They’re
too fat when they have trouble walking or breathing.”“The baby is too fat if she doesn’t
fit in car seat or if he can’t fit in diapers.”“Don’t
worry about the weight until they’re in kindergarten…”One reason that obesity is increasing among Latino kids, the researchers have found, is that their parents, who are second and third generation Americans, have switched from serving traditional foods, such as rice, beans and vegetables, to the much less nutritious, fast-food options.
“ I’ve worked with immigrant families who come with definite ideas about fresh fruits and vegetables and exercise, like Graciella. People with those habits do great,” said Clark. “Two or three generations down the line, especially if they are living in poverty in inner cities, they soon become unhealthy in the typical American fast-food eating environment.”
Designating junk food as a scapegoat isn’t a complete answer. Nor should improved school lunches and fewer drive-through meals be considered a panacea for solving the obesity problem. But unless something is done to stop children’s ballooning weight, society will be faced with a morbidly obese, dysfunctional population that will put strain the health care system with an appalling array of health problems.
Nurses on the front line in the obesity battle
The staggering rise in the numbers of overweight children, with its associated health ills and financial burdens, is an issue that health care providers are facing on a daily basis. It has been noted that school nurses may soon be regularly called upon to administer insulin shots and hypertension medication.
Lack of a “medical home” (a dedicated health care provider or facility) can set patients up to have escalating health problems that aren’t noticed or dealt with in a timely fashion. Nurses may see overweight kids occasionally for acute situations but feel conflicted about dealing with a chronic problem when they might not see the child again for a year.
“ If nurses gave quick advice about getting the child to lose weight, that could possibly harm the child more if he isn’t followed with regular health care,” Clark said. “They’re reluctant to label a child as overweight or obese.”
The study is providing valuable information to the researchers. The next step will be to build a community-based participatory coalition to help develop measurable interventions in Hispanic children. Improving the health of young children who are overweight depends on structuring conversations with parents about obesity prevention, integrated with an understanding of cultural norms and feeding practices specific to the family.
“Biology is not destiny, nor is one’s family eating pathology one’s destiny,” said Clark. “Even preschool children can be supported in learning and applying self-regulation to eating.”
For parents like Graciela Contreras, who have immigrated to the United States and raised healthy children without a weight problem, the answer is vigilance. Clark and her research team are interested in how cultural beliefs and practices in families like Contreras’s set up parents and grandparents to value fresh food, family mealtimes, gardening and developmentally appropriate introduction of weaning foods. Exploring and emphasizing these kinds of cultural values may be the first step in helping families raise a healthy future generation.
“ Parents have to make hard choices. I have never had much money,” said Contreras, “and it is my job to see that I use that money to buy healthy food. I have to say ’no’ a lot.”
