Fighting Childhood Obesity in Minority Communities

The eight-year-old girl in Dr. Sheila Davis’ qualitative study on childhood obesity weighed 205 pounds.

The little girl and 16 other children and their parents were meeting with Davis and her research team. Why, Davis asked her, do you want to lose weight? “Because I don’t want the earth to move,” the girl replied. “When I jump rope, the children say it feels like an earthquake.”

The obesity epidemic currently sweeping the United States is a particularly poignant problem for the nation’s children. A full 30% of all kids age six to 19 are overweight, and their numbers have doubled in the last decade, according to the Centers for Disease Control and Prevention (CDC).

Among minority populations in this country, the numbers are even more alarming. Statistics from the CDC show that more than 33% of Hispanic/Latino boys are overweight, as are 35.7% of African-American boys and 51.2% of Mexican-American boys. As for female children, 30.1% of Hispanic/Latino girls, 46.4% of African-American girls and 36.7% of Mexican-American girls are overweight.

“We Really Have a Problem”

Davis, PhD, RN, a professor in the School of Nursing at the University of Mississippi Medical Center, is the founder of the university’s Cardiovascular Risk Reduction in Children (CRRIC) Committee, which is studying the obesity epidemic among African-American children in Mississippi. The state leads the nation in obesity and heart disease rates and is among the top 10 in chronic renal failure and diabetes.

“We really have a problem here,” says Davis, who is African American, “but we’re influencing the world.”

CRRIC has conducted descriptive studies of the prevalence of obesity and cardiovascular symptoms among 250 children in grades 3, 4 and 5 in inner city schools in Jackson, Mississippi. The studies found that 39% of the boys and 49% of the girls were in the 85th BMI (body mass index) percentile or higher.

In a separate CRRIC study of third- and fourth-graders in the smaller Mississippi town of Canton, 46% of boys and girls were in the 85th percentile or higher for BMI. Along with that, they had blood pressure problems. Their families, especially grandparents, also showed cardiovascular symptoms of high blood pressure and diabetes.

Overweight children have a harder time learning. They are often teased mercilessly—one little girl quietly told Davis that her nickname was “gorillahead.” As a result, they are either reluctant to enter into class discussions or they assume the disruptive role of class clown.

“We knew that intervention was indicated and unless we intervened, these kids were going to follow their families [into poor health],” Davis says.

Why Johnny Can’t Lose Weight

Nurses across the nation are playing critical roles in the front lines of the battle against childhood obesity. In schools, clinics and even in their own churches and community groups, they are helping children and their families learn to make healthier choices about food and exercise.

The near future of school nursing will be one of secondary prevention, Davis believes. Students will increasingly be hypertensive and diabetic. More than ever, school nurses will be dispensing medicine, giving insulin and preaching the importance of good diet and physical fitness.

Another way nurses can help change unhealthy eating habits is by teaching children to cook nutritious meals. With so many mothers working outside the home, children are increasingly cooking for themselves. Their choices gravitate toward quick, easy options high in fat and salt: instant noodles, hot dogs, grilled cheese and fried eggs. Aided by a grant, Davis’ CRRIC will soon be teaching healthy cooking to children in Canton.

It’s an urgent need all over the country. Children are not getting their recommended daily servings of fruits and vegetables. An alarming 51% of children and teens eat less than one serving of fruit per day, the CDC reports, and 29% eat less than one daily serving of vegetables that are not fried.

“We’re not opposed to ‘fast food,’ but the original fast food is fruit—prepackaged, portable, high in vitamins and minerals,” Davis contends.

Rudy Valenzuela, MSN, RN, FNP, director of clinical services and health promotion at Regional Center for Border Health in San Luis, Ariz., says that all too often the schools themselves are part of the problem. It’s a basic matter of economics, he explains, with the poorest schools finding ways to cut corners and increase income that ultimately jeopardize student health. It’s no surprise that the majority of obese children attend poor schools.

School nurses and community health nurses can influence policy to make their schools offer healthier choices, Valenzuela says. His advice:

 

• Push to have junk food snack machines removed from schools. If the machines are an immovable budget booster, lobby for smaller portion sizes or a switch to healthy alternatives.

   

• Question the availability of soft drinks and sweetened juices and the lack of healthier drinks, like bottled water.

   

• If physical education has been eliminated, present the school board with health data urging its return. Or offer alternative forms of exercise that can be easily incorporated into the school day, along with water breaks.

   

• Keep an eye on cafeteria serving sizes and quality. As budgets get squeezed, schools increase the carbohydrates because they are cheaper to provide.

“I think that nurses are in a great position to offer advice,” adds Valenzuela, who is president of the National Association of Hispanic Nurses. “We are the most trusted profession in the United States. The voice of a nurse is a strong voice, and I think that people listen to it [once we get] the voice out there.”

Healthy Eating Begins at Home

Nurses must also recruit parents to their cause, Davis emphasizes. “If you educate and support them, they’ll form that groundswell and they will demand changes.” In fact, she says, if any progress is going to be made in fighting the childhood obesity epidemic, it will have to start in the home.

“Kids are going to have far more access to sweets in the home than they ever will in the school,” she points out. “The school is a structured, scheduled environment. At home it’s a much greater temptation.”

Davis says children in her CRRIC studies watch at least two to three hours of television every evening during the school week, and on weekends it’s considerably more. The cartoons and sitcoms that African-American children in particular watch are full of commercials for high-sugar, high-fat products that they then encourage their parents to buy.

“Dinner in a bag” is an increasing reality for busy families of all economic situations, she adds. “It’s becoming much more of the culture to pick up something in a bag on the way home, and you eat out of the bag in front of the tube. And the stuff in the bag is going to be higher in sodium.”

Davis laughingly calls fast-food dinners “calming the beast”—like soothing a cranky child with a bottle of Pepsi or a bag of chips during a hectic errand run. But they also can be an inexpensive meal for families on tight budgets. The problem is further compounded by a disproportionately low number of large chain grocery stores in minority and low-income neighborhoods, which severely limits these communities’ access to healthy, fresh food choices.

Even so, parents often underestimate the health risks of excess weight in their children, according to an American Obesity Association survey. And CRRIC studies found that parents had little notion of how much physical activity their children needed in order to become physically fit.

Nurses in pediatricians’ offices, clinics and schools who are attuned to these dynamics can do much to help educate parents. School nurses already contact parents when their children’s health screenings cause concern. Take it a step further, Davis suggests, by giving them information packets that offer practical and attainable ways they can help reduce health risks for their families.

For example, the American Diabetes Association, in partnership with Abbott Laboratories, has created “Weight Loss Matters,” a toolkit designed to help health care professionals teach their patients that obesity and a sedentary lifestyle put them at increased risk for type 2 diabetes. The kit includes monthly tip sheets on how to get started losing weight and eating a more healthy diet, plus brochures on topics such as portion control, physical activity and FAQs about weight and health. They can be easily downloaded from the ADA’s web site, www.diabetes.org.

Culture and Carbohydrates

Both Davis and Valenzuela believe minority nurses can be particularly effective in waging the war against childhood obesity in communities of color. Health fairs at schools, community centers and churches are useful venues for getting the word out to the community at large. Have a nutritionist demonstrate recipes, give out informational materials and offer tips for quick-but-healthy dinners and snacks.

In African-American and Hispanic communities, 60 to 70% of people attend church at least twice a month, Davis points out. This makes churches a prime setting for conducting health education. “Nurses can play a pivotal role in a church or community-type setting,” she emphasizes. “I get a lot of calls to go to various community settings to preach, as it were, health to families. Once you get yourself out [in the community], people will call. Most people are aware of the obesity epidemic, [even though] they may blame it on DNA and everything else.”

Minority nurses’ knowledge of a community’s culture—from urban African American to rural Mexican—can also give them an advantage in helping children and families who are struggling with obesity. For example, the traditional Mexican diet is low in carbohydrates; American Indians for centuries have eaten food low in carbohydrates and fat. But as these cultures have assimilated into the dominant society, they have adopted its less healthy eating habits, Valenzuela says.

“Hispanic nurses are well aware of the regional and cultural diet. If they’re creating a diet plan or nutritional plan for kids in the schools or clinic or at home, they can question the family in their own language,” he notes. “Secondly, they also know the dietary habits of the family, so they can be culturally sensitive in regards to the food intake.”

For example, a Hispanic nurse might point out that a corn tortilla has less than half the fat of a flour tortilla. Working with a nutritionist, he or she could present easy, quick meal plans that are healthy and traditional.

Unfortunately, says Valenzuela, “carbohydrates are really cheap compared with protein. [For a low-income family,] it’s easier to buy bread than to eat meat.” That’s one of the hurdles to better eating, he adds: finding a way to modify the diet and still make it affordable. Yuma County, where Valenzuela’s clinic is located, has a 50% poverty rate.

The effect of high-sugar, high-fat foods on Hispanic and Mexican cultures has been devastating, Valenzuela continues. Since the late 1970s, the obesity rate has more than doubled for Mexican-American boys age six to 11 and nearly tripled for boys in their teens. It has also doubled for Mexican-American girls. Hispanic children have become increasingly overweight at a similar rate.

Practicing What You Preach

To make a difference against such daunting odds, nurses should set an example in their own diet and fitness choices, Valenzuela believes. “How many [nurses] are obese or smoke or do not exercise?” he argues. “Nurses are [responsible for] restoring and maintaining health—that’s what we’re about. And because we center on the person and also the environment around the person, nurses should be living by example.”

Valenzuela, who is studying for a doctorate in nursing, would like to see more Hispanic nurses at the master’s and PhD levels who can get involved in research and academics relating to nutrition, obesity and other health issues. There is also a need for more culturally and linguistically competent nurses to provide care for Hispanic patients. The need is critical, he says: Hispanics are a large and growing population in the United States. In Arizona, for example, Hispanics comprise 25% of the population; in Yuma County, nearly 50%; and in San Luis, more than 90%.

In Mississippi, meanwhile, CRRIC’s team of doctors, physiologists, nutritionists and nurses are tracking early biomarkers—as well as psychological, social and cultural indicators—that warn of impending pathology. They are using the information to build a model to track the children from an early age. Davis is optimistic that once the research is complete the model can be extended beyond Mississippi and applied nationwide.

“This is a living experience for me,” adds Davis, whose six siblings are all diabetic. “I know how these children are going to end up unless we intervene aggressively. It’s a powerful enough foe for me as an adult. I can’t imagine what it [must be] for the child.”