Carolyn Montoya MSN CPNP Coordinator FNP/PNP Concentrations College of Nursing University of New Mexico

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Carolyn Montoya MSN CPNPCoordinator FNP/PNP
ConcentrationsCollege of Nursing University of
New Mexico

• Working with Families Cultural Issues
• In Pediatric Obesity

April 28, 2006
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• National Association of Pediatric Nurse
  Practitioners
• Healthy Eating and Activity Together Campaign

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HEAT Focus

• Prevention of overweight in childhood and
  identification of children at risk for overweight
  as well as its physical and psychological
  morbidities.

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HEAT Key Characteristics

• Strength-based
• Relationship-based
• Evidence-based
• Culturally sensitive

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Major Components of the Guideline

• Introduction
• Four age groups divisions
• Infancy
• Early Childhood
• School Age
• Teen
• Four divisions within each age group
• Early identification
• Development, communication and relationships
• Nutrition essentials
• Physical activity and sedentary behavior
• Advocacy

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Prevalence of childhood overweight

• At Risk for Overweight
• Any child ages 2 to 20 years with Body Mass Index
  (BMI)-for-age between 85th and 95th percentiles.
• Overweight
• Any child ages 2 to 20 years with Body Mass Index
  (BMI)-for-age gt95th percentile.
• Centers for Disease Control. (2002). Overweight
  Children and Adolescents Screen,Assess, and
  Manage.

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Measurement of overweight

• Body Mass Index (BMI)
• It is a measure of weight for height
• Correlates well with specific measures of
  adiposity
• BMI     Weight in Kilograms   
• (Height in Meters)2

CDC. (2003).National Center for Chronic Disease
Prevention and Health Promotion.
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Prevalence of OVERWEIGHT Children 2003-2004
Selected Ethnic Groups National Health and
Nutrition Survey (NHANES) 2006 Journal American
Medical Association (JAMA) Article
AGE White Percent African American Percent Mexican American Percent
2-19y 16.3 20.0 19.2
2-5y 11.5 13.0 19.2
6-11y 17.7 22.0 22.5
12-19y 17.3 21.8 16.3
Citation 1
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Prevalence of Overweight Children Trends
Non-Hispanic White
YEARS 2-19y 2-5y 6-11y 12-19y
1999-2000 11.0 8.7 11.7 11.4
2001-2002 13.9 8.7 14.8 15.2
2003-2004 16.3 11.5 17.7 17.3
Ogden, et al. (2006). Prevalence of Overweight
and obesity in the United States, 199-2004.
JAMA 295(13) pg. 1551.
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Prevalence of Overweight Children Trends
African American
YEARS 2-19y 2-5y 6-11y 12-19y
1999-2000 18.8 8.7 19.6 23.1
2001-2002 17.5 8.6 19.9 19.3
2003-2004 20.0 13.0 22.0 21.8
Ogden, et al. (2006). Prevalence of Overweight
and obesity in the United States, 199-2004.
JAMA 295(13) pg. 1551.
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Prevalence of Overweight Children Trends
Mexican American
YEARS 2-19y 2-5y 6-11y 12-19y
1999-2000 20.2 10.9 23.4 23.2
2001-2002 19.5 15.9 20.1 21.1
2003-2004 19.2 19.2 22.5 16.3
Ogden, et al. (2006). Prevalence of Overweight
and obesity in the United States, 199-2004.
JAMA 295(13) pg. 1551.
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Prevalence of Children AT RISK FOR OVERWEIGHT
2003-2004 Selected Ethnic Groups National
Health and Nutrition Survey (NHANES) 2006
Journal American Medical Association (JAMA)
Article
AGE White Percent African American Percent Mexican American Percent
2-19y 33.5 35.1 37.0
2-5y 25.0 24.0 32.6
6-11y 36.9 40.0 42.9
12-19y 34.7 36.5 34.3
Citation 1
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Prevalence of Children AT RISK FOR
OVEWEIGHTTrends Non-Hispanic White
YEARS 2-19y 2-5y 6-11y 12-19y
1999-2000 25.1 21.5 26.0 26.2
2001-2002 27.6 20.0 30.2 28.8
2003-2004 33.5 25.0 36.9 34.7
Ogden, et al. (2006). Prevalence of Overweight
and obesity in the United States, 199-2004.
JAMA 295(13) pg. 1551.
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Prevalence of Children At Risk for
OverweightTrends African American
YEARS 2-19y 2-5y 6-11y 12-19y
1999-2000 34.3 21.2 35.8 39.5
2001-2002 31.8 25.3 31.9 34.5
2003-2004 35.1 24.0 40.0 36.5
Ogden, et al. (2006). Prevalence of Overweight
and obesity in the United States, 199-2004.
JAMA 295(13) pg. 1551.
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Prevalence ofChildren At Risk for Overweight
Trends Mexican American
YEARS 2-19y 2-5y 6-11y 12-19y
1999-2000 36.6 23.1 38.8 43.3
2001-2002 37.0 30.1 39.4 38.5
2003-2004 37.0 32.6 42.9 34.3
Ogden, et al. (2006). Prevalence of Overweight
and obesity in the United States, 199-2004.
JAMA 295(13) pg. 1551.
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Prevalence of Overweight Children

• Native American Rates vary among tribes
  estimates as high as 39 for boys and 40 girls.

Citation 2
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Questions regarding Strategies for Working
withDiverse Populations

• Do health communication campaigns influence
  health behavior?
• Do health campaigns specifically aimed at
  diverse groups work?
• Speaking of Health Assessing Health Communication
  Strategies for Diverse Populations 2001.
  Institute of medicine of the National Academies.
  The National Academies Press. Washington, D.C.
  www.nap.edu 2001

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Strategies for Working withDiverse Populations

• Intracultural Variation
• Stereotyping
• Speaking of Health Assessing Health Communication
  Strategies for Diverse Populations 2001.
  Institute of medicine of the National Academies.
  The National Academies Press. Washington, D.C.
  www.nap.edu 2001

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Cultural Views of What Constitutes an Overweight
Child

• Being overweight not necessarily associated with
  being unhealthy among African American and
  Hispanic families
• Thinness often associated with poor health

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Cultural Views of What Constitutes an Overweight
Child

• One study found that Hispanic mothers believed a
  little extra weight would help children recover
  from illnesses. Thin children tended to be more
  likely to develop disease.
• Crawford, Patricia, et.al. (2004). Counseling
  Latina mothers of preschool children about weight
  issues suggestions for a New Framework.
  Journal of the American Dietetic Association.
  104(3) 387-394.

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Cultural Views of What Constitutes an Overweight
Child

• Majority culture places huge emphasis on
  thinness, youth, and beauty
• More cultural acceptance of larger body type
  among African Americans
• Should the majority culture be held as the ideal?
  OR
• VALUE different body types and emphasize health,
  rather than weight

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See Citation 3
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N223 60 lt6yrs 42 Male 17 Black 35
Hispanic 42 White 7 Other 20 Overweight 19
At risk for overweight
Eckstein, K. et al. (2006) Parents perception
of their childs weight and health. Pediatrics
117 3 681-690.
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Eckstein, K. et al. (2006) Parents perception
of their childs weight and health. Pediatrics
117 3 681-690.
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Does the Hispanic Paradox Exist?

• Even though risk factors may be elevated for
  Hispanics for diseases such as coronary heart
  disease, some national data indicates lower
  mortality rate for Hispanics.
• May be that spirituality, adaptive coping
  behaviors provide a certain protective factor
• Lack of John Henryism need to succeed at all
  costs

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FOOD INSECURITY

• Definition food supply or ability to acquire
  food becomes limited or uncertain
• Greater food insecurity has been associated with
  higher prevalence of obesity in low-income Latino
  women
• Little to no research on the impact of food
  insecurity may have on overweight Latino children

Kaiser,Lucia et.al. (2004). Choice of
instrument influences relations between food
insecurity and obesity in Latino women. American
Journal Clinical Nutrition 80 1372-8.
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ACCULTURATION

• Traditional foods versus alternative foods
• Child-led snacking versus setting limits
• Use of bribes, threats and punishments to
  encourage eating

Kaiser, L. et.al. (2001). Acculturation of
Mexican-American mothers influences child feeding
strategies. Journal American Dietetic
Association. 101(5) 542-547.
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ESSENTIAL CULTURAL CONCEPTS When working with
Hispanic Families

• Simpatia the practice of being respectful
• Familismo need for the patient to consult with
  the family about a treatment plan
• Personalismo need to establish a personal
  relationship
• Respeto - feeling of being respected

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Cultural Considerations ApplicableAll Age Groups
Motivational Interviewing

• Conviction How important is this issue of being
  overweight to the child and family?
• Confidence Whats holding the child/family back
  from making changes?

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Cultural Considerations ApplicableAll Age Groups

• Include extended family members in discussions
  related to childs health (may not be necessary
  with older teen)
• Encourage appropriate physical activity
• Focus on positive health
• Consequences of good
• Nutrition and increased
• Physical activity rather than
• Focusing on the childs
• WEIGHT.

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Cultural Considerations - INFANCY

• Review normal patterns of infant growth and
  closely monitor rate of weight gain especially in
  the first 6 months of life.
• Additional guideline specific for Native
  American infants Assess infant for intrauterine
  exposure to diabetes and promote breastfeeding

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Cultural ConsiderationsSchool Age Teens

• Encourage parents to offer traditional foods and
  not to offer children alternative foods when they
  refuse traditional foods No Come Nada4

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Cultural ConsiderationsSchool Age Teens

• Hispanics and Native Americans beans, corn
  tortillas, vegetables
• African American fruits and vegetables
• Hispanics Encourage parents to involve school
  age children in the preparation and serving of
  meals.
• Native Americans Provide information on the
  Pathways curriculum Http//hsc.unm.edu/pathways

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Envision New Mexico
Pediatric Initiative in New Mexico to deal with
the issue of overweight children in this
state http//www.envisionnm.org/programoverview.ht
ml
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Envision New MexicoOverweight Collaborative AIMS

• To improve health care for children adolescents
  who are recipients of Medicaid in New Mexico
• To implement significant practice changes in
  provider offices in order to
  improve health outcomes and reduce healthcare
  costs
• To offer providers best practice improvement
  tools
• To provide clear and consistent messages for
  children and families
• To facilitate change through improved provider
  communication skills
• To promote collaboration between primary care
  practices, SBHCs, families, and communities

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INTERNET RESOURCES

• VERB Its what you do. is a national,
  multicultural, social marketing campaign
  coordinated by the U.S. Department of Health and
  Human Services Centers for Disease Control and
  Prevention (CDC). http//www.cdc.gov/youthcampaign
  /index.htm
• The VERB campaign encourages young people ages
  913 (tweens) years to be physically active every
  day.
• Spanish VERB and Spanish Parent Site

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Food and Nutrition InformationCenter

• http//www.nal.usda.gov/fnic/index.html

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Native American Food Pyramid http//www.nal.usda.g
ov/fnic/Fpyr/NAmFGP.html
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http//www.napnap.org/index.cfm?page198sec220s
sec486
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Unless effective population-level interventions
to reduce obesity are developed, the steady rise
in life expectancy observed in the modern era may
soon come to an end and the youth of today may,
on average, live less healthy and possibly even
shorter lives than their parents. The health and
life expectancy of minority populations may be
hit hardest by obesity, because within these
subgroups, access to health care is limited and
childhood and adult obesity has increased the
fastest.
Andres
Alejandro
Gabriel
Oishansky, S. J., et.al. (2005) New England
Journal of Medicine 352 (11) pg. 1143.
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Citations

• Ogden, C. Carroll, M., Curtin, L. McDowell,
  M. Tabak, C. Flegal, K. (2006). Prevalence of
  overweight and obesity in the United States,
  1999-2004. JAMA 295(13) 1549-1555.
• Story, M. Stevens, J. Himes, J. Stone, E.
  Rock, B.H. Ethelbah, B. Davis, S. (2003).
  Obesity in American-Indian children prevalence,
  consequences, and prevention. Preventive
  Medicine 37 S3-S12.

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Citations

• 3. Sherry, B. McDivitt, J. Birch, L.L. Cook,
  F.H. Sanders, S. Prish, J.L. Francis, L. A.
  Scanlon, K.S. (2004). Attitudes, practices, and
  concerns about child feeding and child weight
  status among socioeconomically diverse white,
  Hispanic, and African-American mothers. Journal
  of the American Dietetic Association. 104(2)
  215-221.
• 4. Garcia, Richard (2004). No Come Nada. Health
  Affairs. 23(2) 215-219.