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CMA F OUNDATION C HILDHOOD O BESITY M ULTICULTURAL C OMMUNICATIONS W EBINAR Childhood Obesity – Strengthening the Capacity of Healthcare Providers to Work.

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Presentation on theme: "CMA F OUNDATION C HILDHOOD O BESITY M ULTICULTURAL C OMMUNICATIONS W EBINAR Childhood Obesity – Strengthening the Capacity of Healthcare Providers to Work."— Presentation transcript:

1 CMA F OUNDATION C HILDHOOD O BESITY M ULTICULTURAL C OMMUNICATIONS W EBINAR Childhood Obesity – Strengthening the Capacity of Healthcare Providers to Work in Multicultural Communities in the Clinical Setting

2 The Partnership In 2010, the Federal Office of Minority Health, provided funding support to the California Office of Multicultural Health to initiate a partnership with the CMA Foundation to increase awareness among healthcare professionals about the impact and importance of race, ethnicity and culture on pediatric overweight and obesity. This collaboration lead to the update of the Child and Adolescent Obesity Provider Toolkit in 2011 and the development of a series of webinars to provide additional support to healthcare professionals addressing these issues in 2012.

3 Sophia Yen, MD, MPH Assistant Professor Division of Adolescent Medicine Department of Pediatrics Lucile Packard Children's Hospital Stanford University School of Medicine Raynald Samoa, MD Assistant Professor City of Hope Department of Diabetes, Endocrinology and Metabolism Webinar Faculty Ricky Y. Choi, MD, MPH, Department Head of Pediatrics Asian Health Services Community Health Center

4 Disclosure Statement We have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this activity. We do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

5 Webinar Objectives Using a case presentation format, participants will be able to: Identify how culture and ethnicity can influence Asian-American and Pacific-Island patients' decision making related to overweight and obesity. Identify in which target areas (diet, physical activity) APIs are at greater risk for overweight and obesity. Describe effective patient/provider communication techniques to help families understand behaviors they can take to help their child reach healthy weight/lifestyle/behaviors, particularly focusing on increasing healthy food choices.

6 Complexities of Asian Afghanistan Armenia Azerbaijan Bahrain Bangladesh Bhutan Brunei Burma Cambodia China Cyprus Georgia Sri Lanka Syria Taiwan Tajikistan Thailand Turkey Turkmenistan United Arab EmiratesUnited Arab Emirates Uzbekistan Vietnam Yemen Hong Kong India Indonesia Iran Iraq Israel Japan Jordan Kazakhstan Korea, NorthKorea, North Korea, SouthKorea, South Kuwait Kyrgyzstan Laos Lebanon Macau Malaysia Maldives Mongolia Nepal Oman Pakistan Palestine Philippines Qatar Saudi Arabia Singapore

7 Diversity of Pacific Islander Micronesia Tonga Fiji Papua New Guinea Wallis and Fatuna Cook Islands Niue Hawaii Samoa Maori Aborigines New Caledonia Guam Northern Marianna Tahiti Tokelau

8 14 yo Chinese American male presents to clinic with mother for well child check. Noted to have BMI of 28. He gained 10 lb over the summer when he traveled to visit relatives in China. He lives with his parents and grandparents. He is getting As/Bs in school. At home prefers to spend free time playing video games over outdoor activities. Case

9 While mother is concerned about his weight, grandparents are dismissive. Grandmother does most of the cooking while parents work late. Dietary history: He usually eats noodles for breakfast. Meals at home are family style. He prefers salty meat and eats 2 small bowls of rice at each meal, ramen noodles 2x a week. Case

10 Why is This Important In the State of Asian American, Native Hawaiian and Pacific Islander Health in California Report, Pacific Islander children had the highest rates of 5 th graders in the unhealthy zone for body composition of all ethnic groups in the state In Hawaii, Samoan children had the highest prevalence of overweight, and 29% of all 4 & 5 year olds in Hawaii (multiethnic cohort) were either overweight or obese. In a study conducted at a large community health center in New York City, 40% of Chinese US born boys, aged 6–11 years, were identified as overweight or obese. The LA County Department of Public Health looked at Fitnessgram and found that 49% of Samoans in 5 th, 7 th, & 9 th grades were obese.

11 Definitions of the Epidemic In 2001, the Surgeon General declared overweight and obesity a national epidemic. Originally Different definitions, but now the same BMIAdults /Children >85th%-94th% overweight >95th% obese

12 Weight (kilograms) BMI = [Height (meters)] 2 or lbs x703 in 2 Body Mass Index (BMI)

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14 CDC BMI charts not based on APIs APIs had same % body fat as Caucasian at BMI 3-6 points higher –South Asians are thinner but have greater body fat and higher insulin sensitivity for any given BMI 33% of obese APIs (%BF >25 % for boys, >30 % for girls) not identified using WHO criteria

15 BMI by Ethnicity Per 1996 Medical Expenditure Panel Survey: APIA teens more likely to be overweight than Hispanics, blacks and white (non- Hispanic) teens –APIA teens had 4.35 X the odds of being overweight compared to whites/blacks

16 Consequences of Childhood Obesity Low self-esteem Asthma Sleep apnea Heart disease Type 2 diabetes Fatty liver 70% chance of being obese adults

17 What Contributes to Obesity among Children? Genetic factors Behavioral factors –Food intake –Physical activity Environmental factors –Homes –Childcare or schools –Community INOUT IN OUT

18 Which Foods Predispose to Weight Gain? Fast food –High in saturated fat & sugar –Low in protein 2003 CHIS showed: –26% of 2-5 y/o APIAs ate 2 or more servings of high-sugar foods per day –vs. 23% of African Americans

19 Many Asian Teens Eat Fast Food 4+/wk 2009 CHIS showed: 17% of Asian teens vs 10% of whites

20 Eating out adds calories fast-food restaurant increased calories by –126 calories in 2-11 y/o –309 calories in 12-19 y/o full-service restaurant –160 calories in 2-11 y/o –267 calories in 2-11 y/o

21 Which has more calories? JuiceSoda

22 Answer? Juice 14 cal/oz vs Soda 12 cal/oz Juice has more calories!

23 Foods That Cause Weight Gain Drinks with Calories –Juice, soda, sports drinks, 1%/2%/whole milk –Whole milk is OK until 2 years old –AFTER 2 years old, kids should drink non-fat milk –Water is best Large portion size –All-you-can-eat –More than in homeland Rice, Fatty meat

24 Physical Inactivity Watching TV Playing video games Browsing the Internet

25 0<1234-56-20 19% of Asians 3-5 y/o Watch More TV Than Recommended

26 2005 CHIS, 12-18 y/o Asians

27 % Asian Teens that are Overweight/Obese Teen Boys Worse Than Girls

28 2001-03 CHIS

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30 14 yo Chinese American male presents to clinic with mother for well child check. Noted to have BMI of 28. He gained 10 lb over the summer when he traveled to visit relatives in China. He lives with his parents and grandparents. He is getting As/Bs in school. At home prefers to spend free time playing video games over outdoor activities. Case

31 While mother is concerned about his weight, grandparents are dismissive. Grandmother does most of the cooking while parents work late. Dietary history: He usually eats noodles for breakfast. Meals at home are family style. He prefers salty meat and eats 2 small bowls of rice at each meal, ramen noodles 2x a week. Case

32 Components for change Motivation Resources Culture Change

33 Most Asian Americans are new immigrants –66% born outside of the United States Many parents experienced scarcity in childhood –Scarcity mindset: finish every grain of rice, meat While some live in isolation, others live in multigenerational homes and close knit communities –Parents receive input/pressure on child rearing Cultural Context

34 Different sources of unhealthy foods/extra calories: salty meat, other high calorie drinks (boba milk tea), instant ramen noodles, white rice, snacks from grandparents Traditional food may not be so healthy –Carbohydrates –Pork, shrimp, beef –Fried foods - Lumpia, Tempura Recognize food is an intimate connection to culture and community

35 Plate method difficult to translate into family style meals Obesity not just a problem in the US. Families may have limited knowledge of some fruits and vegetable that are available in the US. Cultural Context

36 Improving Patient Communication to Improve Health Outcomes Communication Patient Values Goal Alignment Resources Patient AdherenceHealth Outcomes This makes it critical to identify how we improve communication with our ethnically diverse patients to improve health outcomes. Provider Guidelines

37 Recommendations 1) Breast Feeding % obesity in NON BFBF 4.5%2.8% Longer is better % obesity 2 mos3.8% 3-5 mos2.3% 6-12 mos1.7% >12 mos0.8%

38 2) Healthy Meals - Careful dietary history including ethnic snacks (high calorie drinks) - Identify the person who prepares food for the child. Educate THAT person. - Suggest culturally acceptable food alternatives: Brown rice (vs white rice), ethnic vegetables, avoid fried food -More fish and chicken, less beef/pork - Eat >5 servings of vegetables/fruits per day Recommendations

39 Healthy Meals (cont) - Encourage family to try new fruits and vegetables - Avoid fast food - Stress appropriate serving size

40 3) Brawn helps brain – being fit is key 4) Emphasize importance of setting life long healthy diet and activity patterns 5) Recognize the other competing priorities (stresses of acculturation) and plug them into community activities 6) Screen Time Limit screen time to < 2 hrs/day. Dont eat in front of a screen. Recommendations

41 7) Strengths: Involve the whole family –Family meals –Be physically active together –Plan active family fun

42 Conclusions Overweight and obesity is an important concern in the API community API children are less physically active, watch more screen time, eat more fast food, and eat fewer fruits and vegetables. Ethnic/Cultural accommodations are important in promoting a healthy lifestyle

43 Questions?

44 Multicultural Resources in the Toolkit EthnoMed – http://ethnomed.orghttp://ethnomed.org Healthy Roads Media - www.healthyroadsmedia.orgwww.healthyroadsmedia.org MiPiramide – www.mypyramid.gov/sp-index.htmlwww.mypyramid.gov/sp-index.html Hawaii Pediatric Weight Management Toolkit- www.pfoh.orgwww.pfoh.org or by contacting Chock at gchock@aap.net.gchock@aap.net Consumer Health Materials in Spanish – http://nnlm.gov/outreach/consumer/chspanish.html http://nnlm.gov/outreach/consumer/chspanish.html Think Culturally (Office of Minority Health) – www.thinkculturalhealth.hhs.gov www.thinkculturalhealth.hhs.gov The Providers Guide to Quality & Culture – http://erc.msh.org/mainpage.cfm?file=5.4.5.htm&module=provider&la nguage=English http://erc.msh.org/mainpage.cfm?file=5.4.5.htm&module=provider&la nguage=English

45 Community Resources for Healthy Eating Have your staff identify resources available in your community to help you help your patients. These may include the YMCA, health plans, school based programs, faith based organizations, local hospitals, parks and recreation programs and community centers. –Have the list easily available in your office. Web based Resource List Academy of Nutrition & Dietetics www.eatright.org www.eatright.org Kids Health from Nemours http://kidshealth.org American Assoc. of Diabetes Educators www.diabeteseducator.org USDA Food & Nutrition Services www.fns.usda.gov California Dietetic Association www.dietician.org YMCA of the USA www.ymca.net United States Department of Agriculture www.choosemyplate.gov NCES Health and Nutrition Education www.ncescatalog.com


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