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Childhood Obesity – Strengthening the Capacity of Healthcare Providers to Work in Multicultural Communities in the Clinical Setting.

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Presentation on theme: "Childhood Obesity – Strengthening the Capacity of Healthcare Providers to Work in Multicultural Communities in the Clinical Setting."— Presentation transcript:

1 Childhood Obesity – Strengthening the Capacity of Healthcare Providers to Work in Multicultural Communities in the Clinical Setting

2 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 Donna C. Carey, MD, FAAP. Medical Director | Pediatric Hospitalist Program & Neonatal ICU Chair | Department of Pediatrics Emanuel Medical Center, Turlock, CA L. Hope Wills, MA, RD, CSP, CLS Nutrition Faculty | LEND | High risk Infant, Feeding Clinic | USC University Center for Excellence in Developmental Disabilities | Children's Hospital Los Angeles

4 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 Identify how culture and ethnicity can influence African American patients' decision making related to overweight and obesity. Describe possible challenges, including health beliefs, that contribute to childhood overweight and obesity in the African American community. Describe effective patient/provider communication techniques to help families identify behaviors they can change to help their child reach healthy weight; with a focus on increasing healthy food choices and physical activity Identify risks of overweight and obesity in the African American youth.

6 Overweight - excess body weight Adults BMI Children BMI 85-95th% for age/sex Obese - excess body fat Adults BMI>30 Children BMI > 95% for age/sex Severe BMI >120% of 95%

7 Sisson (2009) Ethic differences in adiposity and subcutaneous fat White children and adolescents demonstrated greater adiposity than black counterparts Use of anthropometric measurements (sum 4 skin fold measures and For a given BMI african american children demonstrated lower skin fold measurements and waist circumference

8 Nearly 1/3 of US children & adolescents Overweight or Obese BMI>85% 26.7% preschool (2-5yrs) 32.6% school aged (6-11 yrs) 33.6% adolescents (12-19 yrs) Obese BMI>95% 12.1% preschool 18% school aged 18.4% adolescents

9 Severe Obesity BMI>97% 9.7% preschool children 13% school-aged children 13% adolescents Highest prevalence in African-American and Mexican-American youth ( Bogalusa Heart Study)



12 American Indian, non- Hispanic Blacks, Mexican-American Child of an obese parent Prenatal/birth environment Low-income (food insecurity, food deserts) Environmental factors (sugar-sweetened beverages, TV time,fast food, computers, playground availability etc) Females vs. males

13 Endocrine - impaired glucose tolerance, metabolic syndrome, PCOS Cardiovascular - HTN, Î LDL, atherosclerosis GI - NAFLD,stones Pulmonary - sleep apnea Psychosocial - body image, self esteem,anxiety, depression Ortho-MS pain, SCFE Neurological Dermatologic

14 16 year old with BMI of 38 Strong family history of type II Db, HTN in both sides of the family Lives with Maternal grandparents, and 2 siblings Wants to lose weight, but cant diet Junior in high school, taking 3 AP courses this year. Needs a scholarship to go anywhere good

15 Challenges Heavy educational load, no room for PE Maternal grandmother does the cooking Picks up siblings after school, no room for afterschool activities Eats under stress

16 Discussion/Solutions – Maternal grandmother (MGM) has high aspirations for Nora. Discussed importance of extra curricular activities in getting into good schools. MGM agreed to support Saturday Drill Team. – Nora will eat family foods on a salad plate in place of a regular plate. – Packing lunch from home so she can spend time relaxing with friends at lunchtime

17 Family composition - single vs multiple parents Discriminatory public/private policies food deserts Access to playgrounds, sidewalks Environmental factors Safety

18 Lack of access to healthy food choices Absence of full-service supermarkets Lack of fresh produce Lack of healthful food options Oversaturation of liquor stores/corner stores Abundance of fast food restaurants

19 Decreased access to physical activity Safety and security Competing priorities (school, exercise, employment, family obligations)

20 13 year old male, BMI 98% for age Lives with both parents, younger sibling Mom & Dad both work 9a-6p-ish jobs Reside in West Oakland Kids home alone after school Not athletic Enjoys playing X-box, Wii

21 After-school snacking at corner store Parents tired after work, eat out a lot Unsafe to play outside No after-school activities Spends a lot of time playing video and computer games

22 Weekend grocery shopping - have to travel outside of neighborhood; teach mom how to read food labels Provide healthy snacks for after-school Crockpot meals on weeknights Purchase interactive games for X-box and Wii (eg Just Dance, sports) Limit TV/computer time on weekends and encourage outdoor play

23 Family structure - who is the real influencer? decision maker? Cultural norms of body image Parental influence Food preparation

24 Culture Misperceptions of weight status External factors

25 Boyington et al, 2008 Weight and body size preference are less influenced by those outside ones social circle Food choices were made based on taste, appearance and context of the meal Engaging in physical activity influenced by social and environmental factors. Participation in structured activity limited by personal aesthetics (time cost of beauty=TCB)

26 19% of mothers of overweight adolescent females underestimated their daughters weight category, 60 % underestimated the severity of their daughters status (Moore et al, 2008) African American Adolescent females under perceived weight status compared to their non-hispanic whites and hispanics (Krause, et al 2011)

27 10 year old female, BMI 88% for age Lives with mother, after-school care by grandmother & grandfather Developing breasts, started menstruation Recent decline in school performance Receiving attention from teen boys for having a body

28 After-school care by grandparents (2 meals) Balance healthy development and encouraging healthy weight status Psychosocial stressors of advanced development Enjoys the attention from teen boys Being thick is it (Krause et al, 2011)

29 Encourage after-school involvement with program that helps her appreciate her developing body (eg. Girls, Inc). Change the focus of what is being esteemed Discuss meal preparation with grandmother. Encourage simple changes and substitutions (e.g.whole to 2% milk, baking vs frying foods)

30 14 y.o, rapid weight gain, over the past 3 months, approaching 95 th percentile Lives with mother and sister. Complaints at school due to excessive sleepiness during the day. Mother complains of snoring at night She sings in the church choir on Sundays. Wheezing, requiring nebulizer three times per day

31 Challenges – Mother works until late, family eats dinner out 4 days out of 7 – Mother frustrated with calls from school, Constance is embarrassed falling asleep at school – Constance and her younger sister stop at the 7 eleven on the way home to pick up snacks, every day.

32 Discussions/Solutions Discussed better food options that Mother can pick up on the way home Discussed things that Constance and her sister can do to get the table ready for dinner (setting table, making salad) Constance loves to SING! Discussed importance of good breath control on singing

33 Family involvement and buy in is CRITICAL to effective change Healthy is just a word, what you are able to do is more important than how you look Important to help youth to define health in THEIR lives TIME cost of fitness, needs to be on the table and discussed openly

34 Health care providers must approach the issue of weight and health as a partnership with the patient and their families. If we work in harmony, building trust and understanding, we have the power to transform our challenges into solutions.

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