Title: Carolyn Montoya MSN CPNP Coordinator FNP/PNP Concentrations College of Nursing University of New Mexico
1Carolyn Montoya MSN CPNPCoordinator FNP/PNP
ConcentrationsCollege of Nursing University of
New Mexico
- Working with Families Cultural Issues
- In Pediatric Obesity
April 28, 2006
2 - National Association of Pediatric Nurse
Practitioners - Healthy Eating and Activity Together Campaign
3 HEAT Focus
- Prevention of overweight in childhood and
identification of children at risk for overweight
as well as its physical and psychological
morbidities.
4 HEAT Key Characteristics
- Strength-based
- Relationship-based
- Evidence-based
- Culturally sensitive
5Major 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
6Prevalence 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.
7Measurement 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.
8Prevalence 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
9Prevalence 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.
10Prevalence 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.
11Prevalence 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.
12Prevalence 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
13Prevalence 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.
14Prevalence 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.
15Prevalence 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.
16Prevalence of Overweight Children
- Native American Rates vary among tribes
estimates as high as 39 for boys and 40 girls.
Citation 2
17Questions 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
18Strategies 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
19Cultural 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
20Cultural 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.
21Cultural 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
22See Citation 3
23N223 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.
24Eckstein, K. et al. (2006) Parents perception
of their childs weight and health. Pediatrics
117 3 681-690.
25Does 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
26FOOD 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.
27ACCULTURATION
- 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.
28ESSENTIAL 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
29Cultural 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?
30Cultural 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.
31Cultural 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
32Cultural ConsiderationsSchool Age Teens
- Encourage parents to offer traditional foods and
not to offer children alternative foods when they
refuse traditional foods No Come Nada4
33Cultural 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
34Envision 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
35Envision 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
36INTERNET 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
37Food and Nutrition InformationCenter
- http//www.nal.usda.gov/fnic/index.html
38Native American Food Pyramid http//www.nal.usda.g
ov/fnic/Fpyr/NAmFGP.html
39http//www.napnap.org/index.cfm?page198sec220s
sec486
40Unless 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.
41Citations
- 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.
42Citations
- 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.