A Meta-Analysis of Adolescent Obesity Among Immigrant Latino Population in San Antonio - Research Paper Example

A META-ANALYSIS OF ADOLESCENT OBESITY AMONG IMMIGRANT LATINO POPULATION IN SAN ANTONIO, TEXAS Affiong Udoiwod Ph.D. Walden PUBH-8115-10 Instructor: Dr. Patrick Williams Spring Quarter 2011 Introduction This research project is focused on the most dramatic problem of the modern society- obesity. Especially, this problem has captured America. On the one hand, this country has a great potential to provide their nation with a worthy life level. On the other hand, the speediest tempos of Americans’ lives and their too active business activities or life positions prevent them from healthy diet. Thus, it is more comfortable for them to eat in fast foods and do not spend much time on cooking at home. A problem of obesity is a complex phenomenon that should be considered on the social, economic, psychological and cultural levels. A target group chosen for the research consists of immigrant Latino population in San Antonio, Texas. It has been often claimed, that ethnic minority groups are subjected to a high risk of becoming obese in comparison with other Americans. Lower living level, other spheres of occupation, a lack of proper education, inability to have a constant access to information about healthy way of life and possibilities to live this kind of life and many other factors have prevented ethnic minorities from being healthy people. Therefore, this target group is one of the most vulnerable social groups to the destructive influence of obesity. POPULATION: Latinos have become the largest racial/ethnic minority group in the United States of America, and are expected to grow to about one-fourth of the population by the year 2050 (Delva, OMalley & Johnston, 2007). The term Hispanic is used interchangeably with Latino and refers to descendents of at least 25 different countries, all of which are Spanish speaking (Centrella-Nigro, 2009). Definition of Hispanic or Latino origin used in the 2010 Census refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race (U.S. Census Bureau, 2010). Hispanics now make up 38 percent of Texas’s 25.1 million people, up from 32 percent a decade ago. Bexar County, which includes San Antonio, grew by 23.1 percent and is home to 1.7 million. In accordance with the 2010 census San Antonio population grew by 25 percent to 1.33 million people , the Hispanic population grew by 25 percent making to 63.2 percent Hispanics in San Antonio (U.S. Census Bureau, 2010). According to the Texas Department of State Health Services, over 30% of adolescents in Texas are overweight or obese. That is 1 in 3 teenagers. Obesity is not just a physical condition –it has many psychosocial implications that need to be acknowledged. PREVALENCE: According to the Health Profiles 2005 by The San Antonio Metropolitan Health District (SAMHD) the Hispanic population is expected to far outpace other ethnicities by 2040 and beyond. The Hispanic population faces well-documented health concerns, such as obesity. Programs addressing those areas should be maintained or increased. Bexar County’s Hispanic population is also younger with fewer college graduates than any other ethnic population. Those factors are often predictors of future poverty and increased risk for associated health problems such as obesity. Unfortunately, 90% of Hispanics in Bexar County have not earned at least a 4-year college degree. Moreover, the Hispanic population is burdened with additional risk factors for childhood obesity, including parental obesity, low socioeconomic status (SES), recent immigration, acculturation to US diet and lifestyle, and limited health insurance coverage, ethnic beliefs, differences in ideal body images, lack of appreciation of weight management, questionable literacy levels, and access to medical care (Wilson, Adolph, & Butte, 2009; Centrella-Nigro, 2009; & Harrington, 2008). Source: 2009 FITNESS GRAM, According to FITNESSGRAM a Healthy Weight equals BMI ranging from 14.7-27.8 for boys and 16.2-27.3 for girls adjusted for age. 216,935 Students (Grades 3-12) 84% Tested or 181,387 Students 30% Unhealthy Weight or 54,717 Students In the review of research by Park, Menard, & Schoolfield (2001), the reasons for the differences in prevalence of childhood obesity in the Hispanic are complex, likely involving genetics, physiology, culture, environment, and interactions among these variables as well as others not fully recognized. Understanding the influence of these variables on the patterns of eating and physical activity that lead to obesity will be critical to developing public policies and effective clinical interventions to prevent and treat childhood obesity. Obesity with its associated metabolic complications, related risk factors and diseases are often seen among adults are increasingly being recognized in obese adolescents and even children and teenagers (Ogden & Carroll, 2009). The prevalence of childhood obesity in Hispanics exceeds that of other ethnic groups. The Centers for Disease Control reported that in 2000 the prevalence of obesity was 20% of Mexican American children. Pubertal maturation is known to impact on obesity development. Girls who mature early have higher BMI and sum skin folds during their teenage years than girls, who mature later, and this interaction is the strongest one among Hispanic girls. More than 35 percent of Texas schoolchildren are overweight or obese. The number of overweight and obese children has doubled over the last 20 years, and it continues to rise. DEMOGRAPHICS: The average age of the Hispanic population is younger than all other ethnic groups and this trend will continue well into the 21 century due to higher birth rates and continued immigration. The Census Bureau projects that by 2050 the Hispanic population will be about 103 million; one in four Americans will be Hispanic; in states such as Texas, Hispanics will be the clear majority. The relevant issue for dealing with obesity is the increased focus on the use of positive youth development interventions for preventing adolescent health risk behaviors. Healthy People 2010 identified overweight and obesity as 1 of 10 leading health indicators and called for a reduction in the proportion of children and adolescents who are overweight or obese. The American Obesity Association declared San Antonio, Texas, the fattest city in the United States. According to statistics from the U.S. Center for Disease Control, 31% of its residents are obese and 65% are overweight: the worst record in the nation. Studies by Kandula et al. (1998) have found increased obesity in immigrants as their time spent in the United States increases. Texas has a disproportionately high Hispanic population in comparison to the total U.S. population. Texas BRFSS 2008 Risk Factor: Obesity (BMI 30 or greater) Area: San Antonio MSA Sample Size* % at risk 95% CI Lower Upper Texas 10,011 28.9 27.4 30.4 Nationwide 395,832 26.7 26.4 27.0 San Antonio MSA 1,387 29.7 26.4 33.3 Gender Male 504 32.4 27.1 38.3 Female 883 26.9 23.0 31.2 Race/Ethnicity Hispanic 467 37.1 31.1 43.4 Age Group 18-29 Years 96 20.7 12.0 33.3 Notes Respondents 18 years and older who have a BMI calculated by self-reported height and weight. This review sought to examine the relationship between acculturation and diet among Latinos living in the United States. A current research initiative, led by the National Heart, Lung, and Blood Institute, addresses these two sufficient information to draw any meaningful conclusions. Researchers are growing increasingly interested in understanding the influence of acculturation on health behaviors and health outcomes INCIDENCE: Longitudinal Studies of Adolescent Health by Popkin & Udry (1998) and Girard, Peterson, & Tatone-Tokuda, (2007), also found that adolescent obesity increases significantly with each generation after immigration, and that Asian American and Hispanic adolescents born in the United States are more than twice as likely to be obese than first generation (foreign-born) adolescents. Culture also has an impact on obesity and probably contributes to some of the racial and ethnic disparities that are present. In the studies of immigrant families who move to the US, rates of obesity skyrocket within two to three generations. The more acculturated individuals become to the American culture, the more likely they are to become overweight (Fleming & Towey, 2004). Fleming & Towey (2004) also noted that because of the limited changes in the genetic pool over the past few generations, environmental and cultural influences appear to be dominant. Key public health issue addressing growing rates of adolescent obesity that is contributing to chronic disease. Estimates how 38.3% of Bexar County residents are overweight and an additional 29.7% are obese. Obesity is a leading cause of diabetes and 15.6% of Bexar County residents are diabetic – this is nearly double the national average. OBESITY AND HEALTH: Childhood obesity has important health consequences for children and is a major antecedent significant predictor of obesity in adulthood and the likelihood of adult obesity is greater for obese adolescents. Adolescent obesity, a major public health problem, has important health, social and economic consequences for the adolescent. The clustering of cardiovascular risk factors related to obesity in children includes hyperglycemia, dyslipidemia, inflammation, and hypertension, which are predictive of adult-onset cardiovascular disease. The association of obesity in childhood with the emergence of type 2 diabetes is also disproportionately seen in Hispanics. The prevalence of type 2 diabetes in increasing, especially in Hispanics and impaired fasting glucose, a risk factor for type 2diabetes, was found in 13% Hispanic adolescents (1999–2002 NHANES). Moreover, liver disorders in obese youth vary from simple steatosis to steatohepatitis to cirrhosis. Fatty liver is more common in obese boys than in obese girls. In a study of obese children ages 2–19 years, fatty liver disease was present in 50% of Hispanics (Park, Menard, & Schoolfield, 2001). Obesity in children is associated with severe impairments in quality of life. BEHAVIORAL DIMENSIONS: According to Seeman (2001), data presented by the Population Association of America pinpoints a study drawn from interviews with about 6,000 teen-agers nationwide about half from recently immigrated Hispanic and Asian families suggests that kids born in the United States quickly adopt "overweight-related behaviors." They dont exercise as much. They watch more TV. They eat less fruit, fewer vegetables, less rice and beans. The trends have alarmed health advocates because overweight people have an increased risk of diabetes, high blood pressure, stroke and some cancers (Seeman, 2001). Studies show that overweight children miss three or four times as much school as children who are not overweight and often struggle with social problems, such as depression and low self-esteem. PSYCHOSOCIAL DIMENSIONS: Obesity during adolescent carries with it important psychosocial sequelae. Obese female adolescents become adults who, on average, earn lower wages and are at increased risk of living in poverty, and obese male adolescents are less likely to marry as adults. According to studies by Goodman & Whitaker (2002) obesity may lead to lower self esteem among adolescents and young adults, especially Hispanic and non-Hispanic white females and the social stigmatization associated with obesity is believed to engender chronic embarrassment, shame, and guilt, all of which may lead to affective disorders. SOCIOECONOMIC DIMENSION: Socioeconomic factors are likely to exert a profound influence on health, and childhood and adolescent obesity. Across school districts, the proportion of children eligible for free school meals, one index of SES, is a reliable predictor of childhood obesity rates. Access to resources and services may not be equivalent for a given level of education or income. In San Antonio and Bexar County among Hispanic students the High School Dropout rate (attrition rate) is 43%. Neighborhood of residence may influence access to healthy foods, opportunities for physical activity, the quality of local schools, time allocation, and commuting time. SES and childhood obesity are linked by the low cost of widely available energy-dense but nutrient- poor foods. Fast foods, snacks, and soft drinks have all been linked to rising obesity prevalence among children and youth. PREVENTION: The Thrifty Food Plan (TFP), a recommended diet meeting federal nutrition recommendations at the estimated cost of $27 per person per week; that would require the commitment of 16 hours of food preparation per week. In San Antonio, ten zip codes have been identified as high-risk areas for ongoing public health problems. The map of Bexar County below outlines the areas in red, green and yellow, which demonstrates the “broken window” effect. The “broken window” metaphor has been used across the country to point out wide disparities in services between the haves-and-have-nots. Health is more than Health Care: Preventable chronic diseases are linked to obesity and no exercise. Among children and adolescents, obesity is more common in Hispanic. Lack of physical activity, a major risk factor for obesity, is notably higher for Hispanic children especially with parents who have lower incomes. Pressures on families to minimize food costs and acquisition and preparation time, resulting in frequent consumption of convenient foods that are high in calories and fat (CDC) Obesity cannot be prevented as an isolated issue, particularly in adolescents. It must be part of a larger approach that addresses all needs of adolescents. Prevention of obesity as it relates to psychosocial factors (such as abuse and depression) may be directly influenced by holistic positive youth development approaches to the health and well-being of children and adolescents on community level interventions. Traditionally, nutrition and physical activity strategies have been behavior-based, and have targeted individuals. Rather, the environment has become conducive to weight gain (busy schedules, larger portions, reliance on cars, unsafe neighborhoods). It is inefficient to try and fix the overweight and obesity problem for one person at a time. Rather, we need to make more widespread changes that can create an environment supportive of healthy weight. Preventing risk factors in younger adults presents a potential money-saving investment for the Medicare program. Medicare costs for those men with three or more risk factors at middle age were more than twice as high at $38,044. Similarly, women without any risk factors earlier in life cost Medicare an average $11,711 to treat cardiovascular disease from age 65 until death while those with three or more cost $38,059, the researchers reported (Ogden & Carroll, 2009). “Medicare costs strongly relate to middle-age risk factors. People need to pay attention to health when they are middle-aged or younger – by the time they are older it could be too late. NEED FOR OBESITY PREVENTION IN SAN ANTONIO/BEXAR COUNTY: 65.8% of adults are overweight or obese 30% of students assessed have an unhealthy weight 15.6% of residents are diabetic –nearly double the national average The rate of end-stage renal disease is twice the national rate Diabetes is the leading cause of death among Hispanic males aged 45-64 26.7% of births are to women with a BMI>30 The American Recovery and Reinvestment Act - San Antonio - Communities Putting Prevention to Work (CPPW) is a result of The American Recovery and Reinvestment Act of 2009 (ARRA) states that “$650M shall be provided to carry out evidence based clinical and community-based prevention and wellness strategies authorized by the Public Health Service Act that deliver specific, measurable health outcomes that address chronic disease rates” (Ogden & Carroll, 2009). The US Department of Health and Human Services (HHS) developed an initiative in response to the Act called Communities Putting Prevention to Work to reduce risk factors and prevent/delay chronic disease and promote wellness in both children and adults, and provide positive, sustainable health change in communities. San Antonio Metropolitan Health District, Texas received $15.6 Million to improve opportunities for physical activity, nutrition, and active living; the San Antonio Metropolitan Health District will work with community partners to expand the number of public facilities, including schools that are available for after-hours use for physical activity. San Antonio will encourage city development projects to improve protection for vulnerable users. The project also will implement voluntary healthy food and beverage guidelines for local restaurants and will conduct trainings for education leaders to improve physical activity and the availability of healthy foods in schools. PUBLIC HEALTH POLICIES: Community-based programs, social marketing campaigns and associated media focusing on the undesirability of obesity and specifically on areas (e.g. schools) with a high density of families of low socio-economic status and poor education are more likely to be heeded by those with already high levels of education; people with lower educational attainment are much less likely to change their behavior as a result of education efforts. Legislative measures with broader policies influencing income distribution, employment, housing and social services, are more likely to affect the whole population, regardless of educational attainment (Walls, Peeters, Proietto, & McNeil, 2011). Bexar County’s broken window shows the areas of greatest need. Red denotes the highest number of low-income households, unemployment, single or school-age mothers, incidents of drug abuse, crime, overcrowded housing, high school dropouts and lack of higher-level educational opportunities all of which are risk factors for adolescent obesity. Public health in San Antonio is tasked to gather all the tools to “fix the window”. Zip codes marked in yellow show emerging concentrations of the same harmful health indicators. For these areas, SAMHD recommends greater public attention and continued funding for promotion of good nutrition and healthy exercise for all ages. Among adolescents aged 12-19, obesity increased from 5.0% to 18.1% from 2007-2008. In 2007-2008, the prevalence of obesity was significantly higher among Hispanic adolescent boys from 14.1% to 26.8%. Among girls in the period 2007-2008 there was an increase from 13.4% to 17.4% among Hispanic girls. CONCLUSION Therefore, an existent problem of obesity among immigrant Latino population in San Antonio, Texas cannot be denied. The problem of obesity should be solved or prevented on local and governmental levels. Moreover, families’ ways of life should be reconsidered and developed in accordance with the obesity preventive factors. Healthy food availability and access to health programs or possibilities to go in for sports do not depend on families only. It is more relevant to give these opportunities to ethnic minorities’ families, who comprise risk group of potentially obese people. Thus, the American government is on the right way when it introduces social programs and policies directed on the ethnic minority families to get access to healthy food or sports activities. The problem of obesity among representatives of immigrant Latino population in San Antonio, Texas, as well as among the rest of the American society cannot be removed at once. It is a complicated multistage process requiring decrease of poverty levels, property taxes, and house values etc. Moreover, it is necessary to develop a more objective way to assess the wealth or the relative deprivation of a neighborhood. All these factors affect access to healthy foods and opportunities for physical activity shows the complex relationships between social and economic resources and obesity prevalence. References Centrella-Nigro, A. (2009). Hispanic Children and Overweight: Causes And Interventions. Pediatric Nursing, 35(6), 352-356. Retrieved from EBSCOhost. Delva, J., OMalley, P. M., & Johnston, L. D. (2007). Health-related behaviors and overweight: a study of Latino adolescents in the United States of America. Revista Panamericana de Salud Pública, 21(1), 11-20. Retrieved from EBSCOhost. Fleming M. & Towey K. (2004, January). Adolescent Obesity, Nutrition, and Physical Activity. Retrieved from www.ama-assn.org/go/adolescenthealth Goodman, E., & Whitaker, R.C. (2002, September). A Prospective Study of the Role of Depression in the Development and Persistence of Adolescent Obesity. Pediatrics, 110, 497-504. Retrieved from http://pediatrics.aappublications.org/cgi/reprint/110/3/497 Gordon-Larsen, P., Harris, K., Ward, D. S., & Popkin, B. M. (2003). Acculturation and overweight-related behaviors among Hispanic immigrants to the US: the National Longitudinal Study of dolescent Health. Social Science & Medicine, 57(11), 2023. doi:10.1016/S0277-9536(03)00072-8 Harrington, S. (2008). Overweight in Latino/Hispanic Adolescents: Scope of the Problem and Nursing Implications. Pediatric Nursing, 34(5), 389-394. Retrieved from EBSCOhost. http://circ.ahajournals.org/cgi/content/full/104/23/2855 Kandula, N. R., Kersey, M., & Lurie, N. (2004, April). Assuring the Health of Immigrants: What the Leading Health Indicators Tell Us. 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