Obesity Ma Adolecents: Family Centered

Obesity Ma Adolecents: Family Centered Intervention

Obesity Among Mexican-American Adolescents: Family Centered Nursing Intervention

Community Diagnosis

Overweight/obesity among Mexican-American middle-school aged children related to unhealthy snacks high in fat and calories, and drinks high in calories and sugar as evidenced by Healthy People 2010 objective 19-3 to reduce the proportion of children and adolescents who are overweight or obese; Baseline: 11% for children ages 6 to 11; 11% for adolescents aged 12 to 19; Target: 5% for children ages 6 to 11; 5% for adolescents ages 12 to 19 (U.S. Department of Health and Human Services, 2001)

Aspects of Cultural Assessment

Ethnic/racial identity

Hispanics are the largest and fastest growing ethnic minority in the U.S. And the largest proportion of that growing population self-identifies as Mexican or Mexican-American (66%). (Flegal, Ogden & Carroll, 2004, p. S144) Most adolescents within this group self-identify as Mexican-American and most attend public schools and interact both inside and outside of their own identified cultural/ethnic groups, to varied degrees. Outside of educational and some mixed community interaction many Mexican-American adolescents interact mainly within their own cultural/ethnic groups and among similar aged peers of like backgrounds.

Values

That having been said it is clear that Mexican-Americans have values associated with a family-centric cultural global view. Families can be large and extended family is often very active in the lives of these adolescents. Additionally, parenting styles are often seen as authoritarian in nature which many believe can have broad implications in values as well as activities related to health and wellness. (Ward, 2008, p.410)

Language

The degree to which these adolescents communicate in their parent's or grandparent's native language is variable and often associated with the generation of immigration, for example if the individual and his or her parents immigrated they are more likely to speak Spanish, and English as a second language, while if the individual's parents immigrated before they were born or shortly thereafter they might also only speak limited Spanish and often only at home. While if their grandparent's immigrated they are more likely to speak only limited Spanish in the home, and often what they term as "Spanglish" or an amalgamation of English and Spanish words. Few second and third generation Mexican-American young people speak what could be called fluent Spanish and are more comfortable communicating in English especially to outsiders of the culture.

Health Beliefs

Access to health care can be limited, depending on socioeconomic status which in general is below the mainstream. The health care system in Mexico must also be mentioned here, as many people in the nation live at or below the poverty level self administration of pharmaceutical drugs is common, and pharmacies/pharmacist are the main source of healthcare education and intervention. Most prescription drugs are over the counter and require no real diagnostic process to obtain, other than the general guidance of a pharmacist. Therefore it is not common to seek medical care from a doctor, unless the situation is perceived as grave. For those who have access to health care intervention may be delayed, if the perception of the illness of unhealthy condition is low risk and some may even be encouraged to self-medicate.

Religious Beliefs

Many Mexican-American families self-identify as Christian (often Catholic), more so in first generation female immigrants and have strong ties to church and conversely to family and culture through church. Second and third generation families are only marginally removed from the rigors of church affiliation. Spirituality is often defined through religious beliefs, though this can be much less for latter generations of immigrants. Adolescents, like those in many cultures often reject strong ties to religion and prefer to define spirituality as separate from religion, though most likely express a strong belief in a higher power and are more or less involved depending on their family demands.

Lifecycle Events

Birth, coming of age, marriage and death are all crucially important to most Mexican-Americans, within the confines of a strong family dynamic, as well as a historically religious culture. Birth is a celebrated event with multigenerational celebration and welcoming of new life into the family. Coming of age is celebrated with elaborate parties that are associated with the culture and faith, (Quincenera) more often for girls than boys at the age of 15 (though some boys also celebrate the passage). Marriage is also an often elaborate family event, within the confines of religion and even in more secular traditions. Death is also a large part of the Mexican-American culture, as ancestors are celebrated in Mexico during an elaborate day of the dead traditions that focus on the comfort and connection one has in the afterlife to the current generations.

Nutritional Behavior/Diet

It must also be said that many individual immigrants have very recent memories regarding food deprivation or food insecurity in their home culture. Culturally speaking many Mexican-American (mother's especially) see a moderately overweight child as healthy, given that their cultural origins are in a nation where malnutrition is common as are intestinal parasitic infestations. For this reason and others the culture has a broad concept of the thin child as being unhealthy and a moderately overweight child, who can still function normally as being healthy rather than overweight and Mother's/Grandmother's are often very insistent on "feeding" children regularly. (Ward, 2008, pp. 410-411) Though these perceptions are changing the availability of unhealthy food is so common in the U.S., and especially low cost food alternatives that the transition from one culture to the other does not allow for very healthy eating. Lastly a very logical though underappreciated problem is that in high-density communities there are fewer supermarkets and grocery stores, where many fresh fruits and vegetables as well as other healthier foods are sold at very reasonable prices. In high population-density areas the options for shopping are limited to corner markets, and are especially limited for those who for reasons of time and language barriers do not frequently leave their communities to shop for food. One very clear reason why some Mexican-American adolescents have a particularly high rate of overweight and obesity could in part be associated with limited availability of healthier options close to where their mothers and grandmothers live and therefore shop.(Kumanyika & Grier, 2006, p.187) Availability of fresh and good looking fruits and vegetables is relatively high in Mexico and the comparative sample of the offerings in American corner stores would leave most people wanting. Many families also rely heavily on the public school nutritional system, which is increasingly in question, especially with regard to fresh fruits and vegetables offerings as compared to cheaper fast-food like offerings and many sugary drinks and snacks.

Review of Literature on the Health Problem

Why is this diagnosis a health problem for this target group?

Overweight/obesity among Mexican-American middle-school aged children related to unhealthy snacks high in fat and calories, and drinks high in calories and sugar as evidenced by Healthy People 2010 objective 19-3 to reduce the proportion of children and adolescents who are overweight or obese; Baseline: 11% for children ages 6 to 11; 11% for adolescents aged 12 to 19; Target: 5% for children ages 6 to 11; 5% for adolescents ages 12 to 19 (U.S. Department of Health and Human Services, 2001) According to the midpoint review the problem among children is in fact increasing rather than decreasing, despite greater awareness and multiple levels of intervention strategies. According to Heiss (2008) the statistical increase is a full 5% with the HP 2010 start point at 11% increasing to 16% during the period of midpoint review. (p. 475) Specifically for the Mexican-American population the increases are even more staggering.

For Mexican-American boys ages 2 to 19 years, the prevalence of overweight was greater (22.0%) than for non-Hispanic Black (16.4%) or non-Hispanic White (17.8%) boys. The prevalence for overweight among Mexican-American girls ages 2 to 19 years (16.2%) was greater than non-Hispanic White girls (14.8%) (Ward, 2008, p. 408)

Additionally, the incidence of obesity among Mexican-American (MA) children like in other populations is increasingly associated with younger and younger incidence of obesity related diseases, including; type 2 diabetes, heart disease, high blood pressure, hyperlipidemia and a host of health related problems. According to Fortmeier-Saucier, Savrin, Heinzer & Hudak MA children diagnosed with type 2 diabetes had higher BMI and higher than normal total cholesterol and triglyceride levels. (2008, p. 142) the findings indicate that overweight/obese MA children show incidence of obesity related disease indicators that are similar to obesity related disease indicators in adults.

What are the current nursing interventions for this problem?

Fortmeier-Saucier, Savrin, Heinzer & Hudak indicate that the health connections between the incidence of obesity in MA children and adolescents and high early markers for cardiovascular disease, i.e. high lipid levels in the blood indicate that one of the best nursing interventions would be to advocate for increased testing of blood lipid levels among at risk youth. The same researchers also stress the need to focus, "… on nursing interventions aimed at maintaining normal lipid values, a leading health indicator of Healthy People 2010 (DHHS 2000), can assist in health promotion." (2008, p. 146) Flegal, Ogden & Carroll stress the need to educate lowering the fat content of the diet through nursing intervention and practice. (2004, p. S147) These nursing interventions can like this work stress the implementation of a program that exposes adolescents to healthier alternatives and builds the efficacy for obtaining them through successfully seeking family behavior changes and building awareness about healthier options and food costing that make such options obtainable.

What interventions have been successful and what interventions have NOT been successful?

It is clear that general nutrition education, in the schools or in the community has not been an effective intervention tool for children in general, especially given what some would consider the deplorable condition of the public school nutrition programs in most states. It is also clear that family focused interventions are rare, but where they have been tried they have proven most successful for the MA population. (Heiss, 2008, p. 475) Seeking to change the cultural understanding of obesity at the maternal and family level is likely one of the most important aspects of nursing intervention for MA adolescents

Ward offered a powerful set of options, coming from the perspective of the school nurse researcher:

By gaining a greater understanding of parental cultural beliefs and values, parenting styles, and acculturation in the Mexican-American community, the school nurse will be able to develop culturally relevant interventions for nutrition education in the school setting….Tyler (2004) explored the interest of overweight Hispanic children in making lifestyle changes to promote a healthy weight and found the children were interested in family-based interventions, such as & #8230;learning about healthy eating together as a family. School nurses should include family participation in many different school-based nutrition education programs. (2008, p. 412)

The development of an intervention plan with both short-term and long-term goals, surrounding family focused interventions is clearly the best and most logical evidentiary standard. (Tyler, 2004)

Planning

Plan Title: "Obesity Among Mexican-American Adolescents: Family Centered Nursing Intervention"

Short-Term Goal

A developed and implemented plan for an obesity prevention family intervention-based program for MA adolescents seeded in one middle school and continued in at least one community center or church. Program components include three strategies, first to introduce middle school classrooms to healthy eating through a demonstration and instructional session. Second strategy is to hold a four-week class involving families in buying, eating and cooking with better healthier options. The third aspect of the work plan will be to evaluate the outcome of the family intervention strategy.

Measurable Objectives

1. The conduction of a mini-introduction to culturally sensitive healthy eating and cooking in middle school classrooms in a single school with a high number of MA students, Cognitive

2. Enrolment of ten families with adolescents in a healthy low cost culturally sensitive healthy eating class, 8 weekly sessions. Consisting of recipes and education about alternative foods. Affective 3. Follow up questionnaire three weeks after close of class, discussing the nature of change in eating and cooking in the home, conduct by phone interview. Affective Objectives Summary

These three objectives involve the family in a change that is health related and specific to culture. The mini-introduction classes may get the individual adolescents thinking about how they cook and eat at home while the classes specifically involve the families and address the ability of the family to stretch its food dollar while still staying healthy and true to their culture. The objectives are specific, measurable, reasonable/feasible and clearly fit within the context of a community setting, they are also clearly understood and practical for the clients. The application of food buying techniques and healthier replacement options that are sensitive to culture, healthy, full of fruits and vegetables and fast and easy to make is essential to involving the family in a change action that will aide them in making better decisions in their own homes, for meals as well as bulk stored healthy snacks.