Obesity in Mexican-American Adolescents: Family Nursing Intervention

Community Diagnosis

Overweight and obesity among Mexican-American middle-school-aged children are related to unhealthy snacks high in fat and calories, and drinks high in calories and sugar. This diagnosis is evidenced by Healthy People 2010 objective 19-3, which aimed to reduce the proportion of children and adolescents who are overweight or obese. The baseline stood at 11% for children ages 6 to 11 and 11% for adolescents ages 12 to 19, with a target of 5% for both age groups (U.S. Department of Health and Human Services, 2001).

Cultural Assessment of Mexican-American Adolescents

Hispanics are the largest and fastest-growing ethnic minority in the United States, 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, attend public schools, and interact both inside and outside of their own identified cultural and ethnic groups to varied degrees. Outside of educational settings and some mixed community interactions, many Mexican-American adolescents interact mainly within their own cultural and ethnic groups and among similarly aged peers of like backgrounds.

Mexican-Americans hold values associated with a family-centric cultural worldview. Families can be large, and extended family members are often very active in the lives of these adolescents. Additionally, parenting styles are often considered authoritarian in nature, which many researchers believe can have broad implications for values as well as activities related to health and wellness (Ward, 2008, p. 410).

The degree to which these adolescents communicate in their parents' or grandparents' native language is variable and is 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 with English as a second language. If the individual's parents immigrated before the adolescent was born or shortly thereafter, the adolescent may speak only limited Spanish, often only at home. If grandparents were the ones who immigrated, the adolescent is more likely to speak only limited Spanish at home — often what is termed "Spanglish," an amalgamation of English and Spanish words. Few second- and third-generation Mexican-American young people speak fluent Spanish and are generally more comfortable communicating in English, especially with those outside the culture.

Access to health care can be limited depending on socioeconomic status, which is generally below the mainstream. The healthcare system in Mexico also warrants mention: because many people live at or below the poverty level, self-administration of pharmaceutical drugs is common, and pharmacies and pharmacists serve as the main source of healthcare education and intervention. Most prescription drugs are available over the counter and require no formal diagnostic process to obtain beyond the general guidance of a pharmacist. As a result, seeking medical care from a physician is not common unless the situation is perceived as serious. For those who do have access to health care, intervention may be delayed if the illness or unhealthy condition is perceived as low-risk, and some individuals may be encouraged to self-medicate.

Many Mexican-American families self-identify as Christian — often Catholic — particularly first-generation female immigrants, and they maintain strong ties to the church and, by extension, to family and culture through church involvement. Second- and third-generation families are only marginally removed from the intensity of church affiliation. Spirituality is often defined through religious beliefs, though this is considerably less pronounced in later generations of immigrants. Adolescents, as in many cultures, often reject strong ties to organized religion and prefer to define spirituality separately, though most likely express a strong belief in a higher power and remain more or less involved depending on their family's expectations.

Birth, coming of age, marriage, and death are all critically important to most Mexican-Americans, situated within the context of a strong family dynamic and a historically religious culture. Birth is a celebrated event with multigenerational participation and a welcoming of new life into the family. Coming of age is marked with elaborate parties rooted in cultural and religious tradition — the Quinceañera — most often for girls at age 15, though some boys also celebrate this passage. Marriage is likewise an often-elaborate family event, held within the bounds of religious tradition and even in more secular contexts. Death holds significant cultural weight as well: ancestors are celebrated in Mexico through the elaborate Día de los Muertos (Day of the Dead) traditions, which emphasize comfort and the continued connection between those who have passed and the living generations.

Many individual immigrants retain vivid memories of food deprivation or food insecurity in their home culture. Culturally, many Mexican-American mothers — and grandmothers in particular — perceive a moderately overweight child as healthy, given that their cultural origins lie in a nation where malnutrition and intestinal parasitic infestations are common. For this reason, the culture broadly associates a thin child with poor health, while a moderately overweight child who can still function normally is viewed as healthy. Mothers and grandmothers are often insistent on feeding children regularly (Ward, 2008, pp. 410–411).

Although these perceptions are gradually changing, the availability of unhealthy, low-cost food in the United States is so pervasive that the transition from one culture to the other does not readily support healthy eating. Compounding this, high-density communities have fewer supermarkets and grocery stores where fresh fruits, vegetables, and other healthier foods are sold at reasonable prices. In high-population-density areas, shopping options are often limited to corner markets — particularly for those who, due to time constraints and language barriers, do not frequently leave their communities to shop. One important and underappreciated factor is that limited availability of healthier food options near where mothers and grandmothers live and shop may directly contribute to high rates of overweight and obesity among Mexican-American adolescents (Kumanyika & Grier, 2006, p. 187).

Fresh and visually appealing fruits and vegetables are relatively abundant in Mexico, and the comparative offerings in American corner stores would leave most shoppers wanting. Many families also depend heavily on the public school nutrition system, which is increasingly scrutinized — particularly regarding the quality and quantity of fresh fruits and vegetables offered compared to cheaper, fast-food-style options and sugary drinks and snacks.

Review of Literature on Obesity as a Health Problem

The Healthy People 2010 objective 19-3 set a target of reducing overweight and obesity among children ages 6 to 11 and adolescents ages 12 to 19 from an 11% baseline to 5%. According to the midpoint review, however, the problem among children was in fact increasing rather than decreasing, despite greater awareness and multiple levels of intervention strategies. Heiss (2008) reports a full 5% statistical increase, with the HP 2010 starting point of 11% rising to 16% during the midpoint review period (p. 475). For the Mexican-American population, the increases are even more pronounced.

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 of overweight among Mexican-American girls ages 2 to 19 years (16.2%) was also greater than that for non-Hispanic White girls (14.8%) (Ward, 2008, p. 408).

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