Nutrition & Secondary

Prevention

University of Florida

Amarillys Alvarado-Sojo, Christie Champaign,

Kristin Miller, Debbie Walker, Chris Weiss

Health Indicator: ObesityEpidemiology

• In the U.S., it is estimated that 1 in 3 adults are now obese: 78.6M

• 1 in 20 are considered extremely obese

• Prevalence is similar for men and women

• Medical costs now exceed 140B annually

• If you are obese, you will spend, on average, $1,400 more in medical care than a non-obese person

(CDC, 2014; WIN, 2014)

Most Affected

• Problem worse in rural areas with estimates around

40% of adults (Befort, Nazir, & Perri, 2012)

• Rates (prevalence) are higher among Hispanics

(78.8%), African Americans (76.7%)

Minorities are among the

fastest growing

populations in the U.S.

(CDC, 2014)

Health OutcomesAs a person becomes obese, their risks increase for:

6.5-13.7 life years

lost

Cancer (breast, colon)

Heart disease

StrokeSleep apnea

Liver disease

Type 2 Diabetes

(Kitahara et al., 2014; Lee,

2014)

Health Outcomes…Bottom

Line

Compared to a non-obese SMOKER, an obese adult is more likely to die earlier

But, this is a largely Preventable problem

Target PopulationLow-Income Hispanic Community in

Florida

About Our Population

Characteristics

• Hispanics (Latinos)

• Overweight, obese

• Adults 18 and older

• Male and Female

• Low-income

• Any education level

Reason for Selection

• Highest prevalence

rates among all

minorities

Vulnerable

population

• Wages inversely

related to BMI/obesity

• This trend is higher

among Hispanics

(FRAC, 2014)

• Cultural differences

Gathering Information

SocialQuality of life of

individuals, families

Extent of problem

Cultural beliefs, practices

(slender physique=not

healthy vs. obese=healthy)

-Community and provider

interviews

EpidemiologicalAssessment of health

condition (obesity)

Assess comorbidities

Assess SES

-US Census, NHANES,

Florida-charts

Gathering Information

Behavioral/Environmental

• Eating/nutritional habits

• Lack of healthy food options

• Convenience of fast food

• Public source data, interviews

Educational/Ecological

• Attitudes/knowledge/beliefs about obesity

• Beliefs about eating

• Social norms of community and culture surrounding diseases and importance of health diet

• Local surveys, focus groups

Levels of addressing the problem:

Applying the CDC Ecological Model

Individual:

• BMI awareness

• Know what a healthy weight is

for an individual

• Active lifestyle

• Education about nutritional

meals/ healthy living

Community:

• Communities making healthy

food options accessible

• Communities providing options

for nutritional education

• Encouraging an active lifestyle

at work

• Distributing education about the

risks of being obese and eating

poorly

Relationship:

• Families engaged in healthy Hispanic

cooking

• Encouraging an active lifestyle at home

with family members

• Education about the risks of being obese

and eating poorly

Societal:

• Implement health education

• Implement nutritional education

• Shift cultural norms

• Social policies

Normal Weight Obese

Variables: Individual Level

BMI (Obesity) Awareness

• Hispanics may rate themselves as ‘more attractive’ with

heavier body weights

• Acculturation in America increases this risk with more

convenient access to less healthy foods, and less healthy

foods in low-income areas (Latino Coalition for a Healthy

California, 2006)

Theory of Planned BehaviorTheory accurately

explains behavior

In this case,

individuals do not

perceive obesity as a

threat nor do their

close contacts

Results in limited

intent to act

Variables: Relationship Level

Hispanic Cooking

• “Family unit”

• Many meals are shared

together

• Typical Hispanic diet:

-fruits, vegetables,

beans, grains,

corn/corn products,

dairy

• Many foods are fried with

fats and oils

(Smith, 2010; Clutter & Nieto, n.d.)

These aspects of the

Hispanic culture contribute

to obesity

Variables: Societal Level

Cultural Norms

• Men- head of the

house

• Women- tend to

household duties

• Grandparents,

parents, and children

may live in the same

house

• Responsibility to

family

Model

Intervention

Organize a Health Fair, “Feria

de Salud para ti,” in a

Hispanic community

Provide basic screenings,

advertise cooking lessons and

trips to local grocery store

Nature of Intervention

Description: Intervention within the community, intent to

empower individuals and families by providing them with

knowledge and skills required to develop healthy eating habits

and learn self monitoring skills

Designed to take into consideration culturally relevant aspects

of dietary behavior, social interactions and beliefs

Assist in helping them make informed dietary choices in

accordance with individual preferences and affordability.

Levels Addressed: Individual and Relationship

Population: Hispanic community adults over age 18 and their

families

Intervention: Individual & Relationship

Levels• Increase awareness, assist in choosing healthier choices

by providing healthy Latino recipes (www.Goya.com)

• Accompany individuals/families in grocery store utilizing

Camino Magico bilingual shopping list and meal planner

• Provide store tour educating consumers about options

available in every aisle that fit the Latin American Diet

Pyramid

• Display a poster of the Latin American Diet Pyramid in-

store and at Health Fair

• Educate on avoiding fast food

Grocery Store Tour

Partner with local grocery store to walk through

showing healthier choices, cooking demonstrations,

and samples

Intervention Objectives● Conduct Secondary Prevention

a. Provide health screenings, including having their

BP checked, weight, height, waist circumference and

BMI calculated to determine if they are obese or at risk

of obesity

b. Identify individuals with immediate health needs

and those who are overweight and obese, and connect

them with primary care clinic near their home or work

c. Make individuals aware of risk factors and

diseases they could develop

d. Increase consumption of fruits and vegetables

instead of less healthy food

Hispanic Food Pyramid

Provide Hispanic food pyramid,

with examples of portion control

Educational MaterialsProvide a visual reminder

in Spanish - to make

healthier choices, recipes,

shopping lists and meal

planner

Measuring Success

Design: Quasi-experimental, pre-test/post-test

• Completion of survey at beginning of health fair

• Follow-up phone call or email (preferred

communication method) 6 weeks post

• Patient satisfaction survey with grocery store tour

• Feedback forms for identifying areas for improvement

Potential Barriers

1. Health Fair may have limited impact on changing

individual and family behavior

2. May be low attended

3. At risk individuals may not follow up with primary

doctor or have a doctor

However,

Could include an invitation to a series of Hispanic

cooking classes

Could partner with local health department to ensure

at-risk individuals are further evaluated

Summary

Secondary prevention efforts incorporating healthy

nutritional habits can impact obesity by

decreasing prevalence

Plan identified 3 variables to target within Hispanic

communities in Florida: Individual awareness,

cooking styles, cultural norms

Conducting Health Fair at local grocery store and

accompanying families/individuals during

shopping is a low-cost, first-step in increasing

healthy nutritional habits

Plan addresses key factors at multiple levels and

acknowledges areas for continued development

Take Home Points

1. Obesity is an epidemic within U.S.

and worse for minorities

2. Collaboration among all health

professionals, policy makers,

community officials is needed to

address this problem

3. Any plan must take into account

cultural beliefs

4. Plans must be multidimensional

and ongoing; will require funding

References

Ammerman, A.S., Lohr, K.N., & Hersey, J. (2002). The efficacy of behavioral interventions to modify

dietary fat and fruit and vegetable intake: A review of the evidence. The Journal of Preventive

Medicine, 35(1), 25-41. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12079438

Bautista, L., Reininger, B., Gay, J. L., Barroso, C. S., & McCormick, J. B. (2011). Perceived barriers

to exercise in Hispanic adults by level of activity. Journal of Physical Activity & Health, 8(7),

916–925.

Befort, C. A., Nazir, N., & Perri, M. G. (2012). Prevalence of obesity among adults from rural and

urban areas of the United States: Findings from NHANES (2005-2008). The Journal of Rural

Health, 28, 392-397. doi: 10.1111/j.1748-0361.2012.00411.x

Centers for Disease Control. (2014). Strategies to combat obesity. Retrieved from

http://www.cdc.gov/obesity/strategies/index.html

Centers for Disease Control. (2014). Adult obesity facts. Retrieved from

http://www.cdc.gov/obesity/data/adult.html

Clutter, A., & Nieto, R. (n.d.). Ohio State University fact sheet. Retrieved from

http://ohioline.osu.edu/hyg-fact/5000/5237.html

References

Dwyer, J. (2006). Starting down the right path: nutrition connections with chronic diseases of

later life. The American Journal of Clinical Nutrition, 83, 415S-420S. Retrieved from

http://ajcn.nutrition.org/content/83/2/415S.full

Food Research and Action Center. (2014). Relationship between poverty and overweight or obesity.

Retrieved from http://frac.org/initiatives/hunger-and-obesity/are-low-income-people-at-greater-

risk-for-overweight-or-obesity/

Kitahara, C. M., Flint, A. J., de Gonzalez, A. B., Bernstein, L., Brotzman, M., MacInnis, R. J., Hartge,

P. (2014). Association between Class III obesity and mortality: A pooled analysis of 20

prospective studies. PLOS Med, 11(7), e1001673. doi: 10.1371/journal.pmed.1001673

Latino Coalition for a Healthy California. (2006). Obesity in Latino communities. Retrieved from

http://www.lchc.org/wp-content/uploads/2005_Obesity_in_Latino_Communities_NewLogo.pdf

Lee, R. (2014). Warning: Obesity is more dangerous than smoking, cuts life span by 14 years.

Retrieved from http://www.techtimes.com/articles/10033/20140711/warning-obesity-is-more-

dangerous-than-smoking-cuts-life-span-by-14-years.htm

References

Salud Mesoamerica. (2014). Salud campaign. Retrieved from http://www.iadb.org/en/salud-mesoamerica-2015/sm2015/sm2015-supports-the-lac-forum-awareness-campaign-in-favor-of-the-right-to-sexual-and-reproductive-health,9347.html

Smith, K. L. (2010). Cultural diversity: Eating in America Mexican-American. Retrieved from http://ohioline.osu.edu/hyg-fact/500

Spanish Sabores. (2014). 8 fried foods you must try in Spain. Retrieved from http://spanishsabores.com/2012/01/25/8-fried-foods-you-must-try-in-spain/

Urban Institute. (2010). Vulnerable populations. Retrieved from http://www.urban.org/health_policy/vulnerable_populations/

USDA. (2011). A visual reminder to help Spanish-speaking consumers make healthier food choices. Retrieved from:http://www.usda.gov/wps/portal/usda/usdahome?contentid=2011/09/0428.xml

USDA. (n.d.). Choose my plate. Retrieved from http://www.choosemyplate.gov/index.htm

References

Weight-Control Information Network. (2014). Overweight and obesity statistics. Retrieved from http://win.niddk.nih.gov/statistics/

Wolf, R. L., Lepore, S. J., Vandergrift, J. L., Wetmore-Arkader, L., McGinty, E., Pietrzak, G., & Yaroch, A. L. (2008). Knowledge, barriers and stages of change as correlates to fruity and vegetable consumption among urban and mostly immigrant black men. Retrieved from http://www.sciencedirect.com/science/article/pii/S000282230800662708006627