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Latinos and Weight loss: Evidence-based Strategies for Culturally Competent Care

Presented By: Laura Rubalcava, MA

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+Objectives

1. Gain deeper understanding of Latino culture: food, health/illness beliefs, personalismo, role of family in weight loss

2. Provide easy to implement strategies for healthcare professionals to effectively treat obesity in Latinos

3. Know the barriers to treatment for Latinos

4. Increase awareness of the personal well-being of the healthcare professional

5. Understand treatment options for referring to a obesity treatment specialist

+Background: Latinos vs. Hispanics Latino

“Latino/a” is a term growing in popularity among US-born Latinos Represents a political consciousness Sense of ethic pride More often used in research Used in this presentation

Hispanic “Term created by federal order in 1978 by the Office of Management and

Budget. Hispanic is defined as, “person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture of origin (Marin & Marin, 1991, p.20).”

Primary purpose of this label- categorize a group of people not by a specific country or origin with unique history, religion, indigenous roots, cultural traditions, and foods but rather by a common language, namely Spanish. The term “Hispanic” leads to people to believe Spanish-speaking individuals

from these countries have one common culture and that the term refers to a racial category (Santiago-Rivera, p21).

+Background: Latinos

Latinos constitute 16% of the US population (US Census Bureau, 2011), largest ethnic minority group in the US…the U.S. Latino population for July 1, 2050 is estimated to reach 132.8 million, constituting approximately 30% of the U.S. population by that date.

Approximately 64% of the Latinos in the US are of Mexican origin (Falicov, 1998).

According to U.S. Census Bureau population estimates as of July 1, 2011, there are roughly 52.0 million Latinos living in the United States, representing approximately 16.7% of the U.S. total population, making people of Latino origin the nation's largest ethnic minority.

+ 1.Latino Culture and Weight loss

Food, family, tradition Family support is significant in recovery of those with disordered eating behavior “A Latino patient can only get as well as the family will allow them” (Lambert, 2011).

Health/ Illness beliefs Internal/ external forces Curanderos/ santeros/espiritisa- can be viewed as having more power than a physician, this

can result in Latinos noncompliance with medical treatments prescribed by professionals who have different beliefs about the etiology of illness” (Santiago- Rivera, Arredondo, Gallardo- Cooper, 2002).

Latinos are highly traditional in their healthcare practices

Personalismo with physician/staff “The valuing of warm, friendly, and personal relationships has important implications for how Latinos

perceive and respond to environments (e.g., hospitals, mental health agencies)that are quite often impersonal and formal” (Santiago- Rivera, Arredondo, Gallardo- Cooper, 2002).

Role of family in weight loss Collectivistic orientation/ Familismo

Gender role Fulfill role of Marianismo, “girls must grow up to be women and mothers who honor the

model of the Virgin Mary… they must be pure, long-suffering, nurturing, and pious. Mothers are viewed as selfless, self-sacrificing, and nurturing individuals (Lopez- Baez, 1999, Santiago- Rivera, Arredondo, Gallardo- Cooper, 2002).

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+2.Evidence-based Strategies to Improve Weight Loss in Latinos

Motivation for change assessment Focus more time on those ready to change

Urge parent/ child to choose desired physical activity Exercise as routinely as you brush your teeth

Emphasize overall health- teeth, bones, immune system, psychological/ self esteem, hair, skin The more we focus on only weight loss/obesity the more it wont change

Ask about exercise environment/ tools for exercise (indoor/outdoor) Ipod motivational songs, tennis shoes, nintendo wii, as a family Buy during tax season Place value on health/wellness, plan for future instead of present

Social identity threat- “psychological state when people feel at risk of being devalued or negatively stereotyped because of social identity” (Major, B., 2011).

+3.Barriers to Treatment for Latinos

Effects of healthcare professional bias Take the blame off the parent and patient Cultural attitudes to health and wellness

(Santiago- Rivera, Arredondo, Gallardo- Cooper, 2002).

Language proficiency/ translating concerns Insufficient financial resources Obesity is commonplace in America- less likely to

seek treatment Lack of awareness- signs & symptoms of obesity

Unable to adjust to life changes Physician understanding of diagnosing Binge Eating

Disorder (Hudson JI, Hiripi E, Pope HG, Kessler RC, 2007).

Self-care of the healthcare professional- Role model Environment of the clinic/hospital/treatment center

Magazines, chairs, scales (privacy)

+ 4. Well-being of the Healthcare Professional

Physician self-care Self sacrificing-eat, sleep to accommodate

others

Addressing your relationship with food Increase self awareness, we all live in the

same toxic food environment

Address personal biases towards obesity

Encourage healthy eating/ exercise in the workplace environment Meatless Mondays Potluck lunches Walk during lunch Bring lunch to work

+5. Who are the Obesity Treatment Specialists

Primary doctors Bariatricians

General doctors, family medicine, psychiatry, endocrinology

Dietician/ Nutritionist ( MA in nutrition) Supervised medical weight loss Exercise physiologists- especially for morbidly

obese Bariatric surgeons Psychologists/ bariatric psychologists Counselors/ social workers Weight watchers Health education coaches Specialty clinics- Ex: National Center for Weight

and Wellness, University Clinics/ Research centers

+References

Hudson JI, Hiripi E, Pope HG, Kessler RC. (2007). The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biological Psychiatry 61: 348-358.

Lambert, S. (2012, February 15). Providing treatment across different cultures. [National Public Radio]. Retrieved from: http://www.npr.org/2012/02/15/146936181/providing-treatment-across-different-cultures

CDC 2013. Health United States, 2012. Retrieved from:http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr12/index.html - See more at: http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=537&ID=6459#sthash.YPxva3Vh.dpuf

Major, B. (2011, November 11). Weight Stigma [The Rudd Report]. Retrieved from:http://itunes.apple.com

2012 National Healthcare Disparities Report. Retrieved http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr12/index.html - See more at: http://minorityhealth.hhs.gov/templates/content.aspx?lvl=3&lvlID=537&ID=6459#sthash.YPxva3Vh.dpuf

Santiago-Rivera, A., Arredondo, P., & Gallardo-Cooper, M. Counseling Latinos and La Familia: A Practical Guide. Thousand Oaks, California: Sage Publications, Inc.