Obesity in Hispanic US Youth and Targeted Lifestyle Intervention

by Bianca Garilli, ND

Obesity, a preventable condition, has tripled worldwide since 1975, with 340 million children and adolescents between 5-19 years of age with overweight or obesity in 2016 according to the World Health Organization (WHO).¹ In children and adolescents, BMI-for-age growth charts are used to determine weight status; >85^th and <95^th percentile is considered overweight, while ≥95th percentile is obese.²

In the US, overweight and obesity disproportionally affect children of low-income households, whereas the risk of overweight and obesity diminishes with higher levels of education within the household.³ Income and education levels are not the only factors affecting adiposity risk in children and adolescents; ethnicity and race also play a role. Both Hispanics and non-Hispanic blacks have higher obesity prevalence than non-Hispanic whites, 25.8%, 22%, and 14.1%, respectively, whereas non-Hispanic Asians have a lower prevalence (11%).³

Overweight and Obesity in Hispanic Youth

The children and adolescents of the Hispanic population are an important cohort to learn more about when it comes to overweight and obesity, since they comprise nearly a quarter (22%) of all children in the US under the age of 18.⁴ With the prevalence of obesity in this group >25%, identifying causes and implementing solutions to the overweight and obesity problem is critical.⁴ The economic status of Hispanic children and adolescents varies with their generation status – non-US born children are more likely to live in poverty when compared to their peers who are third generation US born.⁴ However, first generation Hispanic youth, those not born in the US, typically exhibit better health indicators than their counterparts who were born in the US.⁴

The Hispanic Health Paradox

There are multiple variables at play in understanding why first generation Hispanic children and adolescents enjoy better health than those born in the US; some of these factors influencing the “Hispanic Health Paradox”⁵ may include – greater amounts of regular physical activity (including more outdoor activity and less screen time), greater exposure and adherence to ethnic-based diet (whole foods) including more fruits, vegetables, and whole grains, greater maintenance of cultural behaviors and rituals in family activities, and more two-parent households with frequent parental-child engagement.^5,6

Many of the factors potentially influencing the aforementioned paradox can be categorized as modifiable lifestyle factors, including diet and physical activity. With the majority of the 16 million Hispanic/Latino children in the US being born in this country (89%),⁴ finding viable solutions to the obesity issues by targeting modifiable habits is important.

Lifestyle Intervention Targets Child, Guardian, and Healthcare Practitioner

A lifestyle intervention study published in the Journal of Complementary and Alternative Medicine⁷ was conducted by researchers at The University of Georgia (UGA) to examine the effectiveness of a 12-week lifestyle program on several parameters, including cardiometabolic, behavioral, and psychological outcomes in Hispanic children and adolescents who were overweight. Pediatric primary care patients (6 girls, 16 boys; mean age: 11.7 years) and their guardians participated in a case series study which included pre- and post-test analyses. During the 12-week intervention, the participants engaged in moderate-to-vigorous intensity boxing exercise training for 60 minutes 2x/week; in addition, their guardians underwent 12 hours of nutrition education, and the children were seen by a pediatrician (30 minute appointment).⁷

At the end of the 12-week intervention, significant improvements were seen in several variables:⁷

• ↓ waist circumference, BMI, and fasting glucose levels
• ↓ amotivation (“a state of lacking any motivation to engage in an activity, characterized by a lack of perceived competence and/or a failure to value the activity or its outcomes”)⁸
• ↑ moderate and vigorous intensity physical activity levels
• ↑intrinsic motivation and introjected regulation (“motivation that comes from only partially internalized activities and values and motives such as avoiding shame, seeking approval, and protecting the ego”)⁹

The UGA researchers concluded that their 12-week program, which focused on modifying key lifestyle factors including physical activity and nutrition education, impacted cardiometabolic disease risk via the reduction of fasting glucose, BMI, and waist circumference, increasing physical activity levels, and improving key behavioral and psychological variables.⁷ This study also demonstrates the importance of including the child’s guardian in the lifestyle intervention, as well as partnering with a healthcare practitioner (HCP).

Why is this Clinically Relevant?

Over 25% of US Hispanic children and adolescents have obesity.⁴ US-born Hispanic children are less healthy than their country of origin-born peers living in the US, a phenomenon referred to as the “Hispanic Health Paradox”.⁵ The typical US lifestyle includes less physical activity and fewer whole foods, which negatively influence health choices in Hispanic children and adolescents living in the US. More lifestyle intervention programs that equip the child, their guardian, and a HCP partner together to target improvements in physical activity and healthful dietary patterns are needed to combat the obesity and cardiometabolic disease epidemics in Hispanic and non-Hispanic youth.

Citations

1. WHO. Obesity and overweight. http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed August 17, 2018.
2. NIH. Helping your child who is overweight. https://www.niddk.nih.gov/health-information/weight-management/helping-your-child-who-is-overweight. Accessed August 17, 2018.
3. CDC. Childhood obesity facts. https://www.cdc.gov/obesity/data/childhood.html. Accessed August 17, 2018.
4. Isasi C et al. Health issues in Hispanic/Latino youth. J Lat Psychol. 2016;4(2):67–82.
5. Balcazar AJ et al.. The Hispanic health paradox across generations: the relationship of child generational status and citizenship with health outcomes. Public Health. 2015;129(6):691–697.
6. Fox News. Why are foreign born immigrants healthier than later generations? http://www.foxnews.com/health/2011/06/07/foreign-born-immigrants-healthier-later-generations.html Accessed August 20, 2018.
7. Yli-Piipari S et al. A twelve-week lifestyle program to improve cardiometabolic, behavioral, and psychological health in Hispanic children and adolescents. J Altern Complement Med. 2018;24(2):132-138.
8. The Free Dictionary by Farlex. Amotivation. https://medical-dictionary.thefreedictionary.com/amotivation. Accessed August 21, 2018.
9. Positive Psychology Program. What is self-determination? https://positivepsychologyprogram.com/self-determination-theory/. Accessed August 21, 2018.

 Bianca Garilli, ND

Dr. Garilli is a former US Marine turned Naturopathic Doctor (ND). She works in private practice in Northern California as well as running a consulting company working with leaders in the natural and functional medicine world such as the Institute for Functional Medicine and Metagenics. She is passionate about optimizing health and wellness in individuals, families, companies and communities- one lifestyle change at a time. Dr. Garilli has been on staff at the University of California Irvine, Susan Samueli Center for Integrative Medicine and is faculty at Hawthorn University. She is the creator of the Veterans for Health Initiative and is the current President of the Children’s Heart Foundation, CA Chapter.