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Obesity, Latinos, and Diet
Daniel Santibanez, MPHDepartment of Public HealthUniversity of North Florida
This is part 4 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of
Duval County Health Department. For more information or register for the seminars, please call 620-1289.
Overweight and Obesity Defined
Overweight: refers to an excess of body weight compared to set standards.
Obesity: having a very high amount of body fat in relation to lean body mass.
A person can be overweight without being obese. However, many people who are overweight are also obese.
Childhood Overweight Defined
BMI-for-Age growth charts are used for children and teens because of their rate of growth and development
At risk for overweight: BMI-for-age 85th percentile to 95th percentile
Overweight: BMI-for-age ≥ 95th percentile
There is no established definition of obesity in children
Measuring Overweight and Obesity
Body Mass Index: Measures weight in relation to height, and is closely related to body fat.
Waist Circumference: Individuals who carry fat around their waist are more likely to develop health problems than those who carry fat mainly in the hips and thighs, even if their BMI falls in the normal range.
High risk: more than 35 inches for women and 40 inches for men.
Body Mass Index (BMI)
Body Mass Index (BMI): a measure of an adult’s weight in relation to his or her height, specifically the adult’s weight in kilograms divided by the square of his or her height in meters.
Underweight: BMI Below 18.5
Normal: BMI Between 18.5 and 24.9
Overweight: BMI between 25 and 29.9
Obesity: BMI above 30
Severe Obesity: BMI Above 40
Weight in Kilograms
(Height in meters) (Height in meters)
The Increase in Overweight and Obesity Among Adults
Obesity Trends Among U.S. Adults Between 1985-2003 The data shown in these maps were collected through
CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state health departments use standard procedures to collect data through a series of monthly telephone interviews with U.S. adults.
Prevalence estimates generated for the maps may vary slightly from those generated for the states by BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly different analytic methods are used.
19961991
2003
Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2003
(*BMI 30, or about 30 lbs overweight for 5’4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.
Obesity Trends* Among U.S. AdultsBRFSS, 1985
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1986
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1987
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1988
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1989
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1990
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1991
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1992
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1993
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1994
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1995
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1996
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1997
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1998
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 1999
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 2000
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 2001
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
(*BMI 30, or ~ 30 lbs overweight for 5’4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 2002
Obesity* Trends Among U.S. AdultsBRFSS, 2003
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Smith et al. Circulation. 2005; 111:e134-e139
Epidemiology of Obesity
Obesity has been increasing across all U.S. groups since 1980
Ethnic disparities are prevalent
Obesity prevalence is highest among: African-American Females Hispanic Americans (esp. Mexican-Americans and Puerto
Ricans) Native Americans and Asians/Pacific Islanders
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CDC. Center for Health Statistics. National Health and Nutrition Examination Survey. American Obesity Association
Increase in Overweight and Obesity Prevalence Among U.S. Adults by Racial and Ethnic Group
Overweight Prevalence Obesity Prevalence
Racial/ Ethnic Group
1988 to 1994 1999 to 2000 1988 to 1994 1999 to 2000
Mexican-American
67.4% 73.4% 28.4% 34.4%
Black
(non- Hispanic)
62.5% 69.6% 30.2% 39.9%
White
(non- Hispanic)
52.6% 62.3% 21.2% 28.7%
CDC. Center for Health Statistics. National Health and Nutrition Examination Survey. American Obesity Association
Increase in Overweight Prevalence Among U.S. Adults (Ages 20 -74) by Racial/Ethnic Group and Gender
Men Prevalence Women Prevalence
Racial/ Ethnic Group
1988 to 1994 1999 to 2000 1988 to 1994 1999 to 2000
Mexican-American
69.4% 74.4% 69.6% 71.8%
Black
(non- Hispanic)
58.2% 60.1% 68.5% 78%
White
(non- Hispanic)
61.6% 67.5% 47.2% 57.5%
CDC. Center for Health Statistics. National Health and Nutrition Examination Survey. American Obesity Association
Increase in Obesity Prevalence Among U.S. Adults (Ages 20 -74) by Racial/Ethnic Group and Gender
Men Prevalence Women Prevalence
Racial/ Ethnic Group
1988 to 1994 1999 to 2000 1988 to 1994 1999 to 2000
Mexican-American
24.4% 29.4% 36.1% 40.1%
Black
(non- Hispanic)
21.3% 28.8% 39.1% 40.1%
White
(non- Hispanic)
20.7% 27.7% 23.3% 30.6%
CDC. Center for Health Statistics. National Health and Nutrition Examination Survey. American Obesity Association
Increase in Severe Obesity (BMI ≥40) Prevalence Among U.S. Adults (Ages 20 and older) by Racial/Ethnic Group and Gender
Men Prevalence Women Prevalence
Racial/ Ethnic Group
1988 to 1994 1999 to 2000 1988 to 1994 1999 to 2000
Mexican-American
1.1% 2.4% 4.8% 5.5%
Black
(non- Hispanic)
2.4% 3.5% 7.9% 15.1%
White
(non- Hispanic)
1.8% 3% 3.4% 4.9%
Source: Flegal et al. Nutrition Reviews. 2004; 62(7): S144-S148.
Florida: Prevalence of Overweight*, by race or ethnicity
Ethnicity % Overweight 95% CI (±)
Hispanic 58.1 4.3
White, non-Hispanic 54.0 2.0
Black, non-Hispanic 71.8 5.3
*Overweight is defined as having a body mass index of ≥ 25 and ≤ 29.9
Source: Behavioral Risk Factor Surveillance System (BRFSS), 2001. Mortality and Morbidity Weekly Report. August 23, 2003. 52(SS08); 1-80
Florida: Prevalence of Obesity*, by race or ethnicity
Ethnicity % Obese 95% CI (±)
Hispanic 17.1 3.3
White, non-Hispanic 18.5 1.6
Black, non-Hispanic 32.8 6.1
*Obesity is defined as having a body mass index of ≥ 30
Source: Behavioral Risk Factor Surveillance System (BRFSS), 2001. Mortality and Morbidity Weekly Report. August 23, 2003. 52(SS08); 1-80
Source: Fla. Dept of Health, Florida Obesity Prevention Program
Florida Adults: Behavioral Risk Factors Surveillance Systems (BRFSS) In 2000, 53.9% of Florida adults were overweight and obese
(approx. 6,650,395 adults). By 2002, increased to 57% Of those, 18.7% or ~2,307,280 adults are obese Prevalence of overweight among adults in Fla. has increased by
53.9% since 1986 Obesity prevalence has increased 91% since 1986
The overweight/obesity is increasing in men, women, and children of all ages and of all races/ethnicities
Florida: 2000 BRFSS, AdultsOverall Hispanic Black, non-
HispanicWhite, non-Hispanic
% Overweight 35.2%
% Obese 18.7% 20.2% 29.7% 17.0%
Men: % Overweight 42.8%
Men:
% Obese 18.95% 17.5% 23.5% 18.9%
Women: % Overweight 24.8%
Women:
% Obese 18.7% 22.8% 34.5% 15.3%
Florida: 2000 BRFSS, Adults
Percent ObeseAge Overall Hispanic Black,
non-Hispanic
White,
non-Hispanic
18 – 29 years 13.8% 11.8% 20.1% 11.8%
30 – 44 years 21.2% 19.2% 31.3% 19.0%
45 – 64 years 23.9% 26.9% 37.4% 21.1%
Over 65 years 15.8% 23.3% 25.2% 13.8%
Florida Youth: The Youth Risk Behavior Survey, 2001 (YRBS)
14.2% of high school students are at risk of overweight and 10.4% are overweight.
13.2% of girls are at risk of overweight and 6.8% are overweight
15.1% of boys are at risk of overweight and 13.7% are overweight
More than 50% do not participate in any physical education at school
Florida Youth: The Youth Risk Behavior Survey, 2001 (YRBS) 20.3% reported eating 5 or more servings of
fruits or vegetables in the past 7 days
65.5% reported watching TV for 2 or more hours on an average school day.
32.8% of high school students reported playing video games or using the computer for fun on an average school day
Obesity Risk Factors
Obesity is a risk factor for many chronic conditions including: Diabetes Hypertension High cholesterol Stroke Heart Disease Certain cancers Arthritis
Of these, diabetes is most closely linked to obesity
Source: The rising tide of metabolic syndrome. Postgraduate Medicine. Dec 2004; 116(6):54-57
Source: ATP III. Bethesda: National Institutes of Health, 2001
Diagnostic Criteria for Metabolic Syndrome
Feature Criterion*
Abdominal Girth
Men
Women
Waist Circumference
> 102 cm (>40 in)
> 88 cm (35 in)
Fasting plasma HDL-C
Men
Women
< 40 mg/dL (< 1.04 mmol/L)
< 50 mg/dL (< 1.29 mmol/L)
Fasting plasma triglycerides ≥ 150 mg/dL (≥ 1.69 mmol/L)
Fasting blood glucose** ≥ 110 mg/L (≥ 6.1 mmol/L)
Blood pressure ≥ 130/ ≥ 85 mm Hg
*A diagnosis of metabolic syndrome is made if a patient has three or more of the criteria listed.
**The American Diabetes Association recently set a cut point of ≥ 100 mg/dL at which persons are considered to have impaired fasting glucose
Metabolic Syndrome Prevalence
An est. 55 million US adults have Metabolic Syndrome
Jumps to 64 million when revised value for impaired fasting glucose is used
Affects 6.4% of U.S. adolescents aged 12-19
Accounts for slightly more than 32% of all overweight adolescents
Rates differ across all ethnic groups
Highest overall prevalence found in Mexican Americans
Source: The rising tide of metabolic syndrome. Postgraduate Medicine. Dec 2004; 116(6):54-57
The associations of poverty, acculturation, exercise, and diet to BMI implicate societal as well as individual contributors to obesity among U.S. Latinos.
Causes for Obesity Among Latinos
Attitudes About Obesity Vary Across Cultures
Where thinness is associated with extreme poverty, deprivation, or wasting diseases, obesity may be viewed as a symbol of social stature, prosperity, and robustness.
Goel et al. JAMA. 2004; 292(23):2860-67.
Obesity Among Immigrants
Longer duration of residence in U.S. is associated with higher BMI
After 10 years of residence, BMI increases substantially
May reflect acculturation and adoption of the U.S. lifestyle
May also be response to the physical environment of the U.S.
Unger et al. Journal of Community Health. 2004; 29(6):467
Acculturation Among Latino Adolescents
Acculturation to the U.S. is associated with a lower frequency of physical activity and higher frequency of fast-food consumption.
Why?
Preference for activities and foods classified as “American,” such as watching TV and playing video games, and eating fast foods such as hamburgers and pizzas
Florida: Prevalence of No Leisure-time Physical Activity in the Past Month
Ethnicity % No Activity 95% CI (±)
Hispanic 40.9% 4.3
White, non-Hispanic 23.1% 1.6
Black, non-Hispanic 33.2% 5.3
Source: Behavioral Risk Factor Surveillance System (BRFSS), 2001. Mortality and Morbidity Weekly Report. August 23, 2003. 52(SS08); 1-80
Working with Puerto Ricans and Cubans
Puerto Ricans and Cubans
NY, FL, NJ, PA, CT, MA: Puerto Ricans
Miami & Tampa, FL: Cubans
Grains and Starchy Foods
Cuban & Puerto Rican Crusty loaves – French, Italian, Cuban bread Hot and dry cereals Sweet potato (batata-PR/boniato-C) and potato Tanier (yuca) Cocoyam or dasheen or taro (malanga) Yautia blanca or yautia lila Ripe plantains fried, baked or boiled
Grains and Starchy Foods
Cuban & Puerto Rican Green plantains, fried thick (tostones) or thin/chips
(platanutres-PR/mariquitas-C)
Green plantain with pork cracklings (mofongo-PR/fufu-Cuban)
Soups with mixed root vegetables (viandas) and meats (sancocho-PR/ajiaco-C)
Grains and Starchy Foods
Cuban Pureed green plantain – base
for soup Boiled then fried yucca
Puerto Ricans Green bananas, boiled, with
olive oil and onions Pureed green plantain as
dumplings in soups
Complementary Foods
Puerto Ricans Red beans and white rice Red beans with white rice Yellow rice with pigeon peas
(gandules)
Cuban Black beans and white rice Black beans with white rice:
“congri” (“with gray”)*
Vegetables
Salads: lettuce, tomato, cabbage, avocado common as side dishes
Tomatoes, onions, peppers with garlic, olives, olive oil, bay leaf, capers, and coriander used to season food
Pumpkin, corn, green beans common side dishes
Fruits
CommonOrangesBananasPineapplesWatermelonLemons, limesMangoes
OtherPapayaGuavaCherimoya/soursop/anonCoconutTamarind
Meat and Other Protein Foods
Puerto Rican and Cuban A variety of legumes, including
chickpeas in stews, soups Steaks - thin cut, sautéed or fried Seasoned roast pork or cubed and fried Eggs, poultry, fish, shrimp Paella
Fried Grains and Meat/Protein Combinations
Puerto Rican Fritters mashed potato stuffed with
ground meat (rellenos de papa)
green banana and tanier puree stuffed with ground meat (alcapurrias)
Codfish fritters (bacalaitos)
Both Groups Meat pies
Cuban Fritters ham or
chicken croquettes
Extended/Combination Dishes
Puerto Ricans and Cubans Chicken and rice Rice and codfish Rice with “Ropa Vieja” (Old Clothes -- seasoned
shredded beef) Rice with pork or ham pieces Cuban sandwich Spanish omelet
Extended/Combination Dishes
Puerto Rican Pastel: dough of green plantain,
tanier, green banana, filled with a seasoned cooked pork mixture boiled banana leaf or parchment paper
Cuban Tamal: ground corn and/or
cornmeal, filled with a seasoned cooked pork mixture boiled in a husk
Common Cuban Dishes
Beef roast (boliche) Squid (calamares) Fish soup or broth (caldo de pescado) Marinated fish (escabeche) Stewed minced meat (picadillo)
Common Puerto Rican Dishes
Ripe plantain and ground beef/ vegetable “lasagna” (pastelon) or “rolls” (piononos)
Thick soupy rice (asopao) Rice with squid (calamares)
Desserts
Puerto Rican and Cuban Flan Rice pudding Rum cake Vanilla custard
Cuban Pudin Diplomatico -
Bread style pudding with fruit
Puerto Rican Bunuelos - beignets,
usually topped with honey
Beverages
Puerto Ricans and Cubans Coffee with milk Hot chocolate
Cuban Expresso Expresso with a small
amount of milk and sugar (“Cortadito”)*
Fruit/milk shakes (Batido)
Puerto Rican Food Guide Pyramid
Issues
High fat intake from fats (oils, frying), poultry, beef, dairy intake
Low dairy, fruit and vegetable intake
Acculturation
More varied diet BMI increasing Younger groups’ food patterns related to external
influences Acculturated PR consume more American foods Younger Cuban women had a higher proportion of
energy from fat
Mexican-American Diet Patterns Traditional diet
Varies greatly according to regionsBlend of pre-Columbian, French, and Spanish dietsAmerican foods introduced in recent years
Mexican-American Traditional Diet
CARBOHYDRATES (similar in most regions)corn/ corn products - mainstay in all regionsbeans (black - coastal regions/south; pinto -
north/central)Breads - “pan dulce”rice
Counseling for Dietary Change
“Healthy eating guidelines better met by Mexican-born than U.S. born”
Encourage return to healthy aspects of traditional cookingFresh fruit, fresh fruit drinksSalads, vegetablesBeans, legumes
Mexican-American Traditional Diet
PROTEIN Fish/Shellfish (coastal regions) Goat/Beef/Pork (North/Central
regions) Poultry (all regions) Beans (southern regions, all)
DAIRY fresh cheeses, fresh cream “Batidos” (central regions)
Mexican-American Traditional Diet
FRUITS/VEGETABLESWide variety fresh fruits consumed regularly (all
regions)Fresh fruit drinks (“batidos”, “aguas frescas”)Cooked salads, pickled vegetables (“escabeche”),
lime juice dressing
Mexican-American Traditional Diet
Cooking MethodsFrying (lard)Steaming, wrapped in leaves (coastal regions,
southern regions)Stewing - “moles” (all regions)
Meal Patterns4-5 meals/day, “merienda”
Dietary Changes Due to Acculturation/ Migration Rice and Bean Consumption Consumption of Fresh Fruit Use of Lard (replaced with vegetable oil) Use of sweetened and/or carbonated
beverages vs. fresh fruit drinks Saturated Fat consumption
Dietary Changes Due to Acculturation/ Migration
Food Items Added with Acculturation
White Bread Mayonnaise/ Salad Dressing Cookies/Cakes Ice Cream Tang/Kool-Aid Vegetable Oil/Margarine
Traditional Items
Pan Dulce Dry Salad/ Lemon
Juice/Pickling Pan Dulce Fruit-based “ices” Fresh Fruit drinks Lard
Dietary Changes Due to Acculturation/ Migration Mexicans in U.S. less likely to recognize low-fat
cuts of meat
Mexicans in U.S. less likely to use low-fat dairy products
Mexicans in U.S. less likely to identify low-fat foods
Dietary Changes Due to Acculturation/ Migration Traditional Mexican-American diet tends to be low in
Calcium and Iron
Mexican-Americans eat more fiber than all other Hispanics and non-Hispanics
Traditional Central-American diet may also be low in protein
With acculturation/migration diets may also be low in folate, Vit A, Vit C, and Zinc
Counseling for Dietary Change
Use “modified” traditional favoritesCarnitas, rice, beans
Traditional dishes made with less saturated fat, sodium, and sugar
Identify low-fat cuts of meat –substitutes
Low-fat dairy Fresh cheeses: panela, cotija, queso fresco
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