CMA FOUNDATION CHILDHOOD OBESITY MULTICULTURAL

COMMUNICATIONS WEBINAR

Childhood Obesity – Strengthening the Capacity of Healthcare Providers to Work in Multicultural Communities in the Clinical Setting

LATINO COMMUNITY WEBINAR|OCTOBER 10, 2012

Webinar Faculty

Linda Gallegos, RN, CDEHealthCare Partners

El Monte CA

Mayra Rosado, MD, MPHHealthCare Partners

El Monte CA

Disclosure StatementWe have no relevant financial relationships with the

manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this activity.

We do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

Webinar ObjectivesUsing a case presentation format, participants will be able to:

Identify how culture and ethnicity can influence patient decision making related to childhood overweight and obesity within the Latino Community.

Describe effective patient/provider communication techniques to help families understand behaviors they can take to help their child reach a healthy weight, particularly focusing on increasing healthy food choices.

Determine how and when to access support in their communication, particularly involving nutritionists and dietitians.  

The Partnership In 2010, the Federal Office of Minority Health,

provided funding support to the California Office of Multicultural Health to initiate a partnership with the CMA Foundation to increase awareness among healthcare professionals about the impact and importance of race, ethnicity and culture on pediatric overweight and obesity.

This collaboration lead to the update of the Child and Adolescent Obesity Provider Toolkit in 2011 and the development of a series of webinars to provide additional support to healthcare professionals addressing these issues in 2012.

Teen Female Obesity Rate

Teen Male Obesity Rate

Risk of Being Diagnosed with Diabetes Lifetime Risk for Diabetes Mellitus in the United States. Journal of the American

Medical Association.

0%

10%

20%

30%

40%

50%

60%

27%

45%

40%

31%

53%

49%Caucasian Males

Hispanic Males

African-American Males

Caucasian Females

Hispanic Females

African-American Females

The National Council of La Raza also reports that one out of two Latino children born in the year 2000 will develop diabetes.

There are more than 16 million Latino children under the age of 18 living in the US.

These children are at greater risk for developing health and psychological problems because of their higher risk of overweight and obesity.

In 2010, 27% of Latinos lived in poverty in the US, compared to 15% of the total population. (National Poverty Center) As a result more than a quarter of Latinos live in neighborhoods with limited access to healthy food choices and safe locations for physical activity.

Their neighborhoods often include more fast food and convenience stores and may not have access to locations for safe walking or

physical activity.

Why is This Important

Linking Patient Communication to Health Outcomes

Communication

Patient Satisfaction

Patient Adherence

Health Outcomes

This makes it critical to identify how we improve communication with our ethnically diverse patients to improve health outcomes.

Developed by Joseph Betancourt, MD, MPH Harvard Medical School

Understanding the Latino Community

Myths & Misconceptions “All Latinos are the same.” Latinos

encompass more than one culture. Latinos come from many different countries and have “adapted” to the US culture in varying degrees. Be careful not to stereotype.

There may also be differences based on whether the Latino patient you are seeing is a new immigrant or has been in the US for a number of years.

Levels of education and literacy can play a key role in influencing health decision making as well.

Working with My PatientsLatinos often associate a child’s weight with overall health. A chubby child can be seen as a healthy child. Parents may purchase healthy foods that their kids won’t eat. If the child doesn’t eat the food, they then may buy what their child wants because they don’t want to say “No” to their child.

When I begin my evaluation, I first assess the family’s current health behaviors that can influence achieving and maintaining a healthy weight. I start by identifying –

Eating behaviors and food preferences for the child at home and at school.

Daily activities and exercise patterns.

The same for entire household as well.

Working with My PatientsNext I consider the cultural barriers to changing the patient’s current behavior patterns because identifying these potential blockages is critical for my patient and I to identify areas for change. 1) Ask whether there are any concerns regarding the child’s weight.

2) Get a sense of their nutritional knowledge and family food intake.

3) Determine who does the grocery shopping and where.

4) Assess the neighborhood-physical environment.

5) Discuss schedules and time constraints.

Working with My PatientsAs part of this evaluation, my patient and I will discuss other

issues that have priority over achieving a healthy weight for their child. This may include lack of access to healthy foods near by,

unhealthy foods at school, the patient’s effort to balance a work schedule with meal preparation.

It may also involve other family members, so whenever possible involve other family members in the conversation.

Priority is placed on increased physical activity and good nutrition as one of the key factors in helping the child achieve a healthy weight.

I Identify messages and methods that would most effectively motivate the family to adopt and maintain healthier lifestyles.

Working with My Patients – Vignette Mother and father both work and get home after 5 pm.GM is the caretaker when children get out of school.GM prepares meals and does the grocery shopping.No after school activities because parents work late and

are unable to take them to practices.GM states they just come home and too much homework

to do anything else.Mother complains GM very indulgent.Live in a home, small yard and not too safe for kids to be

out after dark.

Working with My PatientsGoal is to raise the priority of increased physical activity

and good nutrition-motivating and engaging.Explore activities that can be done at home- turn on the

radio and dance, jump rope, hula hoop, take a walk around the block before sundown, possibility of walking to and from school, etc.

Emphasize health risk factors with GM and motherWork with GM and the traditional foods she makes-

introducing a healthy diet while allowing to maintain as much the traditional diet as possible.

Involve child in the buying and cooking of food. Nutrition education and food label reading.

Because the patient’s food choices and meal structure play a key role in helping the child achieve and maintain a healthy weight, I involve a dietician or nutritionist in the dialogue. This helps me and the patient increase our chances in making a positive change.

In HealthCare Partners, we have staff within the medical group to draw on. These resources are also available in the community.

The key is: partner to increase support for the patient.

Partnering with Nutrition/Diet Experts

The Nutritionist/Dietician on the TeamIn working with my patients and their families, I pretty much am in line with what Dr. Rosado has reviewed with you. I also cover emotional aspects of obesity in children with my patients.1) Make small achievable goals:

Keep the Kids Active – take the family for a walk one hour after dinner beginning with 15 minute walks. Increase the walks by 15 minutes every 2 weeks until the goal is met.

Teach Families to Read Food Labels – Focus on avoiding high sugar, high sodium and high fat foods. Have parents read the labels of the foods they have in their home,

this gives them a starting point then replace unhealthy foods with healthier food choices.

The Nutritionist/Dietician on the Team1) Make small achievable goals:

Use Creative Ways to Incorporate Fresh Fruits & Vegetables into Meals and Snacks – Fruit juices are highly used in the Hispanic population. Encourage the family to eat fruit instead of drink the juice.

Incorporate Healthy Alternatives into Typical Ethnic Foods – Use brown rice instead of white rice. Start with ½ brown and ½

white rice mix together then slowly reduce the white . Wheat bread - When purchasing look for the first ingredient to be

whole wheat flour instead of Enriched Bleached Flour.

The Nutritionist/Dietician on the Team

2) Address the Emotional Aspect of Obesity:Teach Parents to –

Avoid Using Pet Names regarding their size.Avoid Emphasizing the Size of the Child.

Toolkit Multicultural Communication Resources

Multicultural Communication ResourcesCultural Competency FocusPatient/Provider Communications ToolsPatient Education & Online Resources

with large section of multilingual and multicultural communications tools

Comprehensive California Health Plan Interpreter Services Directory

Multicultural Patient Communications Vignette

Patient Education MaterialsSections 5 and 6 and Toolbox Section in Toolkit

Multicultural Resources in the ToolkitEthnoMed – http://ethnomed.org

Healthy Roads Media - www.healthyroadsmedia.org

MiPiramide – www.mypyramid.gov/sp-index.html

Oficina de Saluld de las Minorias/Office of Minority Health – www.omhrc.gov/espanol/

Consumer Health Materials in Spanish – http://nnlm.gov/outreach/consumer/chspanish.html

CDC en espanol – www.cdc.gov/spanish

Think Culturally (Office of Minority Health) – www.thinkculturalhealth.hhs.gov

The Provider’s Guide to Quality & Culture – http://erc.msh.org/mainpage.cfm?file=5.4.5.htm&module=provider&language=English

Community Resources for Healthy Eating Have your staff identify resources available in your community to help you help your patients. These may include the YMCA, health plans, school based programs, faith based organizations, local hospitals, parks and recreation programs and community centers.

Have the list easily available in your office.

Web based Resource ListAcademy of Nutrition & Dietetics

www.eatright.orgNational Council of La Raza – Institute for Latino Health

www.nclr.org

American Assoc. of Diabetes Educators

www.diabeteseducator.org

USDA Food & Nutrition Services www.fns.usda.gov

California Dietetic Associationwww.dietician.org

YMCA of the USAwww.ymca.net

United States Department of Agriculture

www.choosemyplate.gov

NCES Health and Nutrition Educationwww.ncescatalog.com

Kids Health from Nemourshttp://kidshealth.org

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