Some Hispanics Are Learning Healthier New Habits to Fight Overweight and Obesity, but Challenges Remain

WASHINGTON (By Krissah Williams, Washington Post) January 17, 2006 — Last year, 12-year-old Alejandra Rojas acknowledged that she was a little too chubby, or gordita , as her Spanish-speaking mother, Gabriela, would say. At 5-4 and 145 pounds, she was overweight, her pediatrician told her, and at risk of becoming obese.

In their Adams Morgan apartment, Alejandra and her mother slathered their breakfast bagels with butter or cream cheese. The girl's lunch was usually a Hot Pockets sandwich, followed by chips and cookies.

At dinnertime, Gabriela Rojas, 48, a single mother from El Salvador, cooked mostly pork and red meat and piled their plates with fried yucca, fried plantains and rice. When Gabriela, who is not overweight, was too tired to cook after a long day cleaning houses, she bought her daughter burgers and fries at McDonald's or fried chicken at Popeye's.

"I ate whatever I liked, but I was always hungry," said Alejandra. She also had little energy during gym class. She and her mother have no car but they rarely walked, preferring to take the bus. They hardly ever exercised, Gabriela said, because they did not think it was important.

The Rojases' experience is common in the U.S. Hispanic population of 41.3 million, where excess weight is a problem. According to the 2005 National Health Interview Survey of the Centers for Disease Control and Prevention (CDC), at least one of every four Hispanic adults living in the United States is obese, which is defined as having a body mass index, or BMI, of 30 or more.

Among the major population categories, only non-Hispanic black women, a group in which at least every one of three is obese, have markedly worse figures. But in some sub-groups, notably Mexican-Americans, the problem is worse than in the Latino population as a whole -- and growing, particularly in children.

Obesity is leading to health problems, according to a 2003 American Medical Association study, which found that Hispanic children under age 10 have about a 50 percent lifetime risk of developing type 2 diabetes. Overweight and obesity also increase risk for other illness, including heart disease, stroke, and certain forms of cancer.

A study released in September by the District's Council of Latino Agencies assessed the health of Washington's Hispanic community (population 47,258, according to the 2000 Census). The study -- which involved 800 Latino adults, 99 percent of whom were recent immigrants -- found that 61 percent were overweight or obese. Community activists now are struggling to change habits that may contribute to this problem, starting with women like Gabriela Rojas.

"We realize that this is an emergency for us," said Eugenio Arene, executive director of the Latino council. "Mothers are the key informant of our culture and customs, and we tell them, 'You have a big responsibility in front of you. We are getting overweight, and we have to do something about it.' "

Placing Blame

National and local health experts offer several theories why overweight and obesity plague such a large portion of the U.S. Latino population.

Madeline Wilks, a primary care physician at La Clinica del Pueblo in the Columbia Heights, which serves a largely Latino clientele of more than 5,500 patients a year, thinks some of the answer lies in cultural norms.

"Being a little gordita is almost seen as a positive," she said. "When people are at an appropriate BMI, they are almost seen as being too skinny."

That view holds in much of Latin America, where people are familiar with the sight of thin, frail children in impoverished areas, health professionals said. Gabriela Rojas carried that perception and a love of starchy foods with her when she fled El Salvador's civil war for the District in 1987. She saw no harm in frying food in cupfuls of oil or in feeding Alejandra lots of sweets even as her daughter grew heavy.

Some experts blame immigrants' excess weight not only on their backgrounds but also on changes in their diet and lifestyle after they reach the United States.

"Often they move from a setting in which food was scarce and physical activity was a way of life to a setting in which food is plentiful and labor-saving devices are all around," said William Dietz, director of nutrition and physical activity at the CDC. "One of the issues is to look carefully at [the differences between] recent immigrants and acculturated Latinos. The experience of under-nutrition in home countries affects the way they perceive obesity in this country. If your experience is that children who are thin are much more likely to get seriously ill, [then] a little excess weight doesn't bother you as a parent. It certainly needs to be something we think about."

The lure of fat-laden fast food also gets frequent mention as a cause of weight problems.

It's not just that fast food presents an easy option for immigrants who "struggle with too much to do, just like anyone else," says Alejandra's pediatrician, Rachel Tellez, who works at Unity Health Care's Upper Cardozo Clinic in Columbia Heights. Some immigrant parents actually take pride in buying their children fast food -- a luxury that many could not afford back home, she says.

"I think for a lot of Latino families it is a privilege to provide their families with fast food," Tellez said. "They could not afford it in their home countries, [and] now they are happy to buy their kids fast food."

Mixing junk food with traditional Latin foods prepared with lots of oil and cheese exacerbates the problem, say health experts. But fresh fruit and vegetables are often expensive and hard to find in immigrant neighborhoods. In the Council of Latino Agencies study, 53 percent of those surveyed reported not eating five or more servings of fruit and vegetables each day -- the amount government nutritionists recommend. Nearly 40 percent said they don't exercise regularly, compared with 20 percent of other D.C. residents.

Dietz cautions against accepting any theory without further research.

"I think we have to be careful not to assume that the same factors are operating in each [national] group," he said. "What little we know is that the problem of weight is perceived much differently in different groups. We have the least information about weight perceptions and potential drivers in the Latino community."

Back to School

Gabriela Rojas said she did not recognize the danger in her family's diet until Tellez referred her to a free nutrition course sponsored by the Upper Cardozo Clinic and the Capital Area Food Bank. The six-week course, conducted in Spanish and held on Saturdays last year, was designed to help Latino families change habits that may have contributed to the community's weight problems.

Local chefs, a nutritionist and a clinic volunteer instructed Alejandra and her mother in the basics of healthy eating. At a grocery store, the instructors translated nutrition labels and taught the families to look for foods high in fiber. In the clinic kitchen, Alejandra and her mother were startled to see the chef prepare a chicken dish with only a capful of oil.

"We did not believe with so little oil the food would be so good," Gabriela said in Spanish. "We had the opportunity to see the difficulties caused by poor nutrition."

The Rojases learned new recipes, such as low-fat vegetarian quesadillas, and new techniques, such as removing the skin from chicken before cooking. The nutritionist also taught them to eat smaller portions. To shorten food preparation time during the work week, instructors advised buying fresh vegetables on the weekend and chopping them ahead of time.

The Rojas family was lucky. Most recent immigrants don't have access to pediatricians, free courses and nutritional counseling. A nationwide survey by the Robert Wood Johnson Foundation found that 20 percent of Hispanic children were not covered by health insurance in 2003. Low incomes and poor education common among recent immigrants can also compound the problem.

Community efforts to promote healthy habits face challenges. La Clinica del Pueblo won two grants last year to try to help overweight and obese Latinos slim down through free nutritional counseling and exercise classes. But Abby Goldstein, the group's director of clinical services, said providing these services proved difficult.

Exercise classes were held once a week but never drew more than a few attendees. One problem was that class times changed each week to accommodate instructors' schedules, and alternatives weren't readily available. "There is no gym in the community where there are Spanish speakers," said Goldstein. "There aren't very many places for Latinos to go where they feel comfortable."

Also, Goldstein needed nearly six months to find a bilingual nutritionist. When that instructor became ill, the clinic had to end the program.

New Lives

Nearly a year after the Upper Cardozo Clinic's nutrition program ended, Gabriela Rojas says she's keeping the changes she learned. Her weekly grocery bill has risen slightly because she buys more fresh fruit and vegetables, but she says the expense is worth it.

"I don't want diabetes or heart disease," she said.

She and Alejandra now eat mostly lean chicken and turkey instead of red meat. They eat smaller portions and often have salad or vegetables as part of their meals. When they order fast food, it's grilled chicken sandwiches -- and hold the mayonnaise, Alejandra said.

They try to walk more rather than ride the bus. Alejandra swims at the local YWCA and often plays soccer, too. She has grown two inches and lost 20 pounds since completing the program. Now, she is tall and slender. And her skin is clearer, too, she said.

"I don't feel as big as I used to, and people tell me I'm healthier," she said, smiling.