Running head: INTERVENTIONS FOR REDUCING OBESITY AMONG LATINO YOUTH

Harry Ta

HSC 435, section 02

Best Practice Research Paper

Interventions for reducing obesity among Latino youth

Word count: 2087

INTERVENTIONS FOR REDUCING OBESITY AMONG LATINO YOUTH 1

Background

Obesity is a term used for people with a body mass index (BMI) of 30 and higher. The

American Heart Association (2016) describes obesity as a condition in which a person is above

his or her ideal weight, and has large amounts of fat in his or her body. Furthermore, being obese

and accumulating fat will cause a person to be more susceptible to heart disease and diabetes by

harming the cardiovascular system and inducing diabetes.

Latino children are especially at high risk for obesity. Approximately 39.8% of Latino

children ages 2 through 19 in the United States are overweight or obese (Obesity Prevention in

Latino Communities, 2014). Leading factors for obesity in Latino children are unsafe areas to

have physical activities and consuming less nutritious foods. Latino children live further away

from parks than non-Hispanic Whites, and lack of transportation to safe areas decreases the

amount of time Latino children to be physically active. Latino children also live in

neighborhoods that are more exposed to fast food and sugar beverages, as well as attend schools

that are near fast food restaurants and convenience stores than non-Hispanic Whites (Obesity

Prevention in Latino Communities, 2014). Having limited access to parks and other safe places

for physical activity, in addition to being exposed to less nutritious foods have increased the

number of obese Latino children. Interventions must be utilized to reduce the proportion of

Latino children and adolescents who are considered obese.

Literature Review

The first intervention is Aventuras Para Ninos study. The purpose of this study was to

evaluate the impact of family interventions and community interventions control childhood

obesity among Latino Children by promoting healthy eating as well as physical activity. The

study was set in San Diego County with 808 Latino children grades kindergartens through
INTERVENTIONS FOR REDUCING OBESITY AMONG LATINO YOUTH 2

second grade with their parents from 13 elementary schools (Crespo et al., 2012). Schools and

students were randomized to receive family interventions or school and community

interventions. Promotoras will conduct home visits or phone calls to discuss barriers to eating

healthy and physical activity, how to prepare healthy meals, and help parents with monitoring for

family interventions. Playgrounds, salad bars, and physical education equipment were improved

in schools, while parks and restaurant menus were improved for families in school and

community interventions (Crespo et al., 2016). Some variables that were examined were

childrens physical activity, TV viewing, dietary intake, family meals, and eating-away-from

home. Children and parents BMI were collected before the interventions was introduced and

after the interventions was implemented to assess effectiveness of the different type of

interventions.

Although there was not a significant change in children BMI for the school/community

interventions, there was a significant change in BMI in family interventions. Not only was the

BMI in family interventions lower than the BMI in school and community interventions, but

children that had the family interventions were physically more active, watch less television, and

ate healthier meals. This study indicates the importance of family in changing health habits.

Explanations for the effectiveness of the family interventions can be because of how influential

and the proximity of the family to the children. The home visits and calls from Promotoras help

parents become more physically active, and create healthier meals. The children will participate

in more physical activities and eat healthier if the parents are physically active and prepare

healthier meals.

The second intervention focused on changing the diet to obesity rates

in Latino youth. Mirza et al. (2013) conducted the intervention to compare

INTERVENTIONS FOR REDUCING OBESITY AMONG LATINO YOUTH 3

the effects of a low glycemic diet (LGD) and a low-fat diet (LFD) on the body

weight of obese Latino youth. One hundred and thirteen obese Latino

children ages 7 through 15 that lived near a Childrens National Medical

Center community clinic were randomized to receive either the LGD or LFD.

The program had a 12-week nutrition and dietary counseling intervention.

The education sessions taught the participants and their parents in the LGD

group how to change their current diet into a LGD, and the participants in the

LFD how to limit fat intake (Mirza et al., 2013). The intervention also included

physical activity sessions to increase physical activity. Weight, height, and

BMI are taken before the intervention and in follow-ups to assess

effectiveness.

By the end of the study, both the LDG groups and the LFD groups had

significantly reduce BMI in Latino children since the baseline assessment

(mirza et al., 2013). The explanation to the success of the intervention is that

Latino children tend to have a high glycemic and high-fat diet. Reducing the

glycemic and fat intake reduced BMI. However, there are no significant

differences between the two diets. This intervention is a good example that

changing the intake of high glycemic and high-fat diets and exercise are

good prevention measures that can reduce BMI and obesity among Latino

children.

In the third intervention Kilanowski and Gordon (2015) made a similar intervention using

nutrition and physical activity to lower risk of obesity among Latino children grades one through
INTERVENTIONS FOR REDUCING OBESITY AMONG LATINO YOUTH 4

eight attending a summer Migrant Education Program (MEP). A total of 171 Latino children

participated, 138 received the intervention and 33 was the control and comparison group. A

certified health, nutrition, and physical educator was assigned to conduct the intervention. The

students in the intervention group were educated on fruits and vegetables, decreasing TV and

video game time, physical activity, sugar beverages, portion sizes, and food labels in classrooms;

for outdoors, the classes were provided with equipment to educate on physical activities and

sports (Kilanowski & Gordon, 2015). The control group only received CDC flyers on healthy

eating. By the end of the summer, the intervention group had a 12% decrease in BMI, but the

control group had an increase in mean weight and none of the 33 children had a healthier BMI

(Kilanowski & Gordon, 2015). Furthermore, the Latino youth in the intervention group

expressed healthier habits and behaviors than the children in control group.

This intervention also suggests the importance of having nutrition and physical education

in school. In a short summer MEP, the intervention has shown effectiveness to reducing obesity

rates among Latino youth. If this intervention were to be implemented in the main school year

throughout the childrens school years, then the intervention would have a larger impact on the

health and obesity rates among Latino children.

The fourth intervention also examined the effects of nutrition and exercise. However, this

intervention by Davis et al. (2010) tested the effectiveness of nutrition education and physical

education independently, and the effectiveness of a combined nutrition and physical education.

The study consisted of 114 overweight Latino adolescents. These Latino adolescents were put

through one of four different programs: Strength training (ST) for 21 Latino boys; nutrition

program (N) for 23 Latino girls; nutrition and strength training combined (N+ST) for 54

participants; and Combination of Aerobic and Strength Training (CAST) added 16 Latino girls to
INTERVENTIONS FOR REDUCING OBESITY AMONG LATINO YOUTH 5

the N+ST program (Davis et al., 2010). By the end of intervention, ST and CAST had a larger

impact on reducing obesity and type 2 diabetes risk in Latino children than the other studies.

The reasons for the ST and CAST studies to effective was that overweight children tend

to score higher in strength exercises than non-overweight children. Thus, the overweight children

felt more keen and comfortable to comply to the program (Davis et al., 2010). The ST study

discovered improved insulin sensitivity for the Latino boys and the Latino youth in the CAST

study had improved glucose control and adiposity levels. In conclusion of this intervention,

exercise had a profound effect on reducing obesity rates in Latino children.

The last intervention was based off the Coordinated Approach to School Health (CATCH)

program. The study included 28 schools in Texas to assess the CATCH program, and the

components of the CATCH program with the combination of gardening and physical activity

interventions on weight status (Evans et al., 2016). The schools were randomized into one of four

programs being evaluated are the CATCH program as the control group; the CATCH program

with a school garden intervention; the CATCH program with physical activities intervention; and

the CATCH program that included a school garden intervention and physical activities

intervention (Evans et al., 2016). The CATCH program promoted nutrition education, physical

education and physical activities. The CATCH program that included the school garden

intervention had a school garden for each class and a curriculum that educated on growing

vegetables and creating healthy meals with vegetables. The CATCH program that included the

physical activity component had a classrooms perform two class activities each week. The last

program is the combination of the CATCH program, school garden, and physical activity

interventions.
INTERVENTIONS FOR REDUCING OBESITY AMONG LATINO YOUTH 6

Despite the CATCH program that included the garden intervention did improve the health

of Latino children, the CATCH program that included physical the activity intervention had the

largest impact among the students compared to the other programs. The reason for the success of

the CATCH program with a physical activity intervention is that nutrition education and physical

activity can be easily implemented in the lives of students in school and home. This intervention

also demonstrates the effectiveness of nutrition and physical education on the weight status of

Latino youth.

Intervention Proposal

I will introduce a school program based off the literature review that focuses on obesity,

nutrition and physical education to reduce the proportion of Latino youth who are considered

obese. The components of the nutrition education component will consist of a learning

curriculum to educate Latino children on obesity and its consequences; different kinds of healthy

foods and its benefits; learning different types of unhealthy foods and how to avoid them; and

how to create a LGD and LFD. The components of the physical education will instruct the

overweight and obese Latino children on the benefits of physical activity, strength training, and

aerobic exercise. I will use the Transtheoretical Model and its stages - pre-contemplation,

contemplation, planning, action, maintenance, and relapse/termination to guide my intervention

program.

Before my school program is implemented, the Latino children are in the pre-

contemplation stage where they are not educated on obesity and nutrition; thus, are not

considering changing behaviors. Once the program begins, the classrooms will educate on

obesity and nutrition. This will push the Latino youth from the pre-contemplation stage to the

contemplation stage where they believe nutrition is important to prevent obesity and consider
INTERVENTIONS FOR REDUCING OBESITY AMONG LATINO YOUTH 7

changing behaviors. After the obesity and nutrition courses, the Latino children will attend

physical education classes to create a routine that includes strength training and aerobic exercise

to perform that will move the children to a healthier weight and BMI. At this point, the Latino

youth are moving from the contemplation stage to the planning stage where they are planning a

course of actions that is achievable for each student to reduce risk of obesity. When a routine has

been made, the students are ready to advance to the action stage where they perform the strength

training and aerobic exercise physical activities. When moving from the action stage to the

maintenance stage, nutrition and physical education must be taught throughout the school. This

curriculum will assist in maintain physical activity in addition to reinforce and further educate

the importance of nutrition to prevent obesity.

There is a possibility that the Latino children in the program will relapse or move to

termination of unhealthy habits. To lower the risk of relapse and increase chances of termination,

the program will hold free summer nutrition and physical education classes. This will result in

more Latino children maintaining obesity and nutrition knowledge, together with physical

activities to easily transition to the new school year without having all Latino students relapsing.

Conclusion

Latino children are at high risk for obesity, which can lead to having heart disease and

diabetes. The leading causes for Latino children being high risk for obesity are lack of areas to

have physical activities and the exposure to many non-nutritious foods. Nutrition and physical

education have proved effective in reducing BMI and obesity in Latino children, especially

learning about healthy and unhealthy meals to create a LGD or LFD as well as strength training

and aerobic exercises. In order for an obesity intervention to work for Latino children the

program must provide a safe place for physical activities, a health curriculum that educates on
INTERVENTIONS FOR REDUCING OBESITY AMONG LATINO YOUTH 8

obesity and nutrition, and physical education that focuses on strength training and aerobic

exercises. If a program has met these requirements, then the program will most likely succeed in

reducing the proportion of Latino children that are considered obese.

References

By ages 6 to 11, 26.1 percent of Latino children are obese compared with 13.1 percent of

Whites. Almost three-quarters of differences in the rates between Latino and White

children happens by third grade.8. (2014, September). Maximizing The Impact of

Obesity-Prevention Efforts In Latino Communities: Key Findings and Strategic

Recommendations. Retrieved November 02, 2016, from

http://stateofobesity.org/disparities/latinos/

Crespo, N. C., Elder, J. P., Ayala, G. X., Slymen, D. J., Campbell, N. R., Sallis, J. F., . . .

Arredondo, E. M. (2012, February). Results of a Multi-level Intervention to Prevent and

Control Childhood Obesity among Latino Children: The Aventuras Para Ninos Study.

Annals of Behavioral Medicine, 43(1), 84-100.

http://dx.doi.org.ezproxy.library.csulb.edu/10.1007/s12160-011-9332-7

Davis, J. N., Ventura, E. E., Shaibi, G. Q., Byrd-Williams, C. E., Alexander, K. E.,

Vanni, A. K., . . . Goran, M. I. (2010, October). Intervention for improving metabolic risk

in overweight Latino youth. International Journal of Pediatric Obesity, 5(5), 451-455.

http://dx.doi.org.ezproxy.library.csulb.edu/10.3109/17477161003770123
INTERVENTIONS FOR REDUCING OBESITY AMONG LATINO YOUTH 9

Evans, A., Ranjit, N., Jovanovic, C., Lopez, M., MicIntosh, A., Ory, M., . . . Warren, J.

(2016, September 13). Impact of school-based vegetable garden and physical activity

coordinated health interventions on weight status and weight-related behaviors of

ethnically diverse, low-income students: Study design and baseline data of the Texas,

Grow! Eat! Go! (TGEG) cluster-randomized controlled trial. BMC Public Health, 16, 1-

16. http://dx.doi.org.ezproxy.library.csulb.edu/10.1186/s12889-016-3453-7

Kilanowski, J. F., & Gordon, N. H. (2015, September/October). Making a Difference in

Migrant Summer School: Testing a Healthy Weight Intervention. Public Health Nursing,

32(5), 421-429. http://dx.doi.org.ezproxy.library.csulb.edu/10.1111/phn.12175

Mirza, N. M., Palmer, M. G., Sinclair, K. B., McCarter, R., He, J., Ebbeling, C. B., . . .

Yanovski, J. A. (2013, February). Effects of a low glycemic load or a low-fat dietary

intervention on body weight in obese Hispanic American children and adolescents: A

randomized controlled trial. The American Journal of Clinical Nutrition, 97(2), 276-285.

Retrieved November 2, 2016, from http://ajcn.nutrition.org/content/97/2/276.full

Obesity Information. (2016, October 18). Retrieved November 2, 2016, from

http://www.heart.org/HEARTORG/HealthyLiving/WeightManagement/Obesity/Obesity-

Information_UCM_307908_Article.jsp#.WBp28CRaGuQ
INTERVENTIONS FOR REDUCING OBESITY AMONG LATINO YOUTH 10