Cultural conflicts in the weight loss experience of overweight Latinos

Understanding family functioning in mothers and daughters with obesity

PURPOSE

This study sought to understand family functioning surrounding weight in Mexican American women with obesity.

METHODS

Semi-structured in-depth interviews were conducted with mothers and adult daughters (N = 116).

RESULTS

Thematic analysis identified five themes. 1) The communication process drives perception of supportive messages. Messages perceived as non-supportive consist of directives as interventions, confirmation of faults, and critical compliments whereas supportive consist of compliments, encouragement, empathetic listening, and disclosure. 2) Acculturation differences interfere with intergenerational alliance. Differences involve dissonance in communication, behavioural expectations, and weight-related practices. 3) Maladaptive conflict responses contribute to relational strain. These responses include avoidance, withdrawal, and defensiveness. 4) Role transformations alter the generational hierarchical relationship. Daughters serve as role models, caregivers, or collaborators. 5) Low communal coping heightens psychological distress. It does so by challenging family roles, increasing social isolation, and compromising social support.

CONCLUSION

Obesity interventions for Mexican American women may benefit from targeting relational skills to improve family functioning.

Healthcare Service Providers' Perspectives on Sociocultural Aspects Affecting Weight Management Activities Amongst People with Obesity in Taiwan-A Qualitative Study

The prevalence of obesity and morbid obesity in Taiwan has risen sharply in recent decades, as in other parts of the world, necessitating urgent action to prevent and curb its detrimental effects. Asian populations are susceptible to the repercussions of obesity at a lower body weight. A higher BMI is associated with more frequent outpatient visits, in-hospital admissions, higher medical costs, and a lower quality of life. However, effective weight management approaches are unlikely to be maintained in the long term without assimilation into daily lifestyle practices. This qualitative study, based on semi-structured interviews with 14 doctors, dieticians, and nurses who work to control the weight of people with obesity, explored and identified multilevel barriers in the context of daily life to improve the efficacy and execution of weight management strategies. They considered diets, physical activity, and sleep as key weight management activities. The cultural and psychosocial aspects of daily life were observed to have an impact upon weight management, particularly family conflicts due to cultural dynamics and socially and culturally reinforced food practices. To improve population weight, less-recognised aspects need to be addressed alongside the inclusion of mental health specialists in weight management protocols and policy interventions to minimise obesogenic practices and create environments conducive to weight management.

Nutrition Effects of a Family-Centered Health Promotion Program for Mexican-Heritage Children in the Lower Rio Grande Valley of Texas

Systemic and social factors, like poverty and food insecurity, negatively influence fruit and vegetable (FV) intake and body mass index (BMI) among Latino/a children. Behavioral programs are needed to support children’s nutrition. This study examined program effects on FV intake and BMI outcomes for Mexican-heritage children (9–11 years). The program used a modified stepped-wedge design in the Lower Rio Grande Valley of Texas (2019 and 2020). Promotoras led experiential nutrition education sessions and collected height, weight, and instant skin carotenoid scores (biomarker for FV intake) at pre-test (baseline), post-test (6 weeks), and maintenance (3–4 months after post-test). Mean changes and group differences in skin carotenoid scores, BMI z-scores and percentiles were obtained from analyses of variance. Linear mixed-effects models were used to determine overall program effects. Mexican-heritage children were enrolled (n = 57 and 52.6% female). An overall decrease in skin carotenoid scores was observed at post-test (−15.1; 95% CI: −24.95, −5.33). While scores varied widely (range: 17–498), an increase of 14.8 ± 23.8 points occurred in one intervention group. Compared to the control period, greater reductions in BMI outcomes occurred during the program. These findings provide evidence for the use of strengths-based approaches in behavioral nutrition programs.

Developing a Culturally Responsive Lifestyle Intervention for Overweight/Obese U.S. Mexicans

INTRODUCTION

Hispanics are the largest minority group in the United States, constituting 18 % of the population. Mexicans are the largest Hispanic subgroup and are at disproportionate risk for overweight/obesity. Lifestyle interventions targeting dietary change and physical activity have resulted in significant weight loss in several large randomized clinical trials in the general population, but few studies have tailored interventions to Mexican Americans. We conducted a community needs assessment from 2018 to 2020 in accordance with Domenech-Rodriguez and Wieling's Cultural Adaptation Process (CAP) model to inform the development of SANOS (SAlud y Nutrición para todOS) (Health and Nutrition for All), a culturally-tailored, community-based diet and lifestyle education and counseling program that addresses overweight/obesity among U.S. Mexicans.

METHODS

Five Spanish-language focus groups were conducted until thematic saturation with 31 overweight/obese Mexicans in New York City about their knowledge, priorities, and preferences regarding diet, exercise, and evidence-based strategies for behavioral change. A grounded theory approach was used to analyze the data.

RESULTS

Five themes were identified: (1) A strong desire for tangible information related to diet and health, (2) Family as a primary motivator for behavior change, (3) Desire for group-based motivation and accountability to sustain intervention participation, (4) Belief in short-term goal setting to prevent loss of motivation, and (5) Time and workplace-related barriers to intervention adoption.

CONCLUSIONS

Ecological factors such as the effect of acculturation on diet, family members' role in behavior change, and socioenvironmental barriers to healthy dietary practices and physical activity should be considered when adapting evidence-based treatments for Mexican Americans.

Perception of students on factors contributing to overweight and obesity among high school students in Kiribati: A qualitative study

BACKGROUND

Overweight and obesity among high school students is a growing distress not only to the individual wellbeing of a person but also to the productivity of communities and economic expense of both developed and developing nations. This study aimed to determine factors contributing to overweight and obesity among high school students in Kiribati through the perception of students.

METHODS

This qualitative study was conducted in four (4) randomly selected senior high schools on South Tarawa, Kiribati from August to November, 2020. A purposive sampling was used to select thirty-two (32) students enrolled into form levels 4-7. A semi-structured open-ended questionnaire was used for data collection using face-to-face in-depth interviews. Data was transcribed and analyzed using thematic analysis method.

RESULTS

This research revealed that the participants were 21 (65.6%) were females and 11 (34.4%) males from form levels four with 9 (28.1%) participants, five with 9 (28.1%) participants, and form seven with 14 (43.8%) participants. Five themes identified including determinants and prevention of overweight and obesity, education and health system factors, stigma, and being fat comes with high risk. These themes collectively elaborate on the essentials of overweight and obesity that are obtained from perspectives of students.

CONCLUSION

A strong cultural belief and practice has caused misperception of overweight and obesity among students with knowledge-behavior gap recognized as the main reason behind the failure in lifestyle changes among adolescents. Strengthen healthy behavioral lifestyle, improve awareness, and support feasible preventative strategies is recommended to all students.

Views of Black women patients with obesity on desired and undesired weight-focused clinical encounters

Non-Hispanic Black women have the highest rates of overweight/obesity of any group in the United States. To date, few interventions have worked to reduce overweight/obesity in this population. This study investigated the views of Black women with overweight and obesity treated in a primary care setting regarding desired and undesired verbal and non-verbal behaviours by providers in provider-patient clinical encounters focused on losing weight, maintaining weight loss, and/or obesity. Two focus groups and an individual interview (n = 15) were conducted. Qualitative data analysis yielded five distinct themes, with 11 codes (listed in parenthesis): (a) desired weight-focused discussions (codes: Discussing weight loss with patients and discussing weight-loss maintenance with patients), (b) desired weight-focused support (codes: Supporting patients experiencing weight loss and supporting patients experiencing weight gain), (c) undesired weight-focused discussions (codes: Things to avoid during weight loss discussions and things to avoid during weight gain discussions), (d) desired attitudes and behaviours during weight-focused discussions (codes: Show caring and understanding and encourage behaviour change for weight loss), and (e) building physician-patient rapport (codes: Enable patients to feel respected by doctors, enable patients to feel comfortable with doctors and enable patients to trust their doctors). The qualitative approach employed in this study generates a deep understanding not only of the experiences of Black women patients but also of potential strategies that physicians could employ to succeed in their discussions with patients regarding healthy weight achievement and maintenance.

Socioeconomic Inequalities and Obesity in South Africa-A Decomposition Analysis

Background: Prior evidence shows that inequalities are related to overweight and obesity in South Africa. Using data from a recent national study, we examine the socioeconomic inequalities associated with obesity in South Africa and the factors associated with it. Methods: We use quantitative data from the South African National Health and Nutrition Examination Survey (SANHANES-1) carried out in 2012. We estimate the concentration index (CI) to identify inequalities and decompose the CI to explore the determinants of these inequalities. Results: We confirm the existence of pro-rich inequalities associated with obesity in South Africa. The inequalities among males are larger (CI of 0.16) than among women (CI of 0.09), though more women are obese than men. Marriage increases the risk of obesity for women and men, while smoking decreases the risk of obesity among men significantly. Higher education is associated with lower inequalities among females. Conclusions: We recommend policies to focus on promoting a healthy lifestyle, including the individual’s perception of a healthy body size and image, especially among women.

The Case for a Health at Every Size Approach for Chronic Disease Risk Reduction in Women of Color

The conventional approach to chronic disease management in women of color is a dieting-for-weight-loss approach, which has not been proven to be effective. The purpose of this article is to highlight the shortcomings of the dieting-for-weight-loss approach and demonstrate the potential efficacy of the Health at Every Size approach when working with women of color to prevent and address chronic diseases. The article's areas of focus are weight stigma, bias, and size discrimination; the implications of differing weight perceptions and motivations for change; and weight as the primary determinant of health and biological factors affecting weight.

Exploring Iranian obese women's perceptions of barriers to and facilitators of self-management of obesity: A qualitative study

BACKGROUND

Despite the clinical importance of self-management for obesity, poor compliance or noncompliance with the treatment regimen is a prevalent and persistent problem concerning people with obesity.

AIMS

The aim of this study was to explore Iranian obese women's perceptions regarding the barriers to and facilitators of self-management of obesity.

MATERIALS AND METHODS

In this qualitative study, the participants were selected through purposeful sampling and the data were collected using semistructured interviews and focus groups between July 2017 and September 2018. Nineteen participants between the age range of 28-50 years and mean age of 38.56 years were interviewed. A focus group with seven participants was conducted to reach data saturation. All the interviews and the focus group were transcribed verbatim and the data were analyzed using constant comparative method.

RESULTS

The perceived barriers to obese women's self-management for obesity were identified and classified into four main categories: (I) restrictions, (II) the pressures of being in the group, (III (temptation, (IV) resonators. In addition, seven main categories emerged as facilitators of obese women's self-management for obesity: (I) achieving self-awareness, (II) positive consequences for weight loss success, (III) positive outcomes of exercise and physical activity, (IV) peers experience, (V) correct and logical program, (VI) autonomy and empowerment, and (VII) having supporting umbrella.

CONCLUSION

This qualitative research provided a range of facilitators and barriers to self-management of obesity perceived by an obese woman to improve our understanding of the complex nature of self-management of obesity. Healthcare providers may consider this issue while designing and implementing appropriate interventions to upgrades woman's ability for self-management of obesity.

A Conceptual Framework Exploring Social Media, Eating Disorders, and Body Dissatisfaction Among Latina Adolescents

The purpose of this review is to propose a conceptual framework using objectification theory and intersectionality theory to examine social media's influence on body image and its effect on eating disorder predictors among Latina adolescents. To examine and explore how these effects from social media usage can result in mental health disparities that affect this group, emphasis was placed on how Latina ethnic identity mediates body image. Implications for clinicians and researchers include using strengths-based and culturally specific approaches as protective factors for Latina adolescents to strengthen ethnic identity.

Exploring the Experiences of Iranian Women Regarding Obesity Self-Management: A Qualitative Study

BACKGROUND

Despite the high and growing prevalence of obesity in Iran and a variety of interventions by the healthcare providers control the problem, and it is still a prevalent health problem among Iranian women.

AIM

The aim of this study is to explore the perspective of obese Iranian women in the process of self-management regarding the facilitating factor in self-management of obesity.

METHODS

In a qualitative study, the participants were selected through purposeful sampling, and the data were collected using semi-structured interviews and focus group (n = 25) between July 2017 and September 2018. All the interviews were transcribed verbatim and the data were analysed using constant comparative method.

RESULTS

Supporting the umbrella was the main category found in the present study. The participating obese individuals found "support" as the main factor with an outstanding effect on motivating, incentivising and keeping diet in long-term. This category contains subcategories: self-help; family, friends, and peers' support; and medical team's support.

CONCLUSION

The findings suggested the critical role of support in obesity self-management process. This critical factor improves our perception of the multi-aspect and complicated nature of obesity self-management. Moreover, policymakers and providers of health services can utilise this finding in the design of care plans with higher chance of success.

Clinical Staff's Motivators and Barriers to Engagement in Health-Promoting Behaviors

Clinical staff can promote patients' engagement in health-promoting behaviors to prevent/treat obesity. However, some clinical staff are overweight/obese and may not model health behaviors for their patients. This cross-sectional survey study tested the hypotheses that clinical staff's level of (1) motivators and (2) barriers to engaging in health-promoting behaviors would be significantly associated with their body mass index (BMI). Barriers were significantly correlated and motivators were not correlated with caregivers' BMI. Implications for nurses in professional development are discussed.

Informing the Adaptation and Implementation of a Lifestyle Modification Program in Hispanics: A Qualitative Study Among Low-Income Hispanic Adults

Low-income Hispanics are a hard to reach population that face unique challenges in achieving behavior change. Understanding such challenges can inform the adaptation of lifestyle behavioral interventions and increase participant engagement. This descriptive qualitative study aimed to (1) inform lifestyle modification programs focused on improving the physical activity and healthy eating of low-income Hispanic adults and (2) explore potential gender differences necessary for consideration. Five gender-specific focus groups were conducted with Hispanic adults from a free community clinic (n = 45, 64% women, 53.1 ± 10.1 years). Sessions were audio-recorded, transcribed, and coded using a general inductive approach. The qualitative software program Dedoose was used to perform a content analysis. Emergent themes included topics of interest, methods of increasing engagement in healthy behaviors, and the delivery of lifestyle modification programs. Men expressed greater interest in physical activity, while women desired to learn about healthy eating. Men described the importance of physician communication, while women focused on the role of social support as facilitators for participating in such programs. Both genders described education as key to behavior change and viewed text messaging as a valuable complement. Results from this study can inform the adaptation of lifestyle modification programs and increase the engagement of low-income Hispanic populations.

Rationale and study protocol for Unidas por la Vida (United for Life): A dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters

BACKGROUND

Half of Mexican-American women are under-active and nearly 78% are overweight/obese. The high lifetime risk of developing type 2 diabetes necessitates a culturally appropriate lifestyle intervention.

PURPOSE

Unidas por la Vida is a novel dyadic intervention that capitalizes on the centrality of family in Latino culture to mobilize an existing family dyad as a resource for health behavior change. The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes.

METHODS

Participants (N = 460 mother-adult daughter dyads) will be randomized into one of three conditions: 1) dyadic participation (mothers-daughters) in a lifestyle intervention; 2) individual participation (mothers alone; unrelated daughters alone) in a lifestyle intervention; and 3) mother-daughter dyads in a minimal intervention control group.

RESULTS

The primary outcome is weight loss. Secondary outcomes include physical activity, dietary intake, physiological measures (e.g. HbA1c), and body composition. Both the dyadic and individual interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group, with women assigned to the dyadic intervention expected to lose more weight and to maintain the weight loss longer than women assigned to the individual intervention.

CONCLUSION

Because health risks are often shared by multiple members of at-risk families, culturally appropriate, dyadic interventions have the potential to increase the success of behavior change efforts and to extend their reach to multiple family members.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT02741037.

Unhealthy weight control strategies: An outcome of body image and eating tensions in women of Mexican origin living in rural farming communities

Unhealthy eating and weight control behaviors are important but modifiable factors that contribute to obesity in majority and minority populations. Studies suggest that these behaviors are common in Mexican American women, but most studies completed to date have focused on college enrolled Mexican American women. Little is known about body weight concerns, eating and weight control behaviors in low acculturated immigrant Mexican women. This qualitative descriptive study utilized two focus groups with 15 women to identify and describe body weight and shape perceptions, and thoughts and behaviors related to eating and weight control of low acculturated Mexican American living in disadvantaged economic situations. Conventional content analysis was used to analyze data and three main themes were identified: (1) body weight values and concerns, (2) eating and food, and (3) weight loss strategies and consequences. The first two themes shared five subthemes including emotion, health, age, family, and culture. Results suggest Mexican American women experience weight concerns that are in conflict with food/eating values and experiences. This conflict is influenced by cultural, family, and inter/intrapersonal factors and contributes to unhealthy eating and weight control behavior. The transition and assimilation to the United States is complex and dynamic. Thus understanding how the conflict regarding body weight and food influence Mexican American women's health behaviors is important and provides valuable knowledge essential to guide further research and intervention development.

The Influence of Ethnic and Mainstream Cultures on African Americans' Health Behaviors: A Qualitative Study

BACKGROUND

Culture plays an important role in shaping individuals' health behaviors. This qualitative research examines the relationship between African Americans' ethnic and mainstream cultures and their health behaviors (i.e., food intake and physical activity).

METHODS

This study used in-depth semi-structured interview format with a group of 25 African Americans to examine the influence of ethnic and mainstream culture on African Americans' food intake and physical activity. Thematic analysis was used to identify common themes and patterns related to African Americans' health behaviors as well as to report these patterns within data.

RESULTS

The present study found that African Americans position both their ethnic and mainstream culture as important influences on their health behaviors pertaining to food intake and physical activity. Most participants reported taking advantage of "the best of both worlds" by engaging in picking and choosing healthy behaviors from both cultures to which they belong, and they perceived preparing healthy makeovers as a way to optimize their health. They also identified a range of practical considerations that can facilitate or hinder engagement in healthy eating and physical activity (e.g., affordability, social support). Participants discussed a number of other positive (e.g., resilience, spirituality) and negative (e.g., experience of discrimination) influences on health behaviors.

CONCLUSIONS

African Americans consider both their ethnic and mainstream cultures important in shaping their health behaviors. These cultural influences need to be understood in the context of other psycho-socio-environmental factors that affect individuals' health behaviors. The current study has practical implications for designing health promotion programs for African Americans.

Cognitive and behavioural strategies for self-directed weight loss: systematic review of qualitative studies

AIM

We conducted a systematic review of qualitative studies to examine the strategies people employ as part of self-directed weight loss attempts, map these to an existing behaviour change taxonomy and explore attitudes and beliefs surrounding these strategies.

METHODS

Seven electronic databases were searched in December 2015 for qualitative studies in overweight and obese adults attempting to lose weight through behaviour change. We were interested in strategies used by participants in self-directed efforts to lose weight. Two reviewers extracted data from included studies. Thematic and narrative synthesis techniques were used.

RESULTS

Thirty one studies, representing over 1,000 participants, were included. Quality of the included studies was mixed. The most commonly covered types of strategies were restrictions, self-monitoring, scheduling, professional support and weight management aids. With the exception of scheduling, for which participant experiences were predominantly positive, participants' attitudes and beliefs surrounding implementation of these groups of strategies were mixed. Two new groups of strategies were added to the existing taxonomy: reframing and self-experimentation.

CONCLUSIONS

This review demonstrates that at present, interventions targeting individuals engaged in self-management of weight do not necessarily reflect lived experiences of self-directed weight loss.

Meeting Weight Management Goals: The Role of Partner Confirmation

Social support research suggests romantic partners could play a vital role in the success of individuals' weight management (WM) efforts, but contradictory findings from previous research have impeded our understanding of how romantic partners influence weight management goal attainment. Employing a confirmation perspective, overweight participants (body mass index [BMI] greater than 25) who were actively trying to manage their weight (N = 53) were asked to respond to daily questionnaires for a period of 2 weeks regarding their interactions with their romantic partner. Diet, exercise, and general weight management goal accomplishment were assessed. HLM was employed to assess the independent and interactive effects of partner acceptance and challenge on each of these goals. Findings suggest that perceiving high levels of both acceptance and challenge from partners was associated with more general WM and diet goal accomplishment. However, greater attainment of exercise goals was associated with only challenge. Fluctuations in partner acceptance and challenge were also examined to determine whether consistency in confirmation behaviors was associated with WM goals. Hierarchical regressions revealed that fluctuations in acceptance, but not challenge, were linked with goal attainment. Specifically, fluctuations in acceptance were helpful for those whose partners were perceived to exhibit lower levels of acceptance, but fluctuations were detrimental for those whose partners exhibited greater acceptance. Implications for communication among couples in which one partner is attempting to lose weight are discussed.

Rebound Body Mass Index Growth in Year-Round Elementary Education Students of Largely Hispanic Descent Undergoing Obesity Interventions

BACKGROUND

Body mass index (BMI) increases when students are away on summer vacation. Evaluation of serial BMI measurements on year-round students allows new insight into the reasons children gain weight seasonally.

METHODS

The 206 first and second graders of 2-year-round elementary schools with obesity intervention programs were weighed and measured every 6 months from April 2011 until April 2013. BMI and BMI percentiles were recorded.

RESULTS

Children <50th, 50th to 85th, and 85th to 95th BMI percentiles showed significant accelerated winter gains in BMI (p = 2.6 × 10(-7), p = 6.8 × 10(-10), and p = .0007, respectively) compared with the previous summers. Accelerated BMI growth of the second summer was absent when compared with the previous winter BMI changes in children <95th percentile (p = .48, p = .81, and p = .93). For children >95th percentile, BMI gain continued without significant changes year-round.

CONCLUSIONS

School-wide interventions to induce BMI growth limitations are associated with significant rebound BMI gain with possible wintertime augmentation in nonobese children of year-round education programs. Obese children do not display rebound BMI gain, BMI seasonal change, or BMI limitations in response to school-based interventions. School weight control programs should consider off-campus sources of weight gain and be vigilant for rebound and delayed seasonal BMI gains.

The role of familism in weight loss treatment for Mexican American women

Mexican American women are disproportionately affected by overweight/obesity and the health complications accompanying them, but weight loss treatments are less successful in this ethnic group. High levels of familism, a value reflecting obligation to family that supersedes attention to oneself, interfere with weight loss for Mexican American women. This mixed methods study investigated overweight Mexican American women’s beliefs about how familism, and Mexican American culture, might hinder weight loss success, and how treatments might be culturally adapted. Results suggest a need to support women in their commitment to family while also helping them make changes. Recommendations for culturally adapted treatments are made.

Depression in Mexican Americans with diagnosed and undiagnosed diabetes

BACKGROUND

Depression and diabetes commonly co-occur; however, the strength of the physiological effects of diabetes as mediating factors towards depression is uncertain.

METHOD

We analyzed extensive clinical, epidemiological and laboratory data from n = 2081 Mexican Americans aged 35-64 years, recruited from the community as part of the Cameron County Hispanic Cohort (CCHC) divided into three groups: Diagnosed (self-reported) diabetes (DD, n = 335), Undiagnosed diabetes (UD, n = 227) and No diabetes (ND, n = 1519). UD participants denied being diagnosed with diabetes, but on testing met the 2010 American Diabetes Association and World Health Organization definitions of diabetes. Depression was measured using the Center for Epidemiological Studies - Depression (CES-D) scale. Weighted data were analyzed using dimensional and categorical outcomes using univariate and multivariate models.

RESULTS

The DD group had significantly higher CES-D scores than both the ND and UD (p ⩽ 0.001) groups, whereas the ND and UD groups did not significantly differ from each other. The DD subjects were more likely to meet the CES-D cut-off score for depression compared to both the ND and UD groups (p = 0.001), respectively. The UD group was also less likely to meet the cut-off score for depression than the ND group (p = 0.003). Our main findings remained significant in models that controlled for socio-demographic and clinical confounders.

CONCLUSIONS

Meeting clinical criteria for diabetes was not sufficient for increased depressive symptoms. Our findings suggest that the 'knowing that one is ill' is associated with depressive symptoms in diabetic subjects.

Environmental influences on small eating behavior change to promote weight loss among Black and Hispanic populations

Small eating behavior changes are proposed as more feasible to achieve and maintain than larger changes used in traditional behavioral weight loss studies. However, it is unclear whether overweight Black and Hispanic adults in a low-income urban setting experience small changes as feasible and what might influence feasibility. Participants' experiences in a 12-week pilot weight loss intervention were explored qualitatively to determine the feasibility of making small eating behavior changes in this population. After the intervention (69% retention), semi-structured interviews with 46 men and women (mean age 51, 50% Non-Hispanic Black, 43% Hispanic) revealed that making small eating changes was a process shaped by participants' intrapersonal and interpersonal eating environments. Participants responded to intrapersonal and interpersonal eating environmental challenges by adapting small change strategies, navigating eating environments, and negotiating household eating practices. Findings highlight how even small eating behavior changes called for adaptation, navigation, and negotiation of complex eating environments in daily life. These findings were used to improve the trial that followed and underline the importance of feasibility studies to inform community trials. Findings also add to understanding of contextual challenges and the skills needed to implement small changes in a low income, ethnic minority population.

A prospective multifactorial intervention on subpopulations of predominately Hispanic children at high risk for obesity

OBJECTIVE

Study the effects of multiple exercise and nutritional educational interventions on adverse body mass index (BMI) gain of BMI sub-groups of predominately Hispanic six through eight year-old children at high risk for obesity.

METHODS

BMI and demographic data were recorded at baseline and six months later in 749 first and second grade public school children at four elementary schools. Two schools (intervention group) received 150 min of extra physical education classes, weekly cooking classes, a structured nutritional curriculum, and parental counseling. BMI changes were calculated for each student and compared by BMI percentile subgroups using the two tailed T-test.

RESULTS

No statistical BMI differences occurred between intervention and control group children below the 25th percentile. Significance differences in BMI gain were noted from the 25th to the 50th percentile (P = 0.027), 50th-75th percentile (P = 0.045), and 75th-95th percentile (P = 0.00007), but not for the 95th-98th percentile (P = 0.288), 98th and above (P = 0.223), or both obese groups combined (P = 0.085).

CONCLUSIONS

Nutritional education and exercise can prevent but not treat obesity in predominately Hispanic first and second grade children. BMI subgroups should be studied to avoid masking differing outcomes of obese and nonobese children.

The cultural context of obesity: exploring perceptions of obesity and weight loss among Latina immigrants

This study used focus group methodology to examine perceptions of obesity and weight management among Latina immigrant women in Alabama. Four focus groups (N = 25) were conducted in Spanish as part of a participatory intervention development process. Participants were obese/overweight Latina immigrant women (BMI > 25) primarily recruited from a community hospital. The majority of participants were from Mexico. Participants described obesity in the context of short-term effects such as physical symptoms and aesthetics. Perceived weight gain was related to lifestyle changes since moving to the US. Social isolation, depression, and stress were reported to contribute to weight gain. Participants expressed interest in weight loss but emphasized a desire for programs that preserve traditional foods and include family. Weight-management programs designed for Latina immigrants should address their perceptions of obesity. This data also suggests that those interventions that preserve culture and incorporate family may have increased community buy-in.

Bodily Aesthetic Ideals Among Latinas With Type 2 Diabetes

Purpose

The purpose of this study was to examine how attitudes and practices related to bodily aesthetic ideals and self-care might inform the engagement of Latinas with type 2 diabetes (T2DM).

Methods

Focus groups were used to collect qualitative data concerning bodily aesthetic ideals and diabetes management, including help-seeking experiences, from Latina women with T2DM (n = 29) receiving care through Latino Diabetes Initiative at the Joslin Diabetes Center. Focus groups were conducted in Spanish, audiotaped, transcribed, and content analyzed.

Results

Four main themes emerged: (1) a preference among participants for a larger than average body size, although perceptions of attractiveness were more closely linked to grooming than body size; bodily dissatisfaction centered on diabetes-induced skin changes, virilization, and fatigue rather than weight; (2) diabetic complications, especially foot pain, as a major obstacle to exercise; (3) fatalistic attitudes regarding the inevitability of diabetes and reversal of its complications; and (4) social burdens, isolation, and financial stressors as contributing to disease exacerbation.

Conclusions

Interventions that emphasize reduced body size may be less effective with Latinas who have T2DM than those that emphasize the benefits of exercise and weight loss for skin health, energy levels, and reduced virilization.

Effects of a healthy eating intervention on Latina migrant farmworker mothers

This is a report of a 2-group pre-/post-quasi-experimental pilot intervention study, Dietary Intake and Nutrition Education-Phase Three. The purpose of the study was to present self-management health education on healthy eating to Latina migrant farmworker mothers. The intervention had three 1-hour classes. Surveys included household food security, general self-efficacy, acculturation, knowledge, and children's food patterns and anthropometric measurements. Positive results were seen in mothers' nutrition knowledge. Intervention children had decreased body mass index percentiles. Children whose mothers had higher acculturation had greater reduction in body mass index percentiles. Mothers living alone had higher probability to attend intervention classes. Lessons learned will guide future health promotion research.

The Factor Structure and Psychometric Properties of the Greek Version of the Eating Disorders Examination Questionnaire (EDE-Q)

This study investigates the latent structure and the psychometric characteristics of the attitudinal subscales of the Greek translation of the EDE-Q (G-EDE-Q) using two samples. The first sample consisted of 500 university female students and tested the latent structure of the G-EDE-Q. The second sample consisted of 164 female psychology students and examined the internal consistency as well as the concurrent, convergent, and discriminant validity of the G-EDE-Q. The results from confirmatory factor analysis (CFA) showed that a three-factor solution fit the data better than the other models examined, providing evidence to contradict the originally proposed structure of the instrument. The results support both, the internal consistency as well as the concurrent, convergent, and discriminant validity of the G-EDE-Q global scale and its subscales. The discussion focuses on the critical review of previous statistical procedures employed and the clinical and research implications of the present findings.

Latino families, primary care, and childhood obesity: a randomized controlled trial

BACKGROUND

Few successful treatment modalities exist to address childhood obesity. Given Latinos' strong identity with family, a family-focused intervention may be able to control Latino childhood obesity.

PURPOSE

To assess the feasibility and effectiveness of a family-centered, primary care-based approach to control childhood obesity through lifestyle choices.

DESIGN

Randomized waitlist controlled trial in which control participants received the intervention 6 months after the intervention group.

SETTING/PARTICIPANTS

Forty-one Latino children with BMI >85%, aged 9-12 years, and their caregivers were recruited from an urban community health center located in a predominantly low-income community.

INTERVENTION

Children and their caregivers received 6 weeks of interactive group classes followed by 6 months of culturally sensitive monthly in-person or phone coaching to empower families to incorporate learned lifestyles and to address both family and social barriers to making changes.

MAIN OUTCOMES MEASURES

Caregiver report on child and child self-reported health-related quality of life (HRQoL); metabolic markers of obesity; BMI; and accelerometer-based physical activity were measured July 2010-November 2011 and compared with post-intervention assessments conducted at 6 months and as a function of condition assignment. Data were analyzed in 2012.

RESULTS

Average attendance rate to each group class was 79%. Socio-environmental and family factors, along with knowledge, were cited as barriers to changing lifestyles to control obesity. Caregiver proxy and child self-reported HRQoL improved for both groups with a larger but not nonsignificant difference among intervention vs control group children (p=0.33). No differences were found between intervention and control children for metabolic markers of obesity, BMI, or physical activity.

CONCLUSIONS

Latino families are willing to participate in group classes and health coaching to control childhood obesity. It may be necessary for primary care to partner with community initiatives to address childhood obesity in a more intense manner.

TRIAL REGISTRATION

This study is registered at Clinicaltrials.partners.org 2009P001721.

Obesity management: what brings success?

The upward trend in obesity prevalence across regions and continents is a worldwide concern. Today a majority of the world's population live in a country where being overweight or obese causes more deaths than being underweight. Only a portion of those qualifying for treatment will get the health care they need. Still, a minor weight loss of 5-10% seems to be sufficient to provide a clinically significant health benefit in terms of risk factors for cardiovascular disease and diabetes. Diet, exercise and behavior modifications remain the current cornerstones of obesity treatment. Weight-loss drugs play a minor role. Drugs which were available and reasonably effective have been withdrawn because of side effects. The fact that the 'old' well known, but pretty unexciting tools remain the basic armamentarium causes understandable concern and disappointment among both patients and therapists. Hence, bariatric surgery has increasingly been recognized and developed, as it offers substantial weight loss and prolonged weight control. The present review highlights the conventional tools to counter obesity, lifestyle modification, pharmacotherapy and bariatric surgery, including some of the barriers to successful weight loss: (1) unrealistic expectations of success; (2) high attrition rates; (3) cultural norms of self-acceptance in terms of weight and beliefs of fat being healthy; (4) neighborhood attributes such as a lack of well-stocked supermarkets and rather the presence of convenience stores with low-quality foods; and (5) the perception of the neighborhood as less safe and with low walkability. Prevention is the obvious key. Cost-effective societal interventions such as a tax on unhealthy food and beverages, front-of-pack traffic light nutrition labeling and prohibition of advertising of junk food and beverages to children are also discussed.

The impact of primary care resident physician training on patient weight loss at 12 months

OBJECTIVE

It is unclear whether training physicians to counsel obese patients leads to weight loss. This study assessed whether a 5-h multimodal longitudinal obesity curriculum for residents on the basis of the 5As (assess, advise, agree, assist, and arrange) was associated with weight loss in their obese patients.

DESIGN AND METHODS

Twenty-three primary care internal medicine residents were assigned by rotation schedule to intervention (curriculum) or control groups. We then conducted follow-up chart reviews to determine weight change at up to 12 months following the index visit. 158 obese patients (76 in the intervention group and 82 in the control group) completed exit interviews; 22 patients who presented for acute care at the index visit were excluded. Chart reviews were conducted on the 46 patients in the intervention group and 41 patients in the control group who were seen again within 12 months of the index visit and had follow-up weight measurements.

RESULTS

The main outcome of interest was mean change in weight at 12 months compared between the intervention and control groups. Patients of residents in the intervention group had a mean weight loss of -1.53 kg (s.d. = 3.72) although the patients of those in the control group had a mean weight gain of 0.30 kg (s.d. = 3.60), P = 0.03. Six (15.8%) patients in the intervention group and 2 (5.4%) patients in the control group lost >5% body weight (P = 0.14).

CONCLUSIONS

Although the magnitude of weight loss was small, this study shows that training physicians to counsel patients can produce measurable patient outcomes.

The Mexican Health Paradox

The Mexican health paradox refers to initially favorable health and mental health outcomes among recent Mexican immigrants to the United States. The subsequent rapid decline in Mexican health outcomes has been attributed to the process of acculturation to U.S. culture. However, the construct of acculturation has come under significant criticism for oversimplifying complex relations between health, behavior, race and ethnic relations, and the environment. Moreover, measurement issues for the construct abound. This article reviews the current state of the acculturation debate, and argues for an integration of current theoretical perspectives and critiques of the construct in order to strengthen the explanatory power of acculturation with regard to the Mexican health paradox.

The role of food culture and marketing activity in health disparities

Marketing activities have attracted increased attention from scholars interested in racial disparities in obesity prevalence, as well as the prevalence of other preventable conditions. Although reducing the marketing of nutritionally poor foods to racial/ethnic communities would represent a significant step forward in eliminating racial disparities in health, we focus instead on a critical-related question. What is the relationship between marketing activities, food culture, and health disparities? This commentary posits that food culture shapes the demand for food and the meaning attached to particular foods, preparation styles, and eating practices, while marketing activities shape the overall environment in which food choices are made. We build on prior research that explores the socio-cultural context in which marketing efforts are perceived and interpreted. We discuss each element of the marketing mix to highlight the complex relationship between food culture, marketing activities, and health disparities.

Community energy balance: a framework for contextualizing cultural influences on high risk of obesity in ethnic minority populations

INTRODUCTION

Increases in the availability, affordability, and promotion of high-calorie foods and beverages and decreased obligations for routine physical activity have fostered trends of increased obesity worldwide. In high-income, plural societies, above average obesity prevalence is often observed in ethnic minority communities, suggesting that obesity-promoting influences are more prevalent or potent in these communities.

METHODS

An interdisciplinary group of scholars engaged in multiple rounds of focused discussion and literature review to develop a Community Energy Balance Framework (CEB). The objective was to explore the nature of the excess obesity risk in African descent and other ethnic minority populations and identify related implications for planning and evaluating interventions to prevent obesity.

RESULTS

A key principle that emerged is that researchers and programmers working with ethnic minority communities should contextualize the food- and physical activity-related sociocultural perspectives of these communities, taking into account relevant historical, political, and structural contexts. This perspective underscores the fallacy of approaches that place the entire burden of change on the individual, particularly in circumstances of social disadvantage and rapid cultural shifts.

CONCLUSION

The CEB framework is proposed for use and further development to aid in understanding potential health-adverse effects of cultural-contextual stresses and accommodations to these stresses.

A focus group study of Mexican immigrant men's perceptions of weight and lifestyle

OBJECTIVE

Despite interest in family-centered obesity and diabetes prevention programs for Latinos, few studies have assessed men's perspectives on obesity-related behaviors. The objective of this study was to explore Mexican immigrant men's perspectives regarding weight, diet, and physical activity as they relate to the individual and the family.

DESIGN AND SAMPLE

This was a focus group study with a convenience sample of Mexican immigrant men (n = 16).

MEASURES

A moderator's guide was used to elicit perceptions of personal and family behaviors influencing weight and lifestyle.

RESULTS

Mean age of participants was 41 years (SD ± 12.7), and 100% were born in Mexico. Mean time in Alabama was 8 years. Perceived benefits of a healthy weight included improved mobility and decreased morbidities. Perceived barriers to a healthy lifestyle included demanding work schedules and an environment not conducive to walking. Participants described immigration as having a negative impact on family unity and established meal structures.

CONCLUSION

Previous studies among Latinas cite husband resistance as a barrier to sustained diet and lifestyle change; however, men in this study voiced openness to programs for obesity and diabetes prevention. Future family centered programs should engage men and promote communication within the family on common goals related to health and illness prevention.

Considering J.Lo and Ugly Betty: a qualitative examination of risk factors and prevention targets for body dissatisfaction, eating disorders, and obesity in young Latina women

Latina women are vulnerable to poor body image, eating disorders, and obesity, particularly during the college years. This study sought to identify common cultural antecedents of these concerns in order to inform the development of prevention programs for this population. Six groups of university students who identified as Latina (N=27) discussed cultural aspects of body image, eating disorders, and obesity. Thematic analysis identified four main themes: (a) cultural disparities in body-ideal, including the influence of the media and acculturation issues; (b) messages about body shape and weight received by family, peers, and society; (c) difficulties making healthy eating and physical activity choices as a function of college life; and (d) the influence of peers and potential male partners on body satisfaction and body-ideals. These results have implications for the development of programs targeting body dissatisfaction and risk for eating disorders and obesity in Latina college women.

Using the health belief model to develop culturally appropriate weight-management materials for African-American women

African-American women have the highest prevalence of adult obesity in the United States. They are less likely to participate in weight-loss programs and tend to have a low success rate when they do so. The goal of this project was to explore the use of the Health Belief Model in developing culturally appropriate weight-management programs for African-American women. Seven focus groups were conducted with 50 African-American women. The Health Belief Model was used as the study's theoretical framework. Participants made a clear delineation between the terms healthy weight, overweight, and obese. Sexy, flirtatious words, such as thick, stacked, and curvy were often used to describe their extra weight. Participants accurately described the health risks of obesity. Most believed that culture and genetics made them more susceptible to obesity. The perceived benefits of losing weight included reduced risk for health problems, improved physical appearance, and living life to the fullest. Perceived barriers included a lack of motivation, reliable dieting information, and social support. Motivators to lose weight included being diagnosed with a health problem, physical appearance, and saving money on clothes. Self-efficacy was primarily affected by a frustrated history of dieting. The data themes suggest areas that should be addressed when developing culturally appropriate weight-loss messages, programs, and materials for African-American women.

Attitudinal familism predicts weight management adherence in Mexican-American women

Adherence to behavioral weight management programs is often limited, especially among ethnic minority populations. The current study examined whether attitudinal familism, or attention to the needs of family above those of the self, predicted poorer adherence to a behavioral weight management program in Mexican-American women. One-hundred overweight or obese Mexican-American women from the southwestern United States were enrolled in a group-based weight loss treatment. Zero-order correlations indicated that general commitment to attitudinal familism, as measured by the Attitudinal Familism Scale, was significantly negatively associated with calorie and physical activity goal completion and marginally negatively associated with session attendance. The results of the current study indicate that researchers may consider addressing familism when developing tailored weight management interventions for Mexican-American women.

Obesity, stigma, and responsibility in health care: A synthesis of qualitative studies

Objective

To synthesize research findings on experiences and attitudes about obesity and stigma in health care.

Methods

We compiled qualitative studies and applied Noblitt & Hare's meta ethnography to identify, translate, and summarize across studies. Thirteen qualitative studies on experiences and attitudes about obesity and stigma in health care settings were identified and included.

Results

The study reveals how stigmatizing attitudes are enacted by health care providers and perceived by patients with obesity. Second-order analysis demonstrated that apparently appropriate advice can be perceived as patronizing by patients with obesity. Furthermore, health care providers indicate that abnormal bodies cannot be incorporated in the medical systems—exclusion of patients with obesity consequently happens. Finally, customary standards for interpersonal respect are legitimately surpassed, and patients with obesity experience contempt as if deserved. Third-order analysis revealed conflicting views between providers and patients with obesity on responsibility, whereas internalized stigma made patients vulnerable for accepting a negative attribution. A theoretical elaboration relates the issues of stigma with those of responsibility.

Conclusion

Contradictory views on patients’ responsibility, efforts, knowledge, and motivation merge to internalization of stigma, thereby obstructing healthy coping and collaboration and creating negative contexts for empowerment, self-efficacy, and weight management. Professionals need to develop their awareness for potentially stigmatizing attitudes towards vulnerable patient populations.

Qualitative investigation of the Cooking with Kids program: focus group interviews with fourth-grade students, teachers, and food educators

OBJECTIVE

Focus group (FG) interviews with students and adults were used to obtain a rich understanding of the Cooking with Kids classroom experience from the child and adult participant perspectives.

METHODS

FG topics included students' cooking experiences at school and home and perceptions of Cooking with Kids. Verified transcripts of recorded interviews were entered into NVivo, coded for themes, and confirmed through intercoder reliability.

RESULTS

Twenty-two FGs were conducted with fourth-grade students (n = 178), 3 FG with teachers (n = 17), and 1 FG with 5 Cooking with Kids food educators. Students in cooking interventions described positive experiences with curriculum integration into academic subjects and were more likely to consider classmates friends.

CONCLUSIONS AND IMPLICATIONS

FG revealed student perspectives to strengthen content and implementation of experiential foods programs. This study provides an example of how qualitative methods can add "student voice" to evaluation of school-based programs.

Collaborative planning approach to inform the implementation of a healthcare manager intervention for Hispanics with serious mental illness: a study protocol

BACKGROUND

This study describes a collaborative planning approach that blends principles of community-based participatory research (CBPR) and intervention mapping to modify a healthcare manager intervention to a new patient population and provider group and to assess the feasibility and acceptability of this modified intervention to improve the physical health of Hispanics with serious mental illness (SMI) and at risk for cardiovascular disease (CVD).

METHODS

The proposed study uses a multiphase approach that applies CBPR principles and intervention-mapping steps--an intervention-planning approach--to move from intervention planning to pilot testing. In phase I, a community advisory board composed of researchers and stakeholders will be assembled to learn and review the intervention and make initial modifications. Phase II uses a combination of qualitative methods--patient focus groups and stakeholder interviews--to ensure that the modifications are acceptable to all stakeholders. Phase III uses results from phase II to further modify the intervention, develop an implementation plan, and train two care managers on the modified intervention. Phase IV consists of a 12-month open pilot study (N = 30) to assess the feasibility and acceptability of the modified intervention and explore its initial effects. Lastly, phase V consists of analysis of pilot study data and preparation for future funding to develop a more rigorous evaluation of the modified intervention.

DISCUSSION

The proposed study is one of the few projects to date to focus on improving the physical health of Hispanics with SMI and at risk for CVD by using a collaborative planning approach to enhance the transportability and use of a promising healthcare manager intervention. This study illustrates how blending health-disparities research and implementation science can help reduce the disproportionate burden of medical illness in a vulnerable population.

Decisions about weight management: a synthesis of qualitative studies of obesity

There is a high non-attendance and dropout attrition from weight management interventions for adults with obesity. Patient dissatisfaction with consultations involving decisions about interventions may be a factor. A systematic review was undertaken of qualitative studies reporting perceptions, experiences, contexts and influences for adults facing, or reflecting on, weight management. The aim was to synthesize a generic model of influences on decision-making about weight management for adult patients. Electronic database and hand searches identified 29 qualitative studies involving 1387 participants (mean age 45.3 years; mean BMI 37.1 kg m(-2) ; 79.9% women). Seven overarching themes were inductively derived from extracted data spanning: cultural identity; social structures such as gender; responses to obesity stigma; previous weight loss experiences; personal motivators and barriers; social support; and practical resources. A model is presented in the paper. Improving decisions about weight management requires attention to how diffuse cultural and psycho-social factors, such as obesity stigma, influence patient choices. Reflection on experiences of previous attempts at weight loss is also essential, as are practical resource factors - particularly for less affluent groups. Considering these factors along with more established theories of individual psychological motivations and barriers may help to improve initial participation and retention within interventions.

Latino parents' perceptions of their ability to prevent obesity in their children

The obesity epidemic in Latino children has reached staggering proportions. This study explored Latino parents' perceptions of their ability to prevent obesity in children. Three focus groups were conducted with 26 Latino parents of preschoolers at a New York City Head Start program. Parents perceived high levels of ability to prevent obesity primarily via dietary influence. Four factors negatively impacted parents' ability: family history, intergenerational and interparental issues, adolescence, and societal pressures. Culturally effective, family-based obesity interventions among Latinos should build upon parental perceptions of ability to prevent obesity, while simultaneously helping parents address the factors they perceive challenge this ability.

"Norwegians fear fatness more than anything else"--a qualitative study of normative newspaper messages on obesity and health

OBJECTIVE

To explore normative aspects of the Norwegian discourse on obesity.

METHODS

We conducted a qualitative study with data from five Norwegian newspapers, focusing normative entries about body weight. Discourse analysis provided a focus on the cultural attitudes when systematic text condensation was conducted. Data comprised 26 normative messages (prescriptions or comments on how obese people are or should be, messages mediating or discussing values prescribing a 'good' body).

RESULTS

Two main normative domains within the obesity discourse were identified. One group of entries warned about obesity from an aesthetic point of view, notifying the reader that beauty would suffer when weight increases, due to reduced attractiveness. These texts appealed to bodily conformity, linking leanness with attractiveness and delight, suggesting that fat people are ugly and unhappy. The other group referred to lack of control in the obese person, linking greediness to lack of responsibility and bad health. Fat people were displayed as undisciplined and greedy individuals who should be ashamed.

CONCLUSIONS

Cultural messages of blame and shame are associated with obesity, but also spreading from body weight to the very scene of life. People with obesity cannot escape this cultural context, only find a way of coping with it.

PRACTICE IMPLICATIONS

Quality care for people with obesity implies that public health and clinical medicine acknowledge the burden of cultural stigma. Developing awareness for cultural prejudices on body weight, doctors could counteract stigmatization and contribute to empowerment and health.

Ethnic minorities and weight control research priorities: where are we now and where do we need to be?

Within the overall obesity epidemic, the burden of obesity and related health problems is particularly high among African Americans, Hispanic/Latino Americans, American Indians, and Pacific Islanders--both children and adults. The often asked question of what types of obesity interventions work in these populations reflects uncertainty about how applicable standard interventions are to diverse socio-cultural groups and socio-environmental contexts. A meta-analysis in this issue of Preventive Medicine (Seo and Sa, 2008. A meta-analysis of psycho-behavioral obesity interventions among US multiethnic and minority adults) includes selected multi-ethnic and minority-focused studies that in total had 40% minority participants. Although the authors' conclusions were congruent with current general guidance for weight loss programs, insights about how to intervene with minority populations were limited by the small amount and nature of the available evidence. Ethnic minorities in the aggregate are now a third of the U.S. population. We should be purposeful in identifying research needs and quality standards for conducting and reporting studies with these populations and in motivating related research. Improving the relevance to and quality of evidence on obesity prevention and treatment for a more diverse set of populations will also improve the weight control literature as a whole.