Obesity is on the rise in America. Latinas—females of Latin-American origin living in the United States—are at an increased risk.
Washington, D.C., physician and former Chief Medical Expert for The Discovery Channel, John Whyte, M.D., MPH, has done a large amount of work in the fields of obesity and disparity.
“Latinas are a growing and influential constituency in the United States,” he says. “The Latina share of the female population in the United States will increase from 16.4 percent today to 25.7 percent in 2050.”
According to The U.S. Department of Health and Human Services’ Department of Women’s Health, Mexican-American women make up the majority of Latinas and 75 percent of them are overweight or obese.
Until recently, Jennie Kramer, MSW, LCSW, founder and executive director of Metro Behavioral Health Associates Eating Disorder Treatment Centers in New York and co-author of “Overcoming Binge Eating for Dummies,” saw few Latinas seeking assistance for weight management.
“Thank God we’re seeing them now,” she says. “There’s more data and more people who are coming forth which allows us to address this more specifically.”
Anthony Terracina, M.D., has been a Hampton Roads weight loss surgeon for 17 years. He trained in Texas and previously lived in Florida.
He says. “There are fairly sizable Latina populations in all locations and my standpoint is we are dealing with significant obesity.”
Many factors contribute to the obesity epidemic in Latinas. Peruvian-born Jesus Lizarzaburu, M.D., FAAFP, with Tidewater Physicians Multispecialty Group, Grafton Family Medicine, conducted his doctoral research on “Immigration, Acculturation and Risk Factors for Obesity and Cardiovascular Disease: A Comparison of Latinos of Peruvian Descent in Peru and in the United States.”
“I looked at all these issues with cardiovascular disease, obesity, immigration, culture and depression and it all seemed to tie together,” he explains.
What is Causing this Rise in Obesity among Latinas?
Dr. Terracina is seeing a rise in significant obesity and notes growing concerns ethnicity-based diets.
“The Latina diet is heavy on corn products, flour products, rice and beans,” he says. “Those are significant carbs.”
He tells his patients this may be the way they were raised, but it doesn’t mean they have to continue that lifestyle. As an Italian, Dr. Terracina grew up eating four major meals a week that incorporated carbohydrate-laden pasta and bread.
“I eat pasta once every two to three months now,” he says. “And bread doesn’t even cross my plate anymore. We have to tighten up on our diets.”
Kramer cites the Latina culture’s focus on family and the use of food as an expression of love.
“Food has a special meaning, but it can be overdone,” she explains. “It can be abused. You don’t have to feed everybody every hour on the hour and you can offer some healthier choices for those very important family meals.”
Dr. Lizarzaburu’s research supports the fact that when Peruvians came to the U.S., the increase in obesity was more of a socioeconomic issue.
“When you look at worldwide distributions in developing nations, only the rich have heart disease,” he explains. “It’s only the well-to-do people in third world countries who were able to afford becoming obese. In the U.S., if you have low socioeconomic status and a low education level, you tend to be more obese.”
Terracina agrees. “It’s a disease of our affluent, western society, which is: bigger is better and more is even better than that.”
Dr. Lizarzaburu believes that the Latinas’ lack of accessible, quality grocery stores contribute to poor eating habits.
“From my point of view, as an immigrant I live in the place I can afford which is going to be sort of a low income neighborhood,” he says. “Then I’m going to find that the best place to buy food for my money is a bakery outlet where I can load up on pastries for $5 and sustain my family. That is exactly what gives us diabetes and our obesity epidemic.”
Kramer points to eating disorders as another contributor to the increased rate of obesity.
“It’s eating that has nothing to do with the response to hunger and satiety cues,” she says of eating disorders. “We see that the largest majority of people who use food in this way have had some history of trauma.”
Kramer breaks down trauma into categories such as: having to immigrate; going through divorce; changing/blending families; etc. But she hones in on the trauma resulting from physical, emotional, verbal or sexual abuse.
According to the National Crime Victimization Survey (Bureau of Justice Statistics, 2004), one in six females who are 13 or older, are victims of rape, attempted rape, or sexual assault. Based on The U.S. Census, projections for the Hispanic female population in the future, and the 1 in 6 victimization calculation, by the year 2050, the number of females of Hispanic origin who have experienced some form of sexual violence could reach 10.8 million.
Kramer says. “Addictive behaviors, and I do include disorder eating in that group, serve many functions most of which are to distract, self-soothe or numb.”
“Another problem is that nearly 6 in 10 Latinas are not physically active,” Dr. Whyte says.5 “Physical activity is important for maintaining a healthy energy balance. Studies have found trends showing Latinos [in general] often have less access to safe places to be active.”
“There are undiagnosed hormonal conditions that can also contribute to obesity,” Kramer says. “For instance, there’s polycystic ovarian syndrome in women that causes hormonal dysregulation which leads to a lot of obesity.”
What are the Health Risks?
“From a health standpoint, we live in a region in Hampton Roads where we’re one of the country’s leaders in diabetics aged 25 to 50 years,” he explains. “The other issue is not only are we obese as a society and less active, the medical problems that are piling up and there’s no end in sight.
People with hypertension live a shorter life. People with diabetes live a shorter life. People with high cholesterol don’t live to their life expectancy.
It’s all diet- and obesity-related, so what we have to do is cure obesity and by curing obesity, we cure health issues.”
Dr. Terracina is seeing a higher proportion of obese patients with complications of gallbladder disease, high cholesterol and heart disease.
“Once you reach a certain weight, everybody’s going to have less ability to fight off heart disease,” he says. “There’s all sorts of things that are going on with the body that create health issues as you become more obese, especially for women.”
The heightened health risk due to ever-increasing obesity can cost an individual the ability to earn their living and can cost the health care system a great deal of money.
“There’s a lot of concern in the Latina community with higher blood pressure,” Kramer says. “Over time the blood pressure rates have been much higher. Obesity, in general, is going to lead to things like: insomnia, joint and body aches; a host of digestive issues including acid reflux; heartburn; very fluctuating blood sugars; high blood fat levels; gall bladder disease; and heart disease. It can affect mobility and can even bring about structural changes like herniated discs, arthritis, etc.”
What Can be Done?
“There is an urgent need for effective and accessible culturally-sensitive weight-loss interventions for the Mexican-American population,” Dr. Whyte says. “Behavioral interventions must provide culturally-centered behavioral strategies addressing some of the difficulties.”
“In centers like ours, we are trying to approach this with all cultures from a very comprehensive, no-stones-unturned approach,” Kramer says. “It really does require attention to psychological, nutritional, physical and environmental factors.”
“Advocates should avoid stereotypical assumptions about Latinas, avoiding a one-size-fits-all approach,” Dr. Whyte explains. “Language, education, and levels of cultural assimilation can vary greatly between and within Latin American groups. While two-thirds of Latina/Latino U.S. residents are of Mexican origin, the remaining groups identify with various national origins and subcultures from North, South and Central America and the Caribbean.”
Dr. Whyte also recommends that agency leaders and directors should ensure that staffing patterns adequately reflect the demographics of the groups being served.
“Bilingual personnel are crucial for eliminating access barriers at every stage of the help-seeking process,” he says, adding that Latino/Latina organizations and grassroots groups that already have bilingual/bicultural components can be valuable allies and agents of change.