Wednesday, January 15, 2020

Obesity Amongst Mexican Children Essay

Abstract: The prevalence of overweight children in the United States of Mexican descent is higher for second generation than their first generation counterparts. First generation immigrants tend to keep a healthier lifestyle by consuming more fresh fruits and vegetables, walking longer distances and smoking less than the more acculturated Mexican-Americans. Acculturation is a major contributing factor for the alarming rates of obesity within Mexican children. When children of Mexican immigrants are exposed to American society, they develop unhealthy habits such as eating pizza and hot dogs during school lunch hours, access to vending machines, and media exposure where they are constantly bombarded with food related commercials of unhealthy nature. A lower socio-economic status, such as the recently immigrated parents, is also a contributing factor for obesity within Mexican children. High calorie and high fat content foods tend to be less expensive than fresh fruits and fresh vegetables, leading to poorer, unhealthier choices. Fast food chains are prohibitory expensive in Mexico, whereas in the US they are not. As young Mexican children develop their sense of identity while they separate from their parents or caregivers and seek acceptance from their American peers, they integrate themselves into the fast food culture leading to obesity amongst Mexican-American children of second generation in the US. The incidence of obesity in Mexican adults has increased markedly over the years. Data from the 1993 National Survey of Chronic Diseases (Encuesta Nacional de Enfermedades Cronicas) showed an obesity prevalence of 21. 5%. The 2000 National Health Survey (Encuesta Nacional de Salud) indicated that 24% of adults suffered obesity. Data from the 2006 National Health and Nutrition Survey (ENSANUT 2006) revealed that 30% of adults of both sexes were obese. (Rojas,R, Aguilar-Salinas, C. , Jimenez, A. , Gomez, F. , Barquera, S. , 2012, p. 8) In the last two decades, the prevalence of childhood obesity, defined as at or above the 95th percentile of body mass index (BMI) for age and gender (Center for Disease Control, 2009), has more than doubled among children aged 6–11 years and tripled among adolescents aged 12–19 years, and here is no evidence that this trend is coming to an end (Ogden, 2002). This is a serious public health concern because obese children and adolescents are at an increased risk for various physical, mental, and emotional health problems, including impaired glucose tolerance , insulin resistance, atherosclerosis , coronary heart disease in adulthood , development of eating disorders, and low self-esteem (Seo, D. & Sa, J. , 2009). The obesity epidemic disproportionately affects racial/ethnic minority children, who are defined as American Indian, Alaska Native, Asian American, Black, African American, Hispanic, Latino, Native Hawaiian, or OBESITY AMONGST MEXICAN CHILDREN: ARE FIRST GENERATION MEXICAN CHILDREN 3 MORE PRONE TO OBESITY THAN THEIR SECOND GENERATION COUNTERPARTS? other Pacific Islander (CDC, 2009). According to estimates based on the 2001–2002 National Health and Nutrition Examination Survey (NHANES), among children aged 6–19 years, 22. 2% of Mexican American children and 20. 5% of non-Hispanic Blacks were obese as compared with only 13. 6% of non-Hispanic whites. Other studies performed by Ogden and colleagues (2002) also affirm a larger prevalence of obesity among Mexican American and Black children compared with white children. These rates of obesity are far from the 2010 national health objective of Healthy People 2010. The higher incidence of obesity among minority children is alarming because these racial/ethnic groups have a lower insulin sensitivity than white children (Seo, D, & Sa, J. 2009). Obesity is an epidemic facing millions of people across the globe, resulting in more than 300,000 deaths in the United States alone (Dishman, 2004). Historically, the majority of people affected by obesity were adults. However, in the last decade this epidemic has spread to our youth. Excess weight in U. S. children has increased in prevalence and has become a serious public health concern. Currently, about 33% of children ages 2–5 in the U. S. are overweight (BMI in the 85th percentile or above), and 12% are considered obese (BMI in the 95th percentile or above) (CDC, 2009). Overweight children have a 70–80% chance of becoming overweight or obese adults, which may lead to an increase in obesity related disease among adults (United States Department of Human Health and Services, 2007). Obesity is one of the leading risk factors for disease and fatal health conditions, such as hypertension, type II diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and some cancers (CDC, 2009). Not only is obesity linked to clinical conditions, but it may also lead to mental health problems such as self-blame and low self-esteem ( Haboush, A., Phebus, T. , Tanata Ashby, D. , Zaikina-Montgomery, H. , & Kindig, K. , 2011). This paper will focus on the contributing factors for the alarming obesity rates amongst Mexican children. Are second generation Mexican children more prone to obesity than their first generation counterparts? Mexican immigrant parents usually don’t view obesity as a threatening health issue. In fact, some research reports that Mexican mothers see childhood obesity as a sign of good heath (Rosas et al. ) and thinness as a sigh of illness (Sosa, 2012). Acculturation, or the process of adjusting to a new culture, describes social, psychological, and behavioral changes that an individual undergoes as result of immigration (Buttenheim, A. , Pebley, A. , Hsih, K. , Chung, C. , Goldman, N. , 2012). The drastic changes in lifestyle and social interactions that immigrants encounter upon arriving to the United States often put them at risk for negative health consequences (Ogden et al. , 2009). Of the negative health outcomes associated with OBESITY AMONGST MEXICAN CHILDREN: ARE FIRST GENERATION MEXICAN CHILDREN 4 MORE PRONE TO OBESITY THAN THEIR SECOND GENERATION COUNTERPARTS?acculturation in Mexican children, obesity is significant because it has implications for development of chronic diseases such as heart disease and Type II Diabetes (CDC, 2009). Mexican children are at increased risk for obesity upon immigration to the United States and are predisposed to development of chronic diseases,(Buscemi, J. , Beech, B. , & Relyea, G. , 2011). Mexican American mothers’ views on obesity, 40% of mothers with overweight children did not identify overweight as a health issue (Ariza et al. , 2004). When weight was used as an indicator of health, parents were more concerned with the health of skinny children than overweight children. Mexican American mothers were concerned with having thin children because a thin child could become sick and die (Small, L. , Melnyk, B. , Anderson-Gifford, D. , & Hampl, J. 2009). A second and less studied mechanism linking nativity of US immigrants to obesity risk is the interconnectedness of the food environment and migration dynamics in the sending country (Buttenheim et al. , 2012). This is particularly relevant in the case of obesity risk for Mexican-origin children in the US, given the large, circular migration flows between the two countries and the well-documented nutrition transition underway in Mexico (Popkin & Udry, 1998). This transition is characterized by a shift from unprocessed and low energy density diets to highly processed, energy dense foods. The transition is due in part to new food marketing strategies and a simultaneous decrease in physical activity that has accompanied urbanization and economic development in Mexico (Popkin &Udry, 1998). Mexico’s nutrition transition has been notably rapid: Mexico now has the second highest rates of adult obesity among OECD (Organization for Economic Co-operation and Development) countries (after the US) (Rosas, 2011). A potential explanation for the increased obesity rates within the Mexican immigrants in the US is acculturative stress (Van Hook et al. , 2011). Mexican-origin immigrants, are often faced with discrimination based on race/ethnicity and immigrant status. This discrimination, in turn, leads to chronic stress and psycho-physiological stress responses, which are known to affect health over the long run . Thus, the process of integration into a society that views Mexican-origin immigrants as being of lower status than other social and racial/ethnic groups may itself result in chronic health problems, even if health behaviors remain constant over time and across immigrant generation. Why would duration of time in the US and immigrant generation affect obesity? The acculturation literature has emphasized the importance of dietary changes by duration in the US and across generation: increased acculturation is hypothesized to lead to decreased consumption of healthy foods and increased consumption of processed high OBESITY AMONGST MEXICAN CHILDREN: ARE FIRST GENERATION MEXICAN CHILDREN 5 MORE PRONE TO OBESITY THAN THEIR SECOND GENERATION COUNTERPARTS? fat/sugar foods. Gordon-Larsen et al. (2003) reported that first generation Mexican immigrant adolescents eat more rice, beans, fruit, and vegetables and less cheese and fast food than second generation Mexican-origin immigrants. Kaiser and colleagues (2007) say that acculturation seems to be a contributing factor for obesity amongst Mexican children. Acculturation can be defined as the process by which immigrants adopt the attitudes, values, customs, beliefs, and behaviors of a new culture. Two studies reported their findings on acculturation and potential implications on the nutritional status of Mexican American children. Kaiser and colleagues (2007) concluded that less acculturated mothers were more likely to provide alternate food choices when a child would not eat and use child-feeding strategies that may contribute to childhood overweight, such as bribes, threats, and punishment. Ariza, Chen, Binns, and Christoffel (2004) conducted a study to test their hypothesis that overweight was more prevalent in highly acculturated Mexican American children aged 5 to 6 years; however, the results did not substantiate an association between overweight and acculturation in this population. Duerksen and colleagues (2007) reported that increased levels of acculturation may lead to higher rates of overweight among Mexican American families if they were eating more meals at fast-food and buffet-style restaurants rather than selecting traditional, authentic Mexican restaurants. Studies indicated that less acculturated Mexican Americans consumed less fat, and more fiber, protein, vitamins A, C, E and B6, folate, calcium, potassium, and magnesium than their more acculturated counterparts (Rosas et al. 2011). Most research conducted across age groups and outcomes indicates that newly-arrived and less acculturated immigrants are healthier and live longer than natives. Unfortunately, this health advantage dissipates with duration of U. S. residence and does not extend to the next generation. In addition to the influence of parents’ acculturation on children’s behaviors, children can accelerate the acculturation process for their families as well because children are more likely to have a consistent exposure to typical American foods at school and likely to affect purchasing decisions of their parents. One of the biggest changes in children’s diets after moving to the United States has been suggested to be with the foods children consume at school. It has been reported that although Mexican American children liked the traditional ethnic foods they received at home, they preferred the American foods they were served at school (e.g. , pizza, hamburgers) (Rosas et al. 2011). Furthermore, there seemed to be a lack of awareness among children about the healthfulness of traditional Mexican foods (such as fruits, vegetables, and beans) or potential health risks of the typical American diet, which was perceived as pizza, hotdogs, hamburgers, and French fries. As children develop their own self and ethnic identities, they may seek separation from their parents and acceptance from their peers, and they may identify fast food and other less healthful food options with the United States culture. This can eventually lead to less healthful dietary patterns both for children and their families because children are likely to affect food-purchasing OBESITY AMONGST MEXICAN CHILDREN: ARE FIRST GENERATION MEXICAN CHILDREN 6 MORE PRONE TO OBESITY THAN THEIR SECOND GENERATION COUNTERPARTS? decisions in their households (Rosas et al. 2011). When looking into the influence of acculturation on food intake behaviors among children and youths, another important element of the social environment must be addressed: media exposure. Media exposure can have detrimental influences at both ends of the spectrum in terms of eating behaviors: children may adopt an unrealistically thin body image through exposure to popular culture, and unhealthy dieting practices or eating disorders may follow. Alternatively, they may increase their consumption of nutrient-poor, energy-dense foods that they are exposed to through advertisements, and this type of behavior may eventually lead to overweight status. There have been some initiatives to limit food marketing aiming at children, but nutritionally poor and energy dense foods (e.g. , high sugar cereals, candy, soft drinks, chips) still constitute the majority of the foods advertised on television (Kunkel et al. 2009). Several reports indicate that children choose advertised foods at significantly higher rates and attempt to influence their parents to purchase these foods. Unfortunately, advertisement of the nutritionally inferior food choices is not limited to television only; it is widespread through a variety of channels such as schools (vending machines, corporate sponsorship of school events and materials, etc. ), and online applications(e.g. , interactive games, sweepstakes, computer screensavers). Media exposure among children has been increasing over the past 10 years, and according to the 2009 estimates (Kunkel et al. 2009). American children spend about 7. 4 hours per day using or watching media such as television, computers, video games or movies. These estimates seem to be even higher among minorities) and individuals with lower socio economical status( SES) (Sussner et al. 2009). Hispanic youths were reported to spend about 5. 5 hours per day watching television while this estimate was 3. 5 hours per day for non-Hispanic whites in 2009. Moreover, screen time seems to increase with greater acculturation (Gordon-Larsen et al. 2003). The data from the 2003–04 National Survey of Children’s Health indicated that, in comparison to U. S. -born non-Hispanic white children with U. S. -born parents, foreign-born Hispanic children with immigrant parents were 31 percent more likely and U. S. -born Hispanic children with U. S. -born parents were 51 percent more likely to watch television. Although foreign-born Hispanics seem to be less likely to consume less healthful foods (Osypuk et al.2009), a reverse trend can be seen if these foods are more expensive in the country of origin but cheaper in the United States. For example, qualitative studies indicated that lower cost and increased availability were among the reasons for Mexican Americans to consume snacks, sweets, and fast food more in the United States . An earlier report pointed out that some foods, such as mayonnaise, margarine, and salad dressing were considered high-status items by many low-income families in Latin America (Romero-Gwynn et al. 1993). Similarly, Mexican adults living in Florida reported that in addition to fast food not being as readily available in their native country, it was more expensive than in the United States and therefore, they tended to eat fast food only for special occasions in their native OBESITY AMONGST MEXICAN CHILDREN: ARE FIRST GENERATION MEXICAN CHILDREN 7 MORE PRONE TO OBESITY THAN THEIR SECOND GENERATION COUNTERPARTS? country. Once these types of foods become more readily available and affordable for the immigrants in the United States, an increase in the consumption levels would be expected. Lower costs, widespread availability, and the convenience of fast food in the United States appear to be an enticing solution especially for time-strapped immigrant families with children (Lindsay et al. 2009). Qualitative studies among immigrants suggest a more relaxed lifestyle in Mexico versus a very busy lifestyle in the United States that leaves less time to cook or prepare foods. This type of lifestyle makes convenience foods very appealing, and it is likely to result in an increase in fast food consumption (Gray et al. 2005). In addition to the economic conditions related to the food environment, limited socioeconomic abilities of individuals also put immigrants at greater risk for unhealthy food intake patterns and entailing health issues. Higher rates of food insecurity and low SES among minorities and immigrants are likely to force individuals to purchase relatively cheaper and filling, but often nutrient-poor, energy-dense foods (Drewnowski and Darmon 2005). A binational study that was conducted in the United States and Mexico provided support for these eating patterns, and it also pointed out the country- or culture-specific variations in these associations. In the United States sample of this study, children with food insecurity were more likely to consume fat, saturated fat, sweets, and fried snacks compared to their food secure counterparts. In Mexico, however, food insecure (versus food secure) children displayed a different food intake pattern that was characterized by higher intakes of carbohydrates, dairy, and vitamin B6 (Rosas et al. 2009). One of the least studied aspects of the relationship between socioeconomic factors and food intake is the residential context and demographic makeup of the neighborhoods. One of the few studies that examined this context in a mostly Hispanic (but mixed ethnic) sample suggested that greater density of immigrants in residential areas was positively related to fruit and vegetable intake after controlling for individual factors such as age, race/ethnicity, language, country of birth, and education (Dubowitz et al. 2008). Another study also reported that high-fat/processed food intake (fats, oils, processed meats, fried potatoes, salty snacks, desserts) was lower in immigrant-dense neighborhoods even after controlling for SES, demographic factors, and acculturation (Rosas et al.2011). These results indicate beneficial dietary intake patterns for all residents (immigrant or not) residing in that area. Some of the potential factors underlying these results could be resulting from socioeconomic advantages through greater social capital, availability of stores with healthier ethnic food options, and higher consumption of healthier food intake habits, social norms, and values in the ethnically dense neighborhoods (Dubowitz et al. 2008). OBESITY AMONGST MEXICAN CHILDREN: ARE FIRST GENERATION MEXICAN CHILDREN 8 MORE PRONE TO OBESITY THAN THEIR SECOND GENERATION COUNTERPARTS? Highly acculturated Hispanic adults were more likely to have higher BMIs than their less acculturated counterparts. Similarly, second or third generation Hispanic youths were reported to be more likely overweight than their first generation counterparts (Popkin and Udry 1998). For adults, the difference in the overweight status by acculturation seems to be seen usually in a range of 10 to 21 years of residence in the United States, but interestingly, BMI differences were detectable by age two among less acculturated mothers’ children in a mostly Hispanic sample (Sussner et al. 2009). Some of the mechanisms underlying these findings could be the existence of cultural beliefs that associate overweight status among children with perception of good health (Sussner et al. 2009), failing to recognize overweight status, or acceptance of a larger body size as a desirable body image among Hispanics. Taken together, these cultural preferences can lead to obesity over time with the additional contribution of the typical environment in the United States that stimulates consumption of energy-dense foods and discourages physical activities. Certain food intake patterns (e. g., energy-dense foods) can lead to overweight or obese status as people acculturate. Although a factor analysis of nationally representative data from the NHANES 2001–02 did not indicate a specific dietary intake pattern in relationship to BMI or waist circumference (as measures of overall or central adiposity) among Mexican Americans (Carrera et al. 2007), it is possible that dietary intake might be related to obesity indirectly, or collectively with other lifestyle factors (e. g. , physical activity). It is also possible that the effects might be most pronounced at specific time periods during acculturation. Supporting this potential mechanism is the results from the National Longitudinal Study of Adolescent Health indicating that increased probability of overweight, which was related to changes in lifestyle factors (i. e. , screen time, diet), was detectable among first generation Mexican adolescents but not among second (or more) generation participants (Gordon-Larsen et al. 2003). Although social economic status (SES) is also linked to obesity, this association seems to vary depending on the SES measures used and also by race or ethnicity. For example, in a nationally representative sample of children, both education and income were negatively related to BMI among non-Hispanic whites, but only income was positively related to BMI among Hispanics (Balistreri and Van Hook 2009). As suggested by the authors, increasing education level may be a reflection of changes in knowledge, learning abilities, social class, and personal skills while higher income among immigrants might be an indicator of greater purchasing capacity, which can result in less healthful eating patterns in the absence of adequate nutrition knowledge, skills, and a healthful food environment. SES also seems to have gender-specific and long-term consequences. Data from a nationally representative longitudinal survey among adolescents indicated that there was a strong positive association between long-term (persistent) low SES and obesity among females. Among males, however, obesity rates were highest among those who had a socioeconomically disadvantaged beginning but gained autonomy, for example, home ownership later on. Most importantly, the report pointed out that the effect of SES on OBESITY AMONGST MEXICAN CHILDREN: ARE FIRST GENERATION MEXICAN CHILDREN 9 MORE PRONE TO OBESITY THAN THEIR SECOND GENERATION COUNTERPARTS?obesity was probably initiated before adolescence (Scharoun-Lee et al. 2009). Conclusion: The research has shown that second generation Mexican children are in fact more prone to obesity than their first generation counterparts. Causative factors such as media exposure, school lunch programs, socio-economic factors, and the influence of parents’ own acculturation into American society are all factors that can be addressed through various means with legislative, policy changes, and education. Then we can begin to affect positively the rising trend of obesity in second generation Mexican children in the United States. OBESITY AMONGST MEXICAN CHILDREN: ARE FIRST GENERATION MEXICAN CHILDREN 10 MORE PRONE TO OBESITY THAN THEIR SECOND GENERATION COUNTERPARTS? References: Abraido-Lanza, A. , White, K. , Vasques, E. (2004)Immigrant populations and health. In: Anderson N, editor. Encyclopedia of health and behavior. Newbury Park, CA: Sage; 2004. p. 533–537. Ariza, A. J. , Chen, E. H. , Binns, H. J. , & Christoffel, K. K. (2004). Risk factors for overweight in 5 – to 6-year old Hispanic American children: A pilot study. Journal of Urban Heath, 81 (1), 150-161. Balistreri, K. , & Van Hook, J. (2007). 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