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Article Excerpt
Recent studies indicate that overweight and obesity among adolescents is a major health problem. Data show the percentage of overweight adolescents (ages 13 to 19 years) has doubled within a 10-year period, from 5% in 1976 to 10.5% in 1988. Between 1988-1998, a reported 14.8% of adolescents were overweight, and by 2004, the rate of overweight teens was 17.4% (Centers for Disease Control and Prevention [CDC] National Center for Health Statistics [NCHS], 2006b; 2007).
Among Hispanic adolescents, current figures for overweight and obesity are almost double that for non-Hispanic Caucasian teens. (American Heart Association [AHA], 2005; CDC, 2009b; CDC NCHS, 2006b). There is a particular need to include samples of adolescents from urban Hispanic cultures to discern the influence of dietary choices on overweight and obesity within this cultural group, which has one of the highest rates of obesity and related health problems (CDC NCHS, 2006b; National Institutes of Health [NIH], 2007; U.S. Census Bureau, 2000).
Over a 26-year period, obesity rates have increased in adolescents as well as in elementary school children. From 1980-2006, obesity rates among elementary school children (ages 6 to 11) doubled, from 6.5% in 1980 to 17% in 2006. This is compared to adolescents (ages 12 to 19), with the rate increasing from 5% in 1980 to 17.6% in 2006 (CDC, 2008). However, the majority of obesity research and interventions within the pediatric population have been limited to samples of children in elementary school. Adolescents represent an under-studied population in terms of analysis of food choices and educational interventions for achieving a healthy dietary lifestyle. Further study is needed using samples of adolescents to examine factors contributing to overweight and obesity during this critical age period before adulthood (Dietz & Gortmaker, 2001).
The purpose of this study was to determine the independent food choices of urban minority adolescents and Hispanic teens in particular, and their knowledge of nutrition and health related to these food selections. This study was an attempt to understand factors influencing healthy meal choices and their relationship to overweight and obesity among this population.
Literature Review
Obesity and Related Problems
The CDC (2009a) defines childhood obesity as weight above the 95th percentile and body mass index (BMI) above 30. BMI is the ratio of height and weight. Overweight children are those who weigh above the 85th percentile with a BMI above 25 (CDC, 2009a). The normal BMI range is 19 to 25. According to the CDC NCHS (2006b), obesity is a complex issue related to lifestyle, environment, and genes. Factors linked to the increase in obesity include increasing portion sizes; eating out more often; increasing consumption of sugar-sweetened drinks; increasing television, computer, and electronic gaming time; changing labor markets; and fear of crime, preventing outdoor exercise.
Obesity and overweight result from an imbalance between food consumed and physical activity (CDC NCHS, 2006b). Data suggest the majority of American children do not get enough daily physical exercise and spend an average of four or more hours a day watching television, using the internet, or playing video games (CDC NCHS, 2006b; U.S. Department of Health and Human Services [DHHS], 2008).
The significance of adolescent obesity is compounded by the serious health risks associated with this phenomenon, including asthma, hypertension, type-2 diabetes, orthopedic complications, sleep apnea, social isolation, and decreased school attendance, thereby affecting the physical, cognitive, and emotional growth and development during childhood and adolescent years. The risk of becoming obese adults is higher among adolescents with a history of overweight. This poses serious health problems, including cardiovascular and renal disorders, later in life (American Academy of Child & Adolescent Psychiatry [AACAP], 2008; American Academy of Pediatrics [AAP], 2003; AHA, 2005; CDC NCHS, 2006b; Hayman, 2004).
Health care costs in diagnosing and treating diseases associated with childhood and adolescent overweight and obesity have posed significant public health concerns. Long-term effects of chronic diseases related to adolescent and adult obesity include a shorter life span than for previous generations. These disturbing facts have far-reaching implications for the future of the nation and are of immediate concern to health care providers, educators, and public policy makers.
The DHHS (2004) has several goals listed in their Healthy People 2010 report. One is to reduce overweight and obesity among all populations, particularly among children and adolescents who are at risk of becoming obese adults. Another goal is to reduce health disparities with regard to obesity and related illnesses (American Obesity Association [AOA], 2007; CDC NCHS, 2006a; DHHS, 2004).
Factors Affecting Food Choices
Food choices are influenced by multiple factors, including health status, age, family and friends, and socioeconomic status. Culture and tradition are among the strongest factors affecting food preferences including food preparation. (Kieffer et al., 2006; Liburd, 2003; Yancey et al., 2006).
Culture
Within the Hispanic culture, the family influences dietary habits by reinforcing traditional ways of behaving, eating, socializing, and overall worldview (Andrews & Boyle, 2002; Gluck & Geliebter, 2002; Leininger & McFarland, 2002). This worldview has an impact upon food choices, body image, and recognition of related healthy and unhealthy states. For example, exposure to and preference for certain foods, such as fried meats, salty foods, and sweet foods, are a few cultural food examples found in the literature (Contento, Basch, & Zybert, 2003).
In a study of Hispanic immigrant parents, cultural beliefs supported a fatalistic acceptance of overweight and obesity (McArthur, Anguiano, & Gross, 2004). In this study, while 47% of parents surveyed believed that being overweight was unhealthy, 11% thought that it was "God's will" that their children were overweight. The selection of high caloric foods in the study's sample did not vary among geographic area (rural or urban), economic status, or parental educational level.
Body Image
A significant factor in diet and obesity is self-perception of body image. Obesity has been linked with feelings of low self-esteem related to body image and social isolation. Cultural values also influence body perception and body image, and can be an obstacle to achieving a healthy diet (AACAP, 2004; Ayala, Mickens, Galindo, & Elder, 2007). Ayala et al. (2007) found that among overweight and obese Hispanic adolescent girls, those with strong affiliations with media images were more dissatisfied with their body image than those with stronger cultural identification.
Among Hispanics, the fuller body frame is more acceptable than it is for Caucasians who generally aspire to obtain a thinner body type and are, to a greater extent, influenced by media images (Ayala et al., 2007). The cultural pressure supports acceptance of a large or small body type and may be counter to the recommended weight or BMI. In a study of body image and food choices among low-income Dominican and Puerto Rican women in New York City, Contento and colleagues (2003) found that most of the young women viewed themselves as overweight regardless of their BMI and preferred a thinner body image. However, they were more accepting of higher weight percentiles (50th to 75th) and a fuller body image...
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