Breaking Bad Habits: Changing the Way Hispanics Eat, Move, Live
Cambiar los malos hábitos: Modificar la manera en que los hispanos comen, se mueven, viven09/25/2015 12:00PM | 22940 views
In 2007, we began planning and developing a new program called Eat Move Live in collaboration with the City of Duarte and the Parks & Recreation Dept. We started the program because we – under the aegis of Dr. Kimlin Tam Ashing, Ph.D., our Director at CCARE – recognized a need in our catchment area and a corresponding opportunity to reach out to the community to help reduce obesity rates and deal with related chronic diseases, especially cancer and diabetes. Our mission was to become a trusted source of information for this underserved population, a place where they could find the resources they needed and medical professionals they could talk to and turn to for help.
The program officially launched in 2008, with flyers going out to every student in the school district. Though we initially targeted students and their parents, the classes in the program are not limited to them and are in fact open to one and all.
The main goal of the program is summed up in its name: we want to change how people eat, move and live. Our classes are designed to enhance knowledge, change attitudes, and connect the dots between nutrition and physical activity – and obesity, chronic disease, and overall health.
For example, we teach healthy food preparation skills to reduce fat and caloric intake and we do so using culturally relevant recipes, so that people are more likely to maintain the behavior change. Other behavior changes we try to influence are increasing fruit and vegetable consumption to 5 or more servings per day, and increasing daily physical activity.
The class is very much a participatory workshop, where we interact with the parents two hours per week over five weeks. Each class comprises three parts: an educational section, a food demonstration, and a physical activity session. We structure it this way so that people can see how easy it is to integrate all three areas into their lives. We give them “real-world” experience by taking them on a grocery store tour so they learn how to shop for food; by bringing in real chefs knowledgeable about food culture and healthy swaps; and by incorporating 30 minutes of activity into every class with a real physical activity instructor who teaches them exercises they can do at home.
We also do a community needs assessment so that participants have a say in the courses and what they cover. Sample topics from last year include: how to deal with kids who are picky eaters, substituting sugary drinks, how to pick produce and lean meats, reading nutrition labels, making healthy food swaps when eating out, and debunking the myth that you can’t eat healthy on a budget.
Along with knowledge, we also give them tools they can take home with them so they can immediately start putting what they learn into action. For example, we’ll give them food store gift cards, recipe books and practical tips like using your hands to determine and control portion sizes.
During the exercise session, we focus on activities that don’t require a gym membership and that anyone can do at home with their family members. We tend to think of exercise in terms of super vigorous cardio workouts, and this expectation is a burden and serves only to discourage us from moving our bodies. Our Eat Move Live (EML) attendees get to go home with yoga mats and resistance bands. Often these gifts provide folks with tools to try new ways to move their bodies, tone and increase strength and flexibility. Any body movement benefits our bodies and minds and makes us look and feel better. Studies show that exercise improves mood and reduces not only risk for illnesses but symptoms of depression and anxiety.
In additional to tackling barriers to and misconceptions about exercise, we also directly address those about eating healthy, such as it is too expensive and takes too much extra time – time that people busy with work and kids and extended family don’t have. So one of the first hurdles is to debunk the notion that there’s no such thing as a quick, healthy meal. You will begin to remove people’s self-doubt that they can change unhealthy habits once you show them that there are convenient and cost-effective ways to eat healthy. This may be harder to do in “food deserts” where supermarkets are rare and convenience stores are the norm. But there are signs of hope that things are changing for the better. For instance, a recent article in the Los Angeles Times reported on a new Farmers’ Market in the city of Compton, one of the biggest food deserts in the LA area.
Another obstacle you will find are the television commercials that target Latino and other children with ads for sugary cereals and other unhealthy foods. We’ve found a unique way to fire back by teaching kids to be more media savvy. After they learn to recognize these ads, we have them make their own commercials promoting healthy food choices.
A real sign of success is when people take initiative and get together outside of the classroom. We’ve seen parents start up yoga clubs and walking clubs on their own, a great example of what the community can do with a little bit of knowledge and guidance. They even inspired us in turn to start a walking challenge where we gave out pedometers so that people could keep track of their steps. At the end of the five week program, the top three walkers get a gift card to a local supermarket where they can purchase healthy foods. All of our incentives are health related and this reward ties their physical activity back to what they learned about nutrition.
Another item that we give away is an insulated grocery bag that reinforces what they learned about food safety and keeping meat refrigerated and separate from fruits and vegetables. We also give them a smaller cooler bag so they can bring their lunch to work – which follows up on our discussion about eating on a budget and preparing foods at home to better control calorie and fat content and portion sizes. We give them a third bag – a backpack tote – that they use for family walks and longer hikes.
On the last day of class, we turn the tables and hold a potluck where the participants get to cook for us. We give them a gift card to go food shopping so there are no out-of-pocket expenses and then they use what they’ve learned in the classroom to create a healthy meal for 4-5 people. One of the most creative student dishes I recall was a vegetarian ceviche that had us all thinking we were eating shrimp when it was actually made with cauliflower!
To measure results, we conduct a pre-test at the beginning of the program consisting of knowledge and behavior questions. At the end of the five weeks, we ask the same questions in a post-test to measure the change in people’s knowledge and behavior. Some of the results we’ve seen have been quite dramatic:
- Those that had difficulty eating healthy went from 42% down to 27%.
- Those that had difficulty being active went from 42% down to 23%.
- Those that had difficulty preparing healthy meals went from 50% all the way down to 9%.
At the end of the day, it’s nice to know we’ve made a difference and that people are more active and eating healthier because of what they’ve learned in the class. Also, with measureable outcomes, we can share our quantitative and qualitative results at local, state and even national conferences. For example, we’ve presented at the California Healthy Cities and Communities Annual Conference; Network for a Healthy California Statewide Conference; and International Cancer Education Conference, Congressional Tri Caucus Childhood Obesity Summit, Intercultural Cancer Council Biennial Symposium on Minorities.
Our hope is that other healthcare institutions will partner with their own cities to leverage funds and create their own programs to replicate the results we’ve seen within their own communities. As we’ve learned, things that are difficult to handle on our own are often made possible when we come together through collaborative leadership. Our most successful site has been in partnership with Head Start, a federally-funded program for preschoolers from the most underserved and low-income families. Thirty-eight percent of our Head Start kids are overweight or obese.
So we are working to improve the health of a community that is at tremendous risk for poor health now and in the future. Anecdotal data from the Head Start staff shows that our EML program is effective: parents are asking for more health information and the kids are more willing to eat more fruits and veggies. Further, our EML program is affecting local food consumption policies within our partner schools, as these schools are adopting healthy snacks and non-sugary drinks at school meetings and events. Our community collaboration also extends beyond government to the business community who want to get involved. For example, Walmart and Food for Less have made monetary donations, and Armstrong Garden Centers has donated gardening tools for tending homegrown gardens.
We should also stress that leaders in this effort should not get discouraged if they initially meet with some resistance and self-doubt among those in the community that do not believe they can change lifelong and ingrained habits. It takes time to establish trust, but once you do many community members are up for the challenge to lead a healthier lifestyle.
Here are a few final tips for promoting healthier diets and more active lifestyles in the Hispanic community:
- EAT: Remember the influence of culture on food. With
Hispanics, meal times are social events with proper rules of engagement and
recipes passed down from one generation to the next. To refuse a dish is an
insult; to eat everything on your plate is a compliment to the chef. So don’t
try to change what people eat, but concentrate on portion control and
preparation techniques, such as replacing lard with canola oil and using corn
tortillas instead of flour tortillas.
- MOVE: Show people that incorporating daily exercise into their lives doesn’t require a high-priced gym membership or expensive equipment. Start them off with small goals they can easily achieve and build upon. If walking for 30 minutes is too much, break it up and walk 10 minutes three times a day. People may become disillusioned if they try to do too much too soon, so motivate them with small behavioral changes and the incremental improvements they see in blood pressure and cholesterol numbers – not just the numbers on the scale.
- LIVE: Focus on health and nutrition versus weight loss and lifelong changes versus dieting. No one can stick to a diet for life, but they can change their eating and exercise habits for a lifetime. One way to change people’s habits, especially in the Hispanic community where the culture revolves around family, is to involve the entire family in the process. It’s a natural fit; for instance, families can shop for food, plan and prepare meals, and take walks together. In this way, parents can serve as great role models for their children and the community at large.