Different food groups
As a clinician, you must learn to tailor your advice to different cultures. For example, with the Spanish speaking population, there are frequently different starch sources that I need to focus on helping people avoid, like plantains, rice or corn. Fortunately though, those Hispanic populations usually eat lots of beans, which the typical American family doesn’t eat, so we try to stress to them, “You need to focus more on the beans component of the rice and beans.” So you definitely try to tailor things, and that also helps them to feel comfortable and feel like they’re being recognized and you’re being sensitive to their specific issues.

Kelly Sinclair, Clinical Nutritionist

 

Defining motivation
I think that, as a [hospital] program, one of the biggest challenges that we face is defining what motivation is– what are people ready to change? I think that there are several perspectives that you can take. If you look at it from a cultural perspective, for many Latino cultures and many of the families that we see from African countries, what is valuable is to have a little more weight on one’s body. So sometimes it is a little bit challenging for us to say, “Okay, well food is good, and food means different things to different people, related to their own families, their cultures, and their levels of affluence.”

These are some of the more challenging things: trying to be respectful and saying that it’s great to eat your traditional meals, but maybe we can work on cooking them with a different type of oil, or work on portion control. Many times families are just so happy that they are not completely giving up their traditional foods and that they do not have to change everything. We really work hard on practical take home points. Another challenge is that sometimes families are very confused. They will say, “I really don’t know why I’m here.” That is very common, and I hear it a lot, mostly when the reason a family came to us was that their child’s weight was concerning for his or her physician and the physician talked to the family and sent them to our program. But when you look around at the family, mom and dad and the child and the uncle all look about the same, so what’s the problem? So we provide a lot of education to people about these issues.

Jennifer Rein, MSW Social Worker and Clinical Coordinator

 

Cultural Differences
The clinical approach to a child with a weight problem should take into consideration the person’s culture. We cannot give the same dietary advice or implement the same lifestyle changes with all patients; we need to take into consideration cultural differences in terms of diet, education, and socioeconomic differences. Obesity and type 2 diabetes affect mostly minorities, which makes any intervention even more challenging, considering that often there are many socioeconomic problems affecting these families. Age and gender should also be taken into consideration; parental participation in implementing lifestyle changes is especially crucial with young children, but older children and adolescents definitely need to play a more active role.

Diego Botero, MD, Pediatric Endocrinologist

 

The Family’s Story
I think it is useful to ask about family history, because you hear the family’s story about being overweight. This can be important in making changes, because some kids think, “I’m going to be overweight because my parents are overweight; it’s just the way things are.” It may also be a way for children to be connected to their parents.

Allison Lauretti, PhD, Staff Psychologist