Approximately 40% of U.S.-born Latino children of immigrant parents experience higher obesity rates than other Latino children. Clinical treatments delivered by teams of medical professionals are currently encouraged but are often not feasible for many immigrant families.
Lisa Ross DeCamp, MD, MSPH, associate professor of pediatrics at the University of Colorado School of Medicine, has adapted an evidence-based weight management program that can be delivered in Latino communities.
Community Active and Healthy Families began in California in 2010 as an evidence-based weight management program designed specifically for Latino immigrant families. It was delivered in a clinical setting with a pediatrician, a dietitian, and a promotora, which is a community health worker. Ross DeCamp first adapted the community pilot program in Baltimore before expanding into Colorado.
“We know that Latino communities, and other racial, ethnic minority youth, are at higher risk of obesity and then at higher risk of experiencing health complications,” says Ross DeCamp, an investigator at the Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS). “We have a lot of resources at Children's Hospital Colorado for healthy weight management that are intensive, and oftentimes families aren't quite ready for that, so we feel that this fills the gap. If they're interested in making changes, this provides a comfortable, non-medical setting where they can start to think about that.”
For families who have yet to begin a health or weight-loss journey, the clinical setting can feel intimidating. It can require seeing a dietitian and having repeat office visits. The Community Active and Healthy Families Program is a more welcoming first step to engage families.
“Some families are going to need or want more support. Among the menu of options would be additional community programs at Children’s Hospital, like Cooking Matters, which teaches cooking healthy foods on a budget,” Ross DeCamp says. “They may go on to do other things, but having this on the menu may be a good fit for families who are really wanting to start their journey and aren't ready for something more.”
Ross DeCamp’s goal is to make the program more accessible beyond the clinic. Patients at Children’s Colorado or in the Denver area can refer to the hospital, but in rural settings, coming to the hospital isn’t an option. For those families, Ross DeCamp’s program is a primary option on the list of treatments available.
“These community-based programs could be a good starting place in the realm of options for weight management,” Ross DeCamp says.
The program partners with Aurora Community Connection to deliver the culturally tailored program to Latino families. The resource center assisted with identifying families, provided the promotora, and helped establish rapport with the new program.
“With underserved communities, building trust and comfortability is important. Our program strives to build that trust and tailor the program to the needs of the families,” says Jenifer Valdez, MS, a research services professional at ACCORDS.
Fourteen families attended eight sessions over a two-month period in 2023. To engage everyone in making healthy changes, the researchers opened the sessions to parents, the research child, and any additional friends or family members interested in attending.
The sessions were led in Spanish by a bilingual and bicultural community health worker and nurse from UCHealth. These facilitators discussed topics such as establishing healthy habits and how to incorporate them into your lifestyle.
After introductions, the group separated so that parents could stay to talk with the facilitators while the children went out to play. Nursing student volunteers from Platt College of Nursing attended to play games with the kids and help further community connections.
“The parents would stay with the nurse and could go over more in-depth topics and ask questions they might not want to ask in front of their kids,” Valdez says. “The format worked well because everyone coming together meant that they held each other accountable, but it also gave the parents an opportunity to dig deeper into the knowledge.”
Ross DeCamp and Valdez say the pilot study results have been positive in several areas.
“We wanted to be mindful of the impact on self-esteem. Anytime you're talking about weight, it can be shaming, so we wanted to make sure the program didn't negatively impact their self-esteem. We heard the opposite in our interviews, that the kids felt empowered,” Ross DeCamp says.
Using a body mass index (BMI) that was standardized for age and sex, the researchers saw a decrease in BMI among the children who participated in the program. They also noted changes in the healthy habits they measured, including fruit intake and other dietary components.
“It also gave us great information about the ability to afford healthy food and the challenges families were facing,” Ross DeCamp says. “With food costs going up each week, it was acutely more difficult. This is a struggle that is probably not going to go away for families, given the current cost climate for purchasing healthy versus unhealthy food.”
The children reported that they enjoyed the physical activity changes, such as going to the park or taking walks as a family. While these are valuable as health gains, the researchers also see this family time as an added value to the program.
“Many of our families wanted to continue and were interested in learning more. It opens my eyes being a minority, but also seeing it in action,” says Valdez. “I saw firsthand how much people don't know of health consequences, and how important it is to build trust to teach them about these important topics. They really enjoyed being able to learn at a level they understood.”
The program is currently working on funding applications for a larger trial in the Denver area, as well as using a two-year PCORI grant to form partnerships on the Western Slope to expand the work.