Incorporating an Increase in Plant-Based Food Choices into a model of Culturally Responsive Care for Obesity in Hispanic/Latino Adults and Children

The national rate of obesity in US Hispanic/Latinos exceeds all other major ethnic subgroups and represents an important health disparity. Plant-based diet interventions that emphasize whole plant foods with minimal processing and less refined grains and sugar have shown have shown great promise in control of obesity, but there is a paucity of data translating this treatment effect to disparity populations. The objective of our study was to evaluate the efficacy and scalability of the Healthy Eating Lifestyle Program (HELP) – a hospital-based, family centered, culturally tailored, plant-based diet intervention for Hispanic/Latino pediatric obesity patients and their families. Our evaluation methods included: 1) a quasi-experimental, one group, longitudinal study to measures changes in BMI at 0, 6, and 18 weeks of follow-up, and 2) A stakeholder analysis consisting of six key informant interviews of HELP program staff. We found a significant decrease in body mass index across all adults (-0.2 kg/m2 p=0.0047), that was much stronger in men. For children ages 5-12 years, there was also a significant decrease in BMI Z score from pre- to post- intervention (p=0.04). Program strengths were the cultural tailoring of the plant-based diet choices, and allowing a tiered approached that did not require adherence to strict vegetarianism. Our pilot study findings from HELP raise the possibility that incorporating plant-based diet choices into the treatment of pediatric obesity patients and their families can be an effective addition to a culturally responsive care model.

[1]  W. Shih,et al.  Plant-Based Diets Are Associated With Lower Adiposity Levels Among Hispanic/Latino Adults in the Adventist Multi-Ethnic Nutrition (AMEN) Study , 2019, Front. Nutr..

[2]  G. Fraser,et al.  Plant-Based Diets in Hispanic/Latino Adult Adventists in the United States and Their Association With Body Mass Index , 2019, American journal of health promotion : AJHP.

[3]  J. Alvidrez,et al.  The National Institute on Minority Health and Health Disparities Research Framework , 2019, American journal of public health.

[4]  T. Turnbull,et al.  Effectiveness of plant-based diets in promoting well-being in the management of type 2 diabetes: a systematic review , 2018, BMJ Open Diabetes Research & Care.

[5]  Craig M. Hales,et al.  Trends in Obesity and Severe Obesity Prevalence in US Youth and Adults by Sex and Age, 2007-2008 to 2015-2016 , 2018, JAMA.

[6]  Andrea M Champlin,et al.  Impact of a Plant-Based Diet and Support on Mitigating Type 2 Diabetes Mellitus in Latinos Living in Medically Underserved Areas , 2018, American journal of health promotion : AJHP.

[7]  C. Murdaugh,et al.  Effects of a Family-based Diabetes Intervention on Behavioral and Biological Outcomes for Mexican American Adults , 2017, The Diabetes educator.

[8]  M. Neuhouser,et al.  Metabolic responses to a traditional Mexican diet compared with a commonly consumed US diet in women of Mexican descent: a randomized crossover feeding trial. , 2016, The American journal of clinical nutrition.

[9]  J. Shikany,et al.  Development and Use of a Traditional Mexican Diet Score in Relation to Systemic Inflammation and Insulin Resistance among Women of Mexican Descent. , 2015, The Journal of nutrition.

[10]  N. Barnard,et al.  A systematic review and meta-analysis of changes in body weight in clinical trials of vegetarian diets. , 2015, Journal of the Academy of Nutrition and Dietetics.

[11]  M. Orlich,et al.  Global epidemiology of obesity, vegetarian dietary patterns, and noncommunicable disease in Asian Indians. , 2014, The American journal of clinical nutrition.

[12]  Lessons Learned from 20 Years of Diabetes Self-Management Research With Mexican Americans in Starr County, Texas , 2014, The Diabetes educator.

[13]  Jie Hu,et al.  A Family-Based Diabetes Intervention for Hispanic Adults and Their Family Members , 2014, The Diabetes educator.

[14]  J. Sabaté,et al.  Obesity and life expectancy among long-lived Black adults. , 2014, The journals of gerontology. Series A, Biological sciences and medical sciences.

[15]  Pei-Chao Lin,et al.  Analysis of Behavior Risk Factor Surveillance System Data to Assess the Health of Hispanics With Diabetes in US-Mexico Border Communities , 2013, The Diabetes educator.

[16]  M. Orlich,et al.  Vegetarian dietary patterns and mortality in Adventist Health Study 2. , 2013, JAMA internal medicine.

[17]  M. Cousineau,et al.  Transforming a Family Medicine Center and Residency Program Into a Federally Qualified Health Center , 2013, Academic medicine : journal of the Association of American Medical Colleges.

[18]  S. Tonstad,et al.  Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. , 2013, Nutrition, metabolism, and cardiovascular diseases : NMCD.

[19]  A. Petersen,et al.  Factors that Influence Diabetes Self-Management in Hispanics Living in Low Socioeconomic Neighborhoods in San Bernardino, California , 2012, Journal of Immigrant and Minority Health.

[20]  B. Caramelli,et al.  Vegetarians from latin america. , 2010, The American journal of cardiology.

[21]  G. Fraser Vegetarian diets: what do we know of their effects on common chronic diseases? , 2009, The American journal of clinical nutrition.

[22]  S. Tonstad,et al.  Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes , 2009, Diabetes Care.

[23]  E. Haddad,et al.  Meats, Processed Meats, Obesity, Weight Gain and Occurrence of Diabetes among Adults: Findings from Adventist Health Studies , 2008, Annals of Nutrition and Metabolism.

[24]  F. Kaufman,et al.  Feasibility of a hospital-based, family-centered intervention to reduce weight gain in overweight children and adolescents. , 2007, Diabetes research and clinical practice.

[25]  J. Sabaté,et al.  Does low meat consumption increase life expectancy in humans? , 2003, The American journal of clinical nutrition.

[26]  A. Jiménez-Cruz,et al.  A flexible, low-glycemic index mexican-style diet in overweight and obese subjects with type 2 diabetes improves metabolic parameters during a 6-week treatment period. , 2003, Diabetes care.

[27]  G. Fraser Diet, Life Expectancy, and Chronic Disease: Studies of Seventh-Day Adventists and Other Vegetarians , 2003 .

[28]  R. Holman,et al.  Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study , 2000, BMJ : British Medical Journal.

[29]  W KOUWENAAR,et al.  [The National Institute of Public Health]. , 1952, Nederlands tijdschrift voor geneeskunde.