Diabetes and obesity rates are high among Latinos. To lower them, providers and payers need to understand cultural factors and barriers to healthcare.
Obesity and diabetes disproportionately affect Latinos in the United States, a group that comprises 18.4% of the population, or approximately 60.5 million people. Latinos are 1.2 times more likely to be obese than non-Latino Whites, according to HHS Office of Minority Health.
Almost 4 out of 5 (78.8%) Hispanic women are overweight or obese compared with 64% of non-Latino White women. Latinos are twice as likely to have type 2 diabetes (17%) than Whites (8%), according to the CDC. The average adult in the United States has a 40% chance of developing type 2 diabetes, but Latino adults have a greater than 50% chance. Furthermore, Latinos are more likely to develop diabetes at a younger age than the average American and therefore are exposed to its negative effects longer.
Although the interplay genetics and environment certainly plays some causative role, social determinants of health are a leading — and modifiable— factor in the complicated, web of factors and influences that affect the health of Latinos in the U.S.
Consider these statistics from a 2019 report by the HHS Office of Minority Health:
Factors that lead to obesity
“Obesity results from an imbalance of calorie consumption and inadequate physical activity, which is persistent among Latinos,” says Anabell Castro Thompson, M.S.N., APRN, ANPC, FAAN, FAANP, senior vice president of health equity at Equality Health in Phoenix. “Furthermore, as with many other health issues affecting the Latino community, this problem is exacerbated by the inaccessibility and unaffordability of healthcare.”
People who lack adequate health insurance often don’t have a primary care provider, so they are less likely to get continuity of care and help with prescription adherence, Castro Thompson says. They also are less likely to seek preventive services and may instead obtain care in expensive emergency room settings.
Franz Monroy, M.D., M.P.H., M.S., associate medical director of family medicine at Intermountain Healthcare in Salt Lake City, believes the high cost of healthy foods and easy access to less expensive, high-calorie fast food options contribute to less-than-ideal food choices for some Latinos. “When finances are tight and time is short, it takes less time and money to purchase fast food from a restaurant than it (does) to buy fruits and vegetables and prepare meals at home,” he says. Additionally, many cultural factors contribute to obesity. For example, some Latino families — especially those who have experienced food insecurities in the past — may see being overweight as an indicator of being in good health and having a higher socioeconomic standing. “Some Latino families think that a fat baby is a healthy baby,” Monroy says. “Children are often encouraged to eat their entire meal even if they’re full, a practice that can lead to overeating as an adult.”
Reducing obesity rates
To reduce incidence rates and costs associated with obesity among Latinos, providers need to adopt a team-based holistic care approach that accounts for medical, behavioral and cultural factors, as well as social and economic needs.
“Some Latinos live in areas of high poverty and food deserts and lack access to adequate or stable housing, transportation and good-paying jobs,” Castro Thompson says. “Providers need to be aware of these potential challenges and screen patients for information related to their social determinants of health. Then they should connect patients to community resources that can address any issues they have. Strong connections between providers and community-based organizations are essential because patients spend most of their time in their communities rather than engaging directly with the healthcare system.”
Based on his experience with his patients, Monroy says Latinos’ lower incomes and decreased access to healthcare contribute to their higher rates of diabetes. A lack of access to healthcare makes it less likely that patients will be seen for preventive visits. That can mean they may not be screened for diabetes and other conditions that are potentially preventable — or at least more easily managed at earlier stage.
“Very few Latino patients make a point to have a preventive visit,” Monroy says. “For some, it’s understandable that they don’t want to leave work if they don’t have a specific concern, which could potentially mean a loss of income and subsequent economic burden. Others don’t want to miss work for fear of losing their jobs. But by not getting seen, I can’t screen people for diabetes, discuss what (makes up) a healthy diet, or review the importance of exercise and weight loss, all of which aid in diabetes prevention.”
As with obesity, diet and lifestyle also are major contributors higher diabetes rates in Latinos. Some traditional Latino foods and ingredients, such as flour tortillas, refried beans, lard, fatty cuts of meat, cheese and cream, are high in fats and calories. There can be cultural pressures to overeat, specifically in the setting of family gatherings and celebrations. “There is typically a negative association (with) declining food, which is often seen as being rude or not culturally acceptable. Generally, (fewer) leisure time activities are exercise focused,” Monroy notes.
How to lower rates
Castro Thompson believes that reducing incidence rates and costs associated with diabetes in the Latino community requires improvements in affordability, accessibility and equity. “Accessibility needs to be expanded beyond medical care and should include prompt access to behavioral health needs and making connections to socioeconomic needs,” she says.
Patient education, whether written or spoken, should be in the correct language and at the right literacy level, which is critical to helping Latino patients better manage diabetes, Castro Thompson says. Providers should also assess patients for social determinants of health and connect them to community resources that can assist with access to healthy foods, housing insecurity, and even with paying for utilities, which is important because insulin, used to manage diabetes, requires refrigeration.
Finally, it’s important to build providers’ cultural competence so they can understand how cultural preferences and beliefs play a role in diabetes medication adherence and preventive care. Patients with diabetes need healthcare services to help them avoid complications such as diabetic retinopathy, neuropathy and amputations, Castro Thompson says.
Karen Appold is a medical writer in the Lehigh Valley region of Pennsylvania.