Defining “Culturally Oriented”

Growing up, in response to my hello, my pediatrician’s greetings consisted of, “How many tortillas do you usually eat? We have to eat less tacos, ok?” While they may have considered this concern about my overweight status, these doctors’ prejudices were explicitly demonstrated before I could even speak. As an overweight Mexican, I faced fat-shaming from friends and family, but worst of all, from doctors. I naively believed these primarily white professionals were supposed to foster healthier eating decisions, however they insinuated my culture’s food was the problem. I was told to avoid my mother’s cooking and choose “better” Western meals since Mexican food was simply “unhealthy”. Since many of my family members were also overweight, I even wondered whether all Mexicans might just be naturally “bigger”.

In the U.S., obesity is a huge public health concern since it affects more than 40 percent of the population. Alarmingly, between 2017 and 2018,44.8 percent and 50.4 percent of Latinx and Mexican Americans, specifically, met the criteria for obesity and displayed a higher prevalence of related comorbidities such as cardiovascular disease and type 2 diabetes. Decades of public health research have found many genetic and social reasons for these disparities, thus public health workers have tried to design nutrition education and weight-loss interventions specifically for Latinx groups. Unfortunately, many programs simply copy-and-paste methods tailored for English-speaking white populations, but claim they were “culturally-oriented” for Latinx groups. In reality, these declarations simply mean materials were given in Spanish or moderators spoke the language. There is no clear procedure for how “culture” should be applied, so a health behavior framework is needed.

Given its successes in African-American populations, health care workers should implement the PEN-3 health behavior model in designing Latinx-specific dietary interventions. This model centers culture in studying health outcomes since it can both influence unhealthy decision-making and also provide solutions for sustainable health behavior change. Through the model’s three dimensions of cultural identity, relationships, expectations, and cultural empowerment, program planners will better understand Latinx groups’ food decisions to tackle the high prevalence of obesity. For example, this model could help health workers understand why newly arrived immigrants from Spanish-speaking countries actually tend to be healthier than the US Hispanic population. Research has found that as immigrants acculturate, poor food behaviors increase. By studying cultural empowerment, health-care workers may realize how immigrants will often adopt unhealthy eating behaviors not from a lack of nutritional awareness but from a monumental change in social standing. Many individuals move due to low socioeconomic status and aim for the “American dream.” Once in the US, they are faced with an increased availability of unhealthy yet comparatively cheaper brand-name “American food”. Internationally, these products are associated with higher social status since they are generally more expensive than local items. Now that they have “made it in life,” immigrants will buy these foods, aware of their low nutritional value, but proud that their new American life facilitates such purchases.

Through the PEN-3 model, health workers can also better appreciate how cultural identity and eating decisions operate on the personal level, as well as at the extended family and neighborhood levels. This is critical for the Latinx community since eating and cooking are tied to family member dynamics and are sacred expressions of comfort and care. When doctors suggested I avoid my mom’s cooking, I did not consider this a health recommendation but an implication that I reject my mother’s existence altogether. Many Latinx groups even see eating as a culturally sanctioned form of stress reduction. This would help public health workers realize that existing recommendations about changing eating behaviors, such as avoiding “emotional eating,” will never work for Latinx groups and require reinterpretation.

Many health workers may criticize this broad approach due to time constraints and a lack of external validity. However, this lack of transferability is necessary because sustainable dietary changes and weight loss require a focused lens. Given that the U.S. Latinx population is often blamed for their eating patterns and stereotyped as lazy, they deserve the combined efforts of public health workers and their broader community for collective efficacy. Thus, I urge public health professionals to be the key players in civic society and reimagine how culture can be implemented for more inclusive dietary interventions and use the PEN-3 model as the first step in building a healthier Latinx community.

Food and weight have always been intimately connected, but changing eating habits is not just for weight loss or shrinking waist sizes. We are more than BMI values and body fat percentages. Addressing obesity in Latinx groups means addressing centuries of values and preoccupations related to food and health. As public health workers, we can use cultural humility to redefine what “healthy” looks like and maintain food as a vehicle that can pass on precious values to future generations.