Perspectives in Health Magazine
The Magazine of the Pan American Health Organization
Volume 7, Number 3, 2002

North meets South

In El Paso, a culturally blended city of 560,000, the largely Mexican-American population is experiencing its own nutrition and lifestyle transitions that in some ways reflect trends in both the developed and the developing world. The results are high rates of overweight and obesity, along with negative health consequences such as diabetes.

PAHO's U.S.-Mexico Border Office in El Paso collected local data on overweight and obesity as part of a study of diabetes in the border region. The results showed that 67.8 percent of women and 76.6 percent of men in the border area are overweight or obese.

Darryl Williams, director of the Office of Border Health at Texas Tech University Health Sciences Center, is one of a dedicated group of local academics and health professionals who are studying the city’s weight-related health problems and ways to address them. Williams attributes part of the obesity epidemic to the possibility that "Mexican-Americans may have a genetic predisposition." He cites the socalled "thrifty gene" theory, which holds that some groups have an inherited tendency toward weight conservation that in earlier contexts increased the chances of survival, but that in modern urban settings leads to high rates of obesity.

But cultural and other exogenous factors seem to be at least as, if not more, important. Williams notes that the average El Pasoan’s daily diet is high in whole milk, soft drinks and refined carbohydrates such as white rice and tortillas, but notably low in fruits and vegetables. Indeed, at least one study shows the city as having one of the lowest levels of fruit and vegetable consumption in the United States.

Williams also faults restaurant and fast food and what he terms "shifts in portion size…it used to be a small Coke, now it’s 48 ounces for the same amount of money." The technique, known as "value marketing," is used to increase sales by making consumers think they’re getting a bargain. Even worse, says Williams, are El Paso’s favorite all-you-can-eat buffet restaurants, where patrons inevitably "feel obliged to get their money’s worth."

Coupled with El Pasoans’ poor eating habits are what Williams and others see as the increasingly sedentary lifestyles of most of the city’s residents. In a study of childhood obesity in the region, Williams says he expected to find higher rates among children living in El Paso’s poorer neighborhoods, the colonias, since overweight and obesity are inversely related to income in most of the United States. Contrary to expectations, he found no significant differences between the colonias and better-off sectors. What did appear as significant was the age at which obesity kicked in.

"In both boys and girls, when they tracked weight and growth, it was normal up to age 7, then there was a problem with obesity. What is clear is that something happens when they go to school," he says.

Williams believes that a key factor may be the "change in activity levels at school." He notes that physical education, once emphasized in U.S. public schools, is now given lower priority. Moreover, "when kids go home, they’re not very active either. It’s all TV watching and video game playing." Especially in the colonias, says Williams, there are few parks or other facilities that promote physical activity. And with summer high temperatures in the mid-90s, air conditioning keeps many El Pasoans—adults and children alike—indoors.

Juan Carlos Zevallos, director of the Diabetes Research Center at Texas Tech University Health Sciences Center, cites similar factors. His recent research on childhood and adolescent obesity and diabetes on both sides of the border found that more than half of the region’s children watch three or more hours of television daily, while a quarter watch upwards of four hours. "And that’s not including Nintendo," he adds.

Aggravating the situation, particularly for adults, is the fact that El Paso, like many other cities, is largely a product of unplanned urban sprawl. Walking and biking are simply not practical ways of getting around. Moreover, "our public transportation is terrible," says Zevallos. "You need a car—you need your own car."

Zevallos and other members of El Paso’s public health community are doing more than studying the city’s obesity problem. They are working to curb the trends through health promotion efforts, some of the most promising of them aimed at children.

One of these is an obesity prevention program known as El Paso CATCH (Coordinated Approach to Child Health), based on a national program of the same acronym. Funded with $5.6 million in grants from the local Paso del Norte Health Foundation, the program promotes active lifestyles and healthy eating among schoolchildren and has been implemented in more than 100 El Paso–area elementary schools.

Karen Coleman, a specialist in childhood obesity and assistant professor of health psychology at the University of Texas at El Paso, evaluated the program and considers it a success. In its first year, CATCH managed to boost moderate-tovigorous physical activity more than 50 percent and reduce the fat content of school lunches to less than 30 percent of total calories. Now rates of overweight in El Paso CATCH schools are lower than those recently reported among Mexican-American children at the national level.

"I think dealing with it in children is the key," says Zevallos, "because one of the greatest risk factors for being an overweight adult is being an overweight adolescent. But you can’t just deal with the kids; you have to deal with the mindset of the families and the schools."

Pediatrician Jose Roman agrees. He notes that in El Paso’s schools, many cafeteria workers, teachers and administrative staff are themselves overweight or obese. They also tend to be staunch members of the "clean-plate club."

"School lunch programs are designed to get kids to eat more, not to eat healthily," says Roman. "They’re told, ‘you have to eat all your food.’ We’re pushing food on children."

Roman notes that El Paso parents tend to be even more difficult targets than schools. Most Hispanics grow up believing that fat children are healthy children, he says. "The more they eat, the better the parents feel. Parents are afraid to limit what their children eat."

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