Obesity In the Haitian Immigrant Population of Philadelphia

1. Obesity In the Haitian Immigrant Population of Philadelphia JULIEN SANON, MD UMASS, AMHERST COMMUNITY NUTRITION 572 DECEMBER 2010

2. Public Health, Nutrition, Obesity Public Health Nutrition 2009

3. Obesity Epidemic World health organization 2009

4. Target Population for Community Assessment Adults Haitian Immigrant Population in Philadelphia particularly the Church followers

5. Obesity In the Haitian Immigrant Population of Philadelphia USA Today 2010

6. Obesity In the Haitian Immigrant Population of Philadelphia Welcoming center for New Pennsylvanian, 2010 Haitian Coalition of Philadelphia, 2010

7. Obesity In the Haitian Immigrant Population of Philadelphia Elyse Joseph Foundation, 2010

8. Priorities • Using the Transtheroretical Model, Motivate the community from Precontemplation to Action • Share Community Assessment findings with stakeholders such as the Haitian Clergy of Philadelphia, the Haitian coalition of Philadelphia, the Haitian media • Establish a campaign against Overweight and Obesity for the month of November

9. GOALS

10. OBJECTIVES

11. Obesity Campaign Designed • 9 interviews with different radio personalities over the month of November • 8 church PowerPoint presentations of 40minutes over the month of November • 1 Newspaper article/ad for November • 30 posted flyers for the month of November • 200 Flyers distributed during November

12. Obesity Campaign Designed (Flyer) Surpoids/ Obesité? Faits : 66 % des gens qui vivent aux États-Unis ont de l’embonpoint ou sont carrément obese. La communauté haïtienne en Philadelphie n’est pas trop loin avec 70%. La surcharge pondérale infirme et tue. Plus de 64 maladies sont causées par le surpoids et l’obésité. On peut nommer, entre autres, l’hypertension, le diabète, la crise cardiaque, la paralysie cérébrale, les douleurs articulaires, l’essoufflement, le ronflement, l’apnée du sommeil, les problèmes pulmonaires, les maladies de la peau, les maux de tête, le cancer, la diminution de l’appétit sexuel et j’en passe. Fiction Je suis née comme ça La race noire est grande Ma famille entière est grande Ma famille et mon mari/ma femme est content(e) avec ma grosseur Mon poids démontre à la société comment je suis en santé Flyer for campaign

13. Surpoids/Obesité Pour un régime minceur équilibre • Mangez seulement un quart de son plat. • Évitez les boissons sucrees de saveurs artificielles. • Consommez beaucoup de fruits et de végétales. • Évitez les repas frits et les produits raffinés. • Lisez toujours l’étiquette alimentaire sur le paquet. • Évitez les chaines de restauration rapide. • Soyez plus actives.

14. Lesson plan • Discuss obesity and co morbidities • Address causes of obesity in the community • Weight management

15. Weight management • Eat a balanced diet based on the food pyramid • Decrease energy intake • Increase energy output • Implement Behavioral changes

16. Cholera/Election and Program Implementation • Increased demand from the community for information • Combined presentations on Cholera and Obesity • Shorter presentations to a more captive audience of 12 churches • Increased demand for radio interviews CDC

17. Evaluation • Survey of 60 church followers in the community • Community leaders feedback • Radio personalities feedback

18. Obesity in The Community • 100 surveys of 7 questions distributed in 2 churches post presentation, 60 surveys returned • Perceived weight problem- 52/60 or 87 % answered that there was no weight problem in the community • Estimation of caloric intake - 58/60 or 96.7 % are unable to estimate their daily caloric intake • Food Pyramid awareness- 54/60 or 90 % are unaware of the pyramid

19. Weight Problem Perception Survey, 2010

20. Calories estimation Survey,2010

21. Food Pyramid

22. Obesity in the community Survey, 2010

23. Obesity in the community Survey, 2010

24. Evaluation • More than 3 slogans retained after church presentations • Increased demand by 20 different churches for presentation • Increased demand for interviews by local radio personalities and broadcasters

25. Marketing Strategy

26. My Advantages • No cultural or language barriers • Program is targeted and free of Charge • Versatility in addressing their health issues as well as their exercise and Nutrition concerns

27. Reflections on the campaign • Limited data available on the community • Overweight and Obesity with high prevalence in the community • Lack of education limits surveys as a method of evaluation • Stakeholders conflict of Interest may hinder efforts

28. Reflections on the campaign • Networking and Coalition building are essential • Versatility is key in a campaign • Adjust campaign based on current events

29. Reflections on the campaign • Community service can be a very gratifying experience and even launch a new career path • Make a lemonade out of a lemon • Campaign was overwhelming successful despite multiple drawbacks

30. Future of the campaign • Stakeholders are enthusiastic about the future of the program for the following year • Many presentations and interviews scheduled for 2011 • New year as another opportunity to strengthen the campaign against obesity

31. Future of the campaign • Extend the campaign to the Caribbean community of Philadelphia • Extend the campaign to the African American community of Philadelphia • Extend the campaign throughout the country

32. References • Alexander, S., Ostbye, T., Pollak, K., Gradison, M., Bastien, L., & Brouwer, R. (2007). Physicians' Beliefs About Obesity: Results from Focus Groups. American Journal of Health Promotion, 21 (6), 498-500. • Boyle M.A, Holben D.H. Community Nutrition in Action: An Entrepreneurial Approach. 5th edition. Belmont, CA: Wadsworth, Cengage learning; 2010 • Center for Disease Control, Behavioral Risk Factor Surveillance System , Prevalence and Trends Data, Pennsylvania, 2009. Retrieved October 3rd, 2010. • CooganPF,Cozier YC et al. Neighborhood Socioeconomic Status in Relation to 10- Year Weight Gain in the Black Women's Health Study. Obesity 2010; 18: 2064-2065 • Daniel Coachi, Haitian Internist in private practice in Philadelphia. Personal conversation, September 24 th , 2010 • Holden, Diana, 2010. Fact Check: The Cost of Obesity, Retrieved from http://www.cnn.com/2010/HEALTH/02/09/fact.check.obesity/index.html • Fitzgibbon, M., Stalley, M., & Ganschow, P. e. (2005). Result of a Faith-Based Weight Loss Intervention for Black Women. Journal of American Medical Association, 97, 1393-1402. • Flegal, K., Graubard, B., & Williamson, D. e. (2005). Excess Deaths Associated With Underweight, Overweight, and Obesity. Journal of American Medical Association, 293, 1861-1867. • Fontaine, K., Redden, D., Wang, C., Westfall, A., & Allison, D. (2003). Years of Life Lost Due to Obesity. Journal of American Medical Asssociation, 289, 187-193.

33. References • Forman-Hoffman, V., Little, A., & Wahls, T. (2006). Barriers to Obesity Management: A Pilot of Primary Care Clinicians. BMC Family Practice, 7 (35). • Frantz, Latour, Haitian pathologist and director of the Haitian Community Center in Philadelphia, personal conversation, October 7th, 2010 • Gaston, M., Porter, G., & Thomas, V. (2007). Prime Time Sister Circles: Evaluating a Gender- Specific, Culturally Relevant Health Intervention to Decrease Major Risk Factors in Mid- life African American Women. Journal National Medical Association, 99 (4), 428-438. • Gilda, Jean Louis. President Elise Joseph Foundation. Personal Communication, October third 2003 • Gorin, A., Phelan, S., & Wing, R. e. (2004). Promoting Long-Term Weight Control: Does Dieting Consistency Matter? International Journal of Obesity and Related Metabolic Disorders, 28, 278-281. • Phanor, Louis . Editor of L'informateur, personal conversation, September 23, 2010 • Ogden, C., Carroll, M., Curtin, L., McDowell, M. T., & Flegal, K. (2006). Prevalence of Overweight and Obesity in the United States, 1999-2004. Journal of American Medical Association, 295 (13), 1549-1555.

34. References • Paschal, A., Lewis, R. K., Martin, A., & al, e. (2004). Baseline Assessment of Behaviors of African Americans Participating in the Activities-for-Life-Program: A Community-Based Health Intervention Program. Journal of Community Health, 29, 305-318. • Physical Activity and Good Nutrition, Essential Elements to Prevent Chronic Diseases and Obesity: At A Glance 2008. (n.d.). Retrieved October 6, 2010, from Center for Disease Control and Prevention: http://www.cdc.gov/nccdphp/publications/aag/dnpa.htm. • Ruelaz, A., Diefenbach, P., Simon, B., Lanto, A., Arterburn, D., & Shekelle, P. (2007).Perceived Barriers to Weight Management in Primary Care: Perspectives of Patients and Providers. Journal of General Internal Medicine, 22 (4), 518-522. • Satcher, D., & Pamies, R. (2006). Multicultural Medicine of Health Disparities. New York, NewYork: McGraw Hill Medical. • Snapshot 2010: Philadelphia, PA, Retrieved on September 24 th, 2010 from http://www.countyhealthrankings.org/pennsylvania/philadelphia

35. References • U.S. Preventive Task Force. (2003). Screening for Obesity in Adults: Recommendations and Rationale. Rockville, MD: Agency for Healthcare Research and Quality. • Waldrop, J. (2006). Behavior Change in Overweight Patients. Motivational Interviewing As A Primary Care Intervention. Journal of Advanced Nursing Practice, 14 (8), 23-27. • Yan, L., Daviglus, J., & Liu, K. e. (2006). Midlife Body Mass Index and Hospitalization and Mortality in Older Age. Journal of the American Medical Association, 295 (2), 190-198. • Yun, S., Zhu, B., W., B., & Brownson, R. (2006). A Comparison of National Estimates of Obesity Prevalence from the Behavioral Risk Factor Surveilance System and the National Health and Nutrition Examination Survey. Internation Journal of Obesity, 30 (1), 164-170. 

36. Obesity in the Haitian Immigrant Population of Philadelphia