Special Thanks to:
Chicago Community Trust
&
Washington Square Health Foundation
for their support and funding.
Helping us get one step closer to our goal.
WHY TALK FAT?
Origins of the Project
1. Growing awareness of obesity as a
national problem
National Concerns
• Doubling of obesity rates
• Associated increase of Type 2 Diabetes
• Anticipated increase of cardiovascular
disease, orthopedic problems, and
depression
Percent of Teens who fall
above the 85th or 95th %ile
for BMI
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
AA boys
AA girls
85%
Mex. Boys
95%
Mex girls
ACHN SBHC vs. NHANES,
Percent of Teens >95%ile BMI
35
30
25
20
15
NHANES
10
SBHCs
5
0
A.A.
boys
A.A.
girls
M.A.
boys
M.A.
girls
WHY TALK FAT?
Origins of the Project
1. Growing awareness of obesity as a
national problem
2. Observation in our own clinics of large
numbers of overweight youth
3. Need to address diabetes prevention and
diagnosis
Where Will Intervention Take Place:
School-Based Health Center(SBHC)
• Provide ease of access and familiarity to
students and families
• Students receive comprehensive health care
services
• Patient population with increased risks for
obesity and diabetes (40% of 1st or 2nd
degree relatives with diabetes)
What is STRIDE?
Smart Teens Reducing the
Incidence of Type 2 Diabetes, Etc.
• SBHC obesity intervention and behavior change
program
• Context: Enhanced diabetes screening study
• Focus: Healthy eating & increase of physical
activity
• Method: Adult and teen focus groups drawn
from 3 urban high schools with SBHC
Teens Talk Fat
Minority Students & their Families
Discuss Experiences and Ideas
for Healthy Eating and Physical
Activity
From the Cook County ACHN
N. Fritz, S. Corbin, C.Stahl,
N. Mourikes, M. Driscoll
Focus Groups
• PURPOSE: Use adult and teen opinions to
guide development of interventional
program to reduce diabetes risks
Focus Group Recruitment
• FOCUS GROUP
Students were recruited via classroom, hallway
fliers, patient contact, word of mouth, and
referral from providers
Parents were recruited via their children, at
report card pick-up and clinic registration, and
from pre-existing school based parent groups
Focus Group
• REVIEW
Groups were held between November 2001January 2002
1 student and 1 parent group from each of 3
schools
Group leader matched by ethnicity
Groups of 7-17 participants
Groups lasted 1-2 hours
Healthy foods served
Focus Groups con’t
• Focus group questions addressed:
Participants’ experience with diet or exercise
change
 Knowledge of community resources for eating
and physical activity
Participants’ opinions about useful intervention
strategies in the SBHCs
Focus Group
• METHODS:
Discussions were audio recorded
 Tapes reviewed by all investigators
independently and themes identified
Transcriptions of discussions were also
reviewed
Analysis:
• Particular attention to:
Common themes across groups
Differences between AA and Latino groups
Differences between teens and parents
Results: All groups
•
•
•
•
•
71 participants
19 males, 52 females
36 teens, 35 parents
22 Latinos, 49 African-Americans
Most participants were overweight
Results: Observations
• Many participants expressed a concern for
better health and nutrition
• All participants were able to list community
resources
• All participants tried the “healthy” foods
that were provided
Themes
1.
Feeling unable to sustain healthy choices
 “One of my ex-boyfriends got me one of
those things you put your feet on, and I sold it
. Then he got me an old stationary bike. .
And I sold that too..”
 “I don’t like walking. I tried sit-ups. I even
tried the cha-cha-cha dance….I am just
lazy…”
 “It’s like when you try…OK, you’re trying..”
Themes
2. Denial there’s a problem
 “I don’t want to talk about diabetes – it scares
me.”
 “My doctor tells me to lose weight; But I’m
happy with how I am. I don’t want anyone
telling me how I should be . .”
Themes
3. Knowledge deficits
 “For a while I tried to stop drinking pop so I
switched to juice”
 “Regular salt is bad for you – you have to buy
sea salt from the health food store, it’s better”
Themes
4. Expediency of junk food:
 “If the junk food’s there, you just eat it…”
 “If you put healthy food in the machines,
don’t SAY it’s healthy. . .or people won’t buy
it. . .they’ll be afraid it tastes nasty.”
Themes
5 Community resources identified and concerns
about these resources (healthy eating):
 “Our neighborhood is ghetto, we don’t sell that
stuff. They sell spoiled, rotten meat and stuff.”
 “Basically, in our neighborhood, you really can’t
buy fresh vegetables from there because they are
not fresh . . .”
Themes
6. Suggestions for programmatic supports:
 Some sort of group—a support group,
cooking group, restaurant field trip group,
dance/drama group, etc.
 Use of school facilities as a resource
 Very few suggestions regarding provider input
Results: Teen Groups
• There were a total of 36 teens (9 male, 27
female)
• 22 African-American and 14 MexicanAmerican teens
• 2/3 of the teens were overweight
• Most of the teens had family hx of diabetes,
as well as, personal experience with dieting
and weight loss
Results: Teen Groups con’t
• Most teens expressed a concern for their
health and nutrition
• Most teens did not eat meals provided by
the schools’ cafeteria
• Most teens were eager to make changes, but
also wanted the support needed to make
these changes
Results: Adult Groups
• There were a total of 35 adults (10 male,
25 female)
• 10 Mexican-American and 25 AfricanAmerican adults
• 2/3 of the adults were overweight
• Some of the adults were diabetic, most had
family hx of diabetes and had some
experience with dieting/weight loss
Contrasts: Adults & Teens
• Parents were more concerned about safety
issues in the community than were teens.
• Parents were less likely to try the various
healthy snacks provided during the groups.
Contrasts: African-Americans
& Mexican-Americans
• Mexican-American teens expressed more
dissatisfaction about their physical appearance
than did the African-American teens
• Mexican-American parents were more open to
changing their eating/cooking habits than the
African-American parents
• African-American teens but NOT parents were
more likely to deny obesity as a problem.
Conclusions:
Intervention needs to
• Address psychological barrier of hopelessness
• Build interpersonal support groups
• Address school environmental issues: lunch,
vending machines, PE classes, after school
opportunities
• Education is important but insufficient
• Support development of change agents among
youth, parents, and staff