Studying Overweight and Obesity Among Latinos

Generalist Physician Faculty Scholar Elena Fuentes-Afflick, MD, MPH, finds a relationship between adopting American beliefs and behaviors and overweight and obesity in Latina mothers and their children.

    • July 15, 2009

The Problem: Acculturation—the process by which immigrants adopt the beliefs and behaviors of another group—has been associated with overweight and obesity among Latino adults. More research was needed about the relationship between a mother’s acculturation and her weight, and the weight of her children.

Grantee Perspective: In 1996, Elena Fuentes-Afflick, MD, MPH, an assistant professor of pediatrics at the University of California, San Francisco, began the Latino Health Project, a study of 351 Latina women from the prenatal clinic at San Francisco General Hospital and their children. She conducted the study under a National Institutes of Health (NIH) Minority Clinical Associate Physician Award.

As a participant in the Robert Wood Johnson Foundation (RWJF) Generalist Physician Faculty Scholars Program from 1998 to 2003, Fuentes-Afflick was able to continue the Latino Health Project—and to develop her career. “This grant was as much about the career development as it was about the project,” she said.

Three members of the national advisory committee mentored Fuentes-Afflick while she was in the program. Evan Charney, MD, was the “formal” national advisory committee mentor. “Dr. Charney gave me a very good big picture, ‘what do you want to do with your life?’ advice,” said Fuentes-Afflick. Fuentes-Afflick had been working with Eliseo Perez-Stable, MD, another member of the national advisory committee, since early in her career. Advisory committee member Michael Weitzman, MD, and Fuentes-Afflick developed an informal mentoring relationship.

The Latino Health Project included a 45-minute interview with women during their pregnancy and annually for three years, and a community assessment. The community assessment included in-person surveys of areas within two blocks of study participants’ homes to collect information about parks, schools, markets, billboards and environmental influences.

While in the program, Fuentes-Afflick received another NIH grant for the Latino Health Project (1999–2005, $484,445).

Results: In one part of the study, Fuentes-Afflick, who is now a professor of pediatrics at the University of California, San Francisco, and her colleagues used data from 313 pregnant Latina women to examine acculturation and body mass. They reported in the Journal of Women’s Health (2008) that:

  • One third of the women were overweight and one fifth were obese.
  • Longer residence in the United States, older age and more pregnancies were significantly associated with obesity.

Using data from 185 Latina mothers and children, Fuentes-Afflick et al. also examined overweight in Latino children (Archives of Medical Research, 2008). They found:

  • At age 3, 43 percent were overweight.
  • Mothers who were more acculturated and obese were more likely to have children who were overweight than less acculturated and healthy weight mothers.
  • Childhood overweight was more likely among children whose mothers reported they ate well or very well and felt their weight was too high.

As a faculty member in a department with a strong tradition of basic science research, the Generalist Physician Faculty Scholars Program helped Fuentes-Afflick gain the respect of her colleagues. “The funding support I received through the award has been really instrumental in solidifying my professional standing at home and in establishing my academic legitimacy,” she said.

Fuentes-Afflick is a member of the national advisory committee for the Robert Wood Johnson Foundation Clinical Scholars Program. In 2008–2009, she served as president of the Society for Pediatric Research.

RWJF Perspective: The Robert Wood Johnson Foundation established the Generalist Physician Faculty Scholars Program to create a cadre of respected generalist leaders in medical schools who would be in a position to influence curriculum, admissions and scholarship. Junior faculty in family medicine, internal medicine and pediatrics conducted research and built their careers under the guidance of mentors.

“Given the shortage of primary care physicians, we need innovative approaches to encourage medical students to choose careers in generalist fields. The Generalist Physician Faculty Scholars Program was designed to emphasize a scholarly foundation for generalism and improve the quality of the education provided to students who choose this important career path,” said Pamela S. Dickson, MBA, assistant vice president of RWJF’s Health Care Group.

When the program ended in 2008, RWJF created the Robert Wood Johnson Physician Faculty Scholars Program to strengthen the leadership and academic productivity of junior medical school faculty who are dedicated to improving health and health care. It is open not only to generalists, but all physicians.