Toward a cultural adaptation of eating disorders treatment for Latinos in United States / Hacia una adaptación cultural del tratamiento de trastornos alimentarios para latinos residentes en Estados Unidos

 Abstract. Eating disorders affect all ethnic and socioeconomic groups. However, currently available assessment instruments, which were developed and validated for exclusively Caucasian populations. With the purpose to develop a culturally sensitive framework for the eating disorders treatment in Latinos/as, the objectives of this work were: 1) identify and describe some of the relevant cultural elements for eating disorders in the Latino population and, 2) to draft a culturally sensitive intervention model for eating disorders in Latino population in the United States. Providing culturally sensitive treatments for Latinos with psychiatric disorders is essential to reverse public health disparities.Key words: Cultural adaptation, Latinos, treatment, eating disorders Resumen. Los trastornos de la conducta alimentaria (TCA) ocurren en todos los grupos étnicos y niveles socioeconómicos. Sin embargo, los tratamientos basados en la evidencia para los TCA han sido desarrollados mayormente para la población caucásica. Con el propósito de desarrollar un modelo de intervención culturalmente sensible, los objetivos de este trabajo fueron: 1) identificar y describir algunos de los elementos culturales pertinentes al tratamiento de los TCA en la población latina y, 2) esbozar un modelo de intervención para los TCA que sea culturalmente  sensible a la población latina de  los Estados Unidos. El desarrollo de intervenciones culturalmente sensibles es un componente importante para reducir la disparidad en los servicios de salud brindados a la población latina residente en los Estados Unidos. Palabras claves: Adaptación cultural, latinos, tratamiento, trastornos alimentarios

“Las penas con pan duelen menos”: The role of food and culture in Latinas with disordered eating behaviors

This study elucidated the experiences of eighteen Latina adults (mean age = 38.5 years) from “Promoviendo una Alimentación Saludable” Project who received nutritional intervention as part of the clinical trial. Half of the participants were first generation immigrants from Mexico (50%), followed by U.S. born with 16.7%. Remaining nationalities represented were Bolivia, Colombia, Guatemala, Honduras, Peru, and Venezuela with 33.3% combined. The average duration of living in the U.S. was 11.1 years. The mean body mass index (BMI) at baseline was 36.59 kg/m2 (SD=7.72). Based on the DSM-IV, 28% (n=5) participants were diagnosed with binge-eating disorder, 33% (n=6) with bulimia nervosa purging type and 39% (n=7) with eating disorder not otherwise specified. Participants received up to three nutritional sessions; a bilingual dietitian conducted 97.8% of sessions in Spanish. In total, fifty nutritional sessions were included in the qualitative analysis. A three step qualitative analysis was conducted. First, a bilingual research team documented each topic discussed by patients and all interventions conducted by the dietitian. Second, all topics were classified into specific categories and the frequency was documented. Third, a consensus with the dietitian was performed to validate the categories identified by the research team. Six categories (describing eating patterns, emotional distress, Latino culture values, family conflicts associated with disturbed eating behaviors, lack of knowledge of healthy eating, and treatment progress) emerged from patients across all nutritional sessions. Considering the background of immigration and trauma (60%, n=15) in this sample; the appropriate steps of nutritional intervention appear to be: 1) elucidating the connection between food and emotional distress, 2) providing psychoeducation of healthy eating patterns using the plate method, and 3) developing a meal plan

Race, Ethnicity, and Eating Disorder Recognition by Peers

We investigated racial/ethnic stereotyping in the recognition and referral of eating disorders with 663 university students. We explored responses to problem and eating disorder recognition, and health care referral after reading a vignette concerning a patient of different race/ethnic background presenting with eating disorders. A series of three 4 × 3 ANOVAs revealed significant main effects for eating disorder across all three outcome variables. There were no significant main effects across the four different race/ethnicity conditions and no significant race by condition interactions. Lack of general eating disorder recognition and health care referral by student participants were found

Eating Disorders, Trauma, PTSD, and Psychosocial Resources

The frequency of traumatic events and comorbid post-traumatic stress disorder (PTSD) in women with eating disorders (EDs) was assessed. Also, patients with anorexia nervosa (AN) and bulimia nervosa (BN) were compared with regard to post-traumatic symptomatology and the role of psychosocial resources was analyzed. 103 ED patients (29.1±10.5 years) were studied through the use of standardized questionnaires. 23.1% of AN and 25.5% of BN patients fulfilled the study definition for a current diagnosis of PTSD. Cumulative traumatization led to more severe symptomatology. Psychosocial resources were found to have strong associations with symptomatology. These findings provide additional support for the association between traumatization and ED. Clinical interventions for traumatized ED patients may benefit from a focus on post-traumatic stress symptomatology and personal resources

Promoviendo una Alimentación Saludable (PAS) design and methods: Engaging Latino families in eating disorder treatment

The use of culturally sensitive intervention could improve mental health care for the eating disorders treatment in the Latino population. The aim of this report is to describe the rationale, design, and methods of the ongoing study entitled “Engaging Latino families in eating disorders treatment.” The primary aim of the study is to compare (a) the combined effect of individual cognitive behavioral therapy for bulimia nervosa (CBT-BN) that has been previously adapted for the Latino population plus Family Enhanced (FE) modules, with (b) the standard adapted individual CBT-BN in a proof-of-principle study with 40 Latina adults with eating disorders and one relative or significant other per patient. We hypothesize that 1) the feasibility, acceptability, and adherence of participants in CBT-BN+ FE will be superior to individual CBT-BN only; 2) relatives in CBT-BN+ FE will report greater treatment satisfaction, greater reduction in family conflict, and greater decreases in caregiver burden than relatives in the individual CBT-BN only condition; and 3) patients who participate in CBT-BN+ FE will show trends towards greater decreases in ED symptoms compared with patients in CBT-BN only; although power will be limited to detect this difference. However, we predict that they will show greater retention in treatment, greater treatment satisfaction, and greater decreases in family conflict than patients in CBT-BN only. The completion of this investigation will yield important information regarding the acceptability and feasibility of a culturally sensitive evidence-based treatment model for Latinos with eating disorders. (Word Count=240

Diet and physical activity in women recovered from anorexia nervosa: A pilot study

After recovery, women with anorexia nervosa (AN) tend to maintain lower body mass indices (BMI) than women in the general population. Reasons for this are unknown as little is known about diet, food choices, physical activity levels (PAL), and reasons for exercise in women recovered from AN

Ethnic and racial differences in body size perception and satisfaction

Body dissatisfaction in women in the United States is common. We explored how women from various racial and ethnic groups used figural stimuli by exploring differences in current and preferred silhouette, and their discrepancy. We surveyed 4,023 women ages 25-45 in an on-line investigation. Participants were identified using a national quota-sampling procedure. Asian women chose a smaller silhouette to represent their current body size, which did not remain significant after adjusting for self-reported BMI. After controlling for BMI, African American women selected a smaller silhouette than White women to represent their current size. Both African American and women reporting “Other” race preferred larger silhouettes than White women even after controlling for BMI. The discrepancy score revealed lower body dissatisfaction among African American than White women. Understanding factors that promote body satisfaction differentially across racial and ethnic groups could become a tool in appropriately tailored interventions designed to prevent eating disorders

Depression symptoms and stressful life events among college students in Puerto Rico

The transition from adolescence to adulthood is associated with stressful adaptation experiences that may increase symptoms of depression. We explored the prevalence and sex differences of depressive symptoms and suicidal ideation in freshmen Latino college students in Puerto Rico, and identified stressful life events that could contribute to symptoms of depression

Collaborative Care for Depressed Patients With Chronic Medical Conditions: A Randomized Trial in Puerto Rico

This study examined whether a collaborative care model for depression would improve clinical and functional outcomes for depressed patients with chronic general medical conditions in primary care practices in Puerto Rico

A Description of Disordered Eating Behaviors in Latino Males

Objective: To explore disordered eating and eating disorders (EDs) in Latino males. Participants: Participants are 722 male college students from a larger prevalence study conducted in the University of Puerto Rico system. Methods: Participants were selected from a list of sections of required courses for first-year students on each campus. Self-report instruments were used to explore ED symptoms (the Eating Attitudes Test [EAT-26] and the Bulimia Test-Revised [BULIT-26-R] and the Beck Depression Inventory depression (BDI). Results: Overall, 2.26% scored above the cut-off point on the BULIT-R and 5.08% score above the cut-off point on the EAT-26. Of the males, 4.43% reported sufficient frequency and severity to approximate DSM-IV criteria for bulimia nervosa. Depression symptomatology was found in those who scored above the cut-off point on both instruments of EDs. Conclusion: College health practitioners should be aware of disordered eating in Latino males and include them in efforts to detect disordered eating behaviors in college students