No Come Nada

In this article, a Mexican American pediatrician practising in California, USA explores the issue of physician-patient/parent communication around childhood obesity. Based on his experience, he argues that sincerity, empathy, and "cultural competence" in the area of healthcare communication are not always adequate to support healthy patient outcomes.

Specifically, Dr. Garcia begins by providing this introduction: "The child 'doesn't eat anything' is the literal translation of no come nada but is not what the Mexican mother of an obese toddler really means when she presents this complaint. Deciphering the code of Mexican culture in present-day California, I think the mother means that the child doesn't eat as much as Mama would like him to - that he doesn't eat as much as he did when he was a hungry, rapidly growing, normal infant. I hear this chief medical complaint over and over again each day in the Los Angeles pediatric clinic where I treat mostly Hispanic children...Each of these patients at morning clinic falls within the normal or higher range for weight; all are healthy. But the parents want me to stimulate their child's hunger. They want me to provide them with proof that their alarm about their child's "poor appetite" is valid."

Dr. Garcia explains that, while he is certain that Hispanic parents do not want their children to become adults who suffer with the diabetes, heart disease, and hypertension associated with obesity in childhood, the view that overweight babies are healthier babies is culturally embedded - and difficult (even for an empathetic physician who understands and shares this cultural background) to challenge.

The author acknowledges that US government efforts to provide more healthful school cafeteria meals and more exercise for elementary and middle schoolers are steps in the right direction. However, he wonders how the message that overfed children are not healthy children can be communicated to Mexican American parents. He urges that "The American problem of childhood obesity, which is so pronounced among my Hispanic patients, requires the full attention of private and public health care professionals and the agencies charged with education and health. It calls for a shift in the greater American culture itself." That is, Garcia suggests that physicians should not be expected to - they cannot - accomplish broad changes in attitudes on a one-on-one, physician-to-patient basis. Rather, public education, enforcement, and new cultural attitudes - perhaps accomplished through mass media campaigns - are needed to reshape the cultural attitudes that may contribute to the problem of childhood obesity in the United States.

Click here to access a related peer-reviewed summary on the Health e Communication website, and to participate in peer review.

Click here for the full article in HTML format; click here to access it in PDF format.

Source

Health Affairs: The Policy Journal of the Health Sphere, Vol. 23, No. 2, March/April 2004. Project HOPE - The People-to-People Health Foundation, Inc. Pages 215-219. Notice sent from Pan American Health Organization to The Communication Initiative on March 15 2004.