Dear DOCTOR Owen:

I am Hispanic, live in a Latino neighborhood, and am fat. My friends are also fat. In fact, almost everyone in my neighborhood is fat. I have four children—two of whom are still at home. I wonder if a genetic defect predisposes Hispanic people to obesity. I feel trapped inside my body and in my home.

Fatino Latino

Dear “Fatino”:

Yes. Men and women of Latin descent in the United States have a higher prevalence of obesity than other cultures living here. Not surprisingly, they also have three times the risk of developing diabetes, high blood pressure, and central body fat. These findings are similar to those of African Americans. Many Latinos have a Native American genetic heritage, which is associated with a high rate of diabetes.

Researchers at San Diego State University, in the heart of the U.S. Latino culture, have studied these and other findings in Proyecto Familia Sana, an exercise intervention study that focuses on Latino women (Latinas).

Findings of the study revealed two major differences between Latinos and Caucasians: a higher consumption of soft drinks (cola) and decreased exercise (both behaviors can be changed). While Latinas had half the rate of vigorous exercise as Caucasians, they were more active in two areas: walking and playing with their children. Caucasian women were more likely to walk for exercise whereas Latinas usually walked out of necessity. (Forty-nine percent of Latinos had their own cars compared to 97% of Caucasians.) Latinas usually had highly valued playtime with their children built into their days.

All socioeconomically deprived cultures are becoming obese in the developing countries. “Fatness” is clearly related to poverty—which is kind of paradoxical to the traditional thinking of the “starving children in China.”

Barriers to physical activity to Latinas were significantly different than those for Caucasians. More than 25% of all U.S. Latinos lived below the poverty level. Caucasian women listed “lack of time” as their primary barrier to physical activity. Latinas’ barriers, on the other hand, were lower education levels, minimal access to exercise facilities (especially in the poorer areas), and other socioeconomic obstacles. Latinas were less likely to live in attractive, safe areas for walking nor did they have dogs to walk. Even access to free community-based programs was less in Latino areas compared to Caucasian or African American neighborhoods. Furthermore, few exercise clubs were bilingual.

Leaving children with paid babysitters was an unfamiliar concept to many Latinas. Even when affordable, they preferred to take their children everywhere. Most gyms did not have childcare areas. Motherhood itself is a barrier to exercise in all cultures. It was no surprise, therefore, that Latino men often did not consider childcare their responsibility, and had a low level of programmed activity for themselves. Let’s face it: Who wants to work out in the gym after a long day of physical labor? This is much more likely in Latino populations.

Indeed, most Latino neighborhoods lacked affordable transportation. Exercise in a gym was considered an “elitist” activity, with physical activity frowned upon subtly in the friendship circles. One Latina stated: “Exercise is an activity for rich people who have nothing better to do.” Most of those surveyed had no familiarity with the benefits, health-wise and other, of exercise. Misconceptions included a belief that high pulse rate could cause a heart attack. According to the study, few Latinos were aware that exercise has health benefits; most of them thought that people exercise for appearance’s sake. While aerobics is a favorite activity due to the cultural importance of dance, few home exercise videos are in Spanish.

Pools are rare in Latino neighborhoods, and most of the residents did not know how to swim.

The study identified that attitudes, too, were barriers. For example, many Latinas rated high on “shyness”: It was a common belief that older people should not exercise in public. (Even menstruation was considered a barrier because of Latinas’ unfamiliarity with using tampons.)

Despite these daunting obstacles, many Latinas are nonetheless very interested in exercise and are eager to learn weight-management skills. Most said that they would exercise if only they were able to do so, and expressed a strong interest in good instruction. It will be a challenge for the medical, childcare, government, and fitness business communities to promote exercise among the poorer socioeconomic cultures.

This study of one subculture points to the complications involved in weight management. Yet it is vitally important to deal with, and solve, these problems. Healthcare costs for the poor contribute to high taxes and high health insurance premiums. Educating the poor and mainstreaming into American culture will decrease crime, social isolation, and prejudice—which, in turn, will lower law enforcement costs.

children and adults alike, could use more dancing and hugging.