FAT: What No One Is Telling You
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Meet the Characters: Dr. America Bracho
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Dr. Amanda Bracho

Dr. America Bracho is the Executive Director of Latino Health Access, a center for health promotion and disease prevention located in Santa Ana, California. This organization was created under her leadership to assist with the multiple health needs of Latinos in Orange County. Latino Health Access facilitates mechanisms of empowerment for the Latino community and uses participatory approaches to community health education. The programs train citizens as community health workers to become leaders of wellness and change. America worked as a physician in her native Venezuela, before coming to the U.S. to obtain a master's degree in Public Health at the University of Michigan. Her public health specialty is Health Education and Health Behavior.

Watch Dr. America Bracho in FAT: What No One Is Telling you


Describe the community of Santa Ana.
Santa Ana is a beautiful city with 350,000 people, with 90% of kids in the schools speaking Spanish at home. It's just a large city with pockets of misery, with pockets of misery and places where places that don't get the attention of the officials and the people that have power and resources. (Many Santa Ana) people work other cities and sustain the economy of Orange County, but (these workers) are not offered the possibility of living in a decent way. They work in, let's say Juan Capisono or Mission Viejo, or they work in Disneyland. You are talking about cities in Orange County where you are poor if you make less than $40,000! And we are talking about people that make $17,000-$20,000 per year. So they can not afford a rent of $1,500 for a two-bedroom apartment. They have to rent an apartment with other families and live in very overcrowded neighborhoods. And these neighborhoods are not designed for people to be healthy.

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Can you remember when you first became concerned about obesity in your community?
We started working on diabetes with adults 13 years ago in Santa Ana. Because we were the only group working on diabetes in Latinos (at that time), we started receiving phone calls from Children's Hospital and from local providers, asking "Do you also have training and services for kids with Diabetes Type 2?" We didn't; there are only so few (pediatric) cases.

Then we learned that were more and more (pediatric diabetes cases) every month. We saw that the majority of these kids were very overweight, and we started trying to alert families about how obesity was making our kids develop diabetes, and it was something that could be prevented. Parents were very unaware of the signs (of diabetes). They were not aware of how obesity was impacting their kids, and so we started doing outreach and working with the Children's Hospital and providers.

It was just amazing; the problem was already so out of hand. There was nothing for these kids. We realized that there wasn't a single program that could address the issue of obesity in a way that could be effective. So we decided to start and try to learn, you know?

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What inspires your commitment to obesity prevention activism?
I think that what really sparks my activism in obesity is the experience that I have in public health where I have learned that medical approaches to systemic issues will not solve anything. I worked in mobile HIV, and I know what happened, painfully I know what happened, when you only focus on condoms, knowing that the HIV epidemic has so many complicated situations underlying it.

So what really inspires my activism is that I know the obesity epidemic will not be stopped by teaching people only one thing, or by telling people only one thing, or by preaching about TV or by preaching about food only. We do a comprehensive intervention. You have to be really active in fighting this.

I am not only advocating for kids. When you talk about kids, then everybody goes along. But it's kids, or adults, it's people that want to live a full life and deserve to live in healthy environments, and will not live in healthy environments unless we do something about it.

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What is it about this community that makes it particularly vulnerable to obesity?
This community has a lot in common with the general (population) in terms of vulnerability to obesity, so let's talk about that to start. In terms of being bombarded by TV, all kids in the nation are bombarded. In terms of being sedentary, all kids in the nation are sedentary. In terms of being glued to electronic games, all kids in the nation are. In terms of not having the parents at home, maybe many of the kids in the nation don't, either.

So what is the difference? The difference is that in many families that are affluent, maybe not parents, but someone is watching the kids. If the kids get overweight, they might get to go to a gym. They might go to a school where they have physical activity. They might have more resources to fight this epidemic. Our kids have these same behaviors: they are eating a lot of junk; they are watching TV. But the schools don't have a lot of programs, and PE doesn't exist. They don't have parks and safe places to walk. They live in very unsafe streets or neighborhoods, and they cannot even go out. The parents need to work two or three jobs in order to pay rent. So the difference is that the opportunity for prevention (in Santa Ana) is minimal, and the opportunity for action is reduced. There is not an organized voice. There is not an organized power.

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What kinds of problems do kids face as they get older if we don't prevent or control obesity?
Emotionally, they are going to face issues of rejection. These kids feel horrible, that they don't have respect, and that they are a stereotype that people judge all the time.

Physically, (obese kids) end up with major problems in their bones and their knees and their legs because the body has been designed to support a certain weight. More than that will start damaging the structure of the body. The fat also affects your organs: your liver, your kidneys, your arteries, your heart. So what we are going to be seeing--and it breaks my heart to even think about this--but we will see kids developing diabetes at a very early age. The complications from diabetes include blindness, which they might develop at 25, 30. These kids are going to be amputated as very young adults.

A majority of people in this very vulnerable community do not have health insurance, and there is not a government policy for early intervention and education. So we're going to have a very large population of people with chronic diseases without support. And this is extremely expensive not only for them, but for the nation.

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As a public health advocate, can you explain why obesity is a problem for the whole country?
If we have a very large number of people with chronic conditions, this will affect the entire country. I don't think that we want to live in a society where kids are sick and bitter, and young adults cannot be productive, where the system is overburdened, where people are dying of heart attacks at a very early age, where an entire generation will disappear earlier than what they should.

This will be an extremely deep burden financially for the health system, and for the nation. Congress will need to pay attention to this. Money needs to be placed to support agendas to reverse (obesity). If we don't support this, we will have to spend the money anyway to deal with the tremendous burden of chronic diseases.

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What have you learned through your outreach in Santa Ana that could be applied nationwide?
We have learned that the work that we do is at all levels. We believe that this epidemic is individuals' responsibility. We do believe in that. Individuals need to learn about nutrition and fitness and junk food and how to discipline their kids. So we have to do that level. This is your immediate level.

There's also an environmental level to our work, with the lack of parks, and the schools are not serving the appropriate food. There is an emotional or psychological level that is the family component, where the parents and kids are not connected because the parents come home late and the kids are alone all day. There is then the political level in which you need to advocate at the local level, at the state level, and at the national level. We have rights and we need to organize the voice of our community, and the mayor needs to know this, and we need to work with the recreation department and with the schools.

So with that said, what have we learned? We actually have learned that individuals, once they've received a certain level of information and have the skills and the support--they do engage in change. They do. But instead of doing six classes and disappearing from their lives, we follow up on the phone. We visit families and they tell us, "Thank you for visiting me because I really was not even paying attention to this. Every time you call me I remember to wake up, because this is serious for my kids." It's a lot of trust building. We have a community where the social network and the social support is almost non-existent. We really need to build that network.

The other part is that we have learned that if we preach good nutrition, and we preach exercise, we need to facilitate. We need to create the mechanisms for people to actually do it. So we partner with families to find a place (to exercise). It might be a warehouse, or it might be the backyard of a neighbor that has a very good heart, or it might be an open space within a church. When we appeal to the goodwill of people--guess what? People actually come up with ideas, they offer their property.

We have learned that we need to make sense with our requests and our analysis, and we need to support our political representatives so they can represent us. They have that role. Collaboration is very hard because you have to deal with people's personalities. That is the most difficult part of our work, is to deal with the personalities, including our own! It's easier to, say, give away brochures, because you don't have to deal with the personality of that politician. But to sit down, to negotiate, to articulate in a consistent way, that is difficult. But so necessary.

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So what kinds of things do you do with your parents and kids?
(We have) classes in which, in a very respectful way, we put kids on one side and parents on the other side, and we talk with them about the real concerns that they have. We not only teach them about good food and exercise, but we talk to them about discipline and frustrations and real ideas that they can use to improve their kids' lives. And believe me, these parents talk about safety and gangs, and how they are very concerned about their kids going out without supervision. They prefer (their children) to be inside the house. So together we come up with ideas to help them with these problems. We also have a psychologist that meets with them to deal with issues of discipline and power and violence or whatever is the issue.

We also talk about political involvement and civic engagement, and we create mechanisms in which these parents can participate and advocate and meet their political representatives. So we work these parents from many, many fronts, and we are creating a co-op of parents that work with other parents and can share what they have learned, they can support each other, they can even drive each other to classes. So at the very local level we are trying to do our best to engage parents at a deeper level.

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Sociologists define "food deserts" as neighborhoods where larger grocery stores don't exist, so fresh, healthful food is difficult to find. Is this true in your community?
This is not the case of Santa Ana, but it is the case of many neighborhoods, where many people can't get fresh fruit and vegetables because the stores that could sell these choose not to be in the neighborhood. And the stores that choose to be in the neighborhood assume that these are not items that people want to buy. So they have just oil and sugar and doughnuts and probably a very old apple if you are lucky.

There are things that also communities can do about it, but they also need to collaborate and exercise some pressure on political representatives. And if you have a store that is not serving (fresh food), you should meet with your city council members and talk about tax breaks for stores that sell fresh fruit and vegetables. We need to also increase the awareness of the people in the neighborhood so they want to buy (fresh foods). Otherwise these store owners say, "You know, you are asking me to sell these foods and people don't buy them."

It is a matter of understanding that as an individual in a community, you have a lot of power. As an individual, you can mobilize an entire city. The store that is not selling you fresh fruits and vegetables and good food is still there making money out of you, and you decide if you want to buy there.

In Oakland, for example, they created a Farmer's Market. Oakland was one of those places where people couldn't buy fresh food at all. It started with a group that got organized and got together with the health department and the city council and more and more neighbors until they got it. So there are many stories of success.

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What advice do you have for other individuals or community groups who would like to initiate a similar civic health venture?
I would be more than open to be in touch with them. They can send us an email, they can call us. People see our program and they find this very helpful. You live in a town or a city, and you know your community, you know your players there. You have some ideas of what you want to do, and a talk or visit (with us) can help you see your ideas in a more clear way.

As far as advice, there are two things to remember (as you create your local health venture). First, don't address complex issues with very simple solutions. The reason why we are having this problem with obesity is because we didn't pay attention to a lot of things that have been happening for years. When we started eliminating programs in the schools like music, PE, art, and all of that--we knew we were going to have problems with kids that are not being helped to develop to their full capacity. When we started not giving priority to affordable housing for low and middle class in America, we knew that these neighborhoods were going to be created. We have known about classism and racism and inner city poverty for years, but we are not paying attention. Obesity is related to all of this. We really need to pay attention to the other issues--again, the lack of parks and the basic rights of these children and families. We need to be more comprehensive and to advocate.

And the second thing that I want to repeat is that we can recommend that people eat better and exercise more, but one of the most important things for your health is to participate. When you participate, when you decide that you are going to become one voice to push for common sense and for the rights of other folks in this country, you are actually are improving your health, your emotional health, your spiritual health, and your physical health. So participation should be a key part of our prescription.

For more information about America's organization or to start action in your community, visit

Latino Health Access: www.latinohealthaccess.org/

Public Citizen: www.citizen.org/hrg/activistcour

Center for Disease Control and Prevention: www.cdc.gov/nccdphp/dnpa/obesity/

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