SOUTH BRONX, New York (WOMENSENEWS)--With diamond-shaped yellow signs screaming "Save More!" in Spanish and English, the Bravo supermarket here might not seem like the kind of place to think about nutrition.
With its large supply of packaged products and small fresh-produce section in the front, it could be considered a typical outpost of an inner-city "food desert." A place to avoid, in other words, it you're trying to shop for foods that might lower the high rates of obesity and diabetes in this heavily Hispanic part of New York.
One store shopper, Diana Perez, said the produce wasn't as good as other grocery stores in the city. "But when you can't get there, this is where we have to go," she said. "It's what you put out is what we're going to buy."
But Bravo offers something that nutritional counselors call a key ingredient for discussing healthy eating with Hispanic shoppers: familiar foods. This Bravo stocks foods such as tomatillos and malangas and has an aisle filled with Goya products.
"Outreach to Hispanic and immigrant communities has to include their cultural ideas of what food is," said Andrew Rundle, an associate professor of epidemiology at Columbia University.
Rundle and other researchers released a study last year showing that low-income immigrant Hispanic women in New York City, like those in the organic and local food movements, prefer farm-to-table foods.
They defined "healthy food" by its freshness, whether it was locally grown and if it lacked preservatives or was processed, and consumed more fruit, vegetables and juice when there was a farmers' market within the neighborhood.
Health experts say that working with such cultural preferences can help combat obesity and related risks such as diabetes.
That's a priority for Hispanic women, who had the highest rate of the disease among demographic groups in a survey released in 2009 by the New York City Department of Health and Mental Hygiene. Hispanic women's rate of diabetes was 14.5 percent compared with 11.4 percent for male counterparts. Their obesity rate--at 28 percent--was high relative to many other groups in the city and exceeded the 23-percent rate of male counterparts.
Creative Outreach Efforts
In the absence of any concerted effort targeting immigrant and different ethnic groups, various organizations and individuals are developing their own outreach efforts.
Lorena Drago, a dietitian and certified diabetes educator, spearheaded a grocery store tour last year for Hispanics on Long Island to talk about healthy shopping.
Since most of the participants were from Central America, her shopping list included root vegetables such as taro, cassava and Caribbean yams, as well as plantains, pork rinds and creams widely used in the region. Each food was accompanied with a graphic, since one food can have varying names in the Hispanic community.
Drago said that direct translations of generic nutrition materials, while common, aren't enough.
"The information may be linguistically Spanish but it doesn't mean it's culturally specific," she said.
Drago added that she's learned that healthy eating isn't an easy concept to teach or apply in one's life.
"The [nutrition] message needs to be a bit more uniform, it needs to be heard from many venues and it needs to be done in a way so that it's not the person who fits the tool, but the tool that fits the person," she said. "You don't get good at this by hearing the message once or getting a pamphlet."
Poverty and Health Disparities
Poverty often goes hand-in-hand with health disparities. Low-income neighborhoods in the city, where many immigrants live, have a higher rate of both obesity and diabetes.
Christina McGeough, a certified diabetes educator who's worked as a bilingual nutritionist for almost 10 years, said many immigrants eat the same amount of food as in their home country but are less active once in the United States, while others give up traditional foods and switch to the many convenience and easy-to-access foods available here. This can increase waistlines, as well as the chance of developing diabetes.
"Lots of communities of immigrants live in low-income areas where there's less fresh fruits and vegetables available and more fast food," said McGeough.
In this setting, she said teaching nutrition demands a good understanding of the local population. "Once you know that, you can design a message that speaks to them," she said. "It's about creating tools that the cultural group you're working with can relate to. Often people create one-size-fits-all materials and it's not useful."
McGeough uses focused tactics with her patients at The Institute for Family Health in the Bronx. If her patient is West African, for instance, she may work with food options such as starchy cocoyam, cornmeal and cassava and protein-filled black-eyed peas, maafe and kitoza.
Healthy Cooking Basics
Late last year City Harvest, a non-profit organization that works to feed the city's population, conducted a six-week class on healthy cooking techniques, recipes and nutrition basics in the heavily Hispanic neighborhood around the Bravo supermarket.
City Harvest doesn't mold its healthy cooking classes around traditional ethnic diets. But its choice of venue--the Bronx Spanish Evangelical Church--offered a familiar setting to many in the class.
On one December afternoon about 30 participants--mostly women and girls--sat at tables covered in Christmas-themed plastic coverings. Under fluorescent lighting they listened to two volunteer nutritionists and a chef talk about how to chop the vegetables and fruit that lay in front of them on flimsy cutting boards.
That day's menu: veggie pizza on whole wheat English muffins and fruit and yogurt parfait. The instructions were translated into Spanish, as two-thirds of the class was Hispanic.
Instructors said they purchased ingredients at the Bravo supermarket, down the street, where Perez was shopping.
One of the class participants was Gladys Bonilla, who moved into the neighborhood from Honduras in 1985. While many of the recipes were different from the Honduran food she makes at home for her family, Bonilla said she's learned a lot about healthy eating. Bonilla, who has diabetes, said she's using less salt and oil in her cooking now and is eating less fried foods.
She heard about the cooking class when visiting the church's food pantry and soup kitchen. At first, one of her two granddaughters didn't want to go. Now the girls push her to attend the class weekly.
"I feel happy in this place," Bonilla said in Spanish through a translator. "I feel like part of the family here."