Obesity in International Migrant Populations

"For me, it is for longevity and making sure I am fit and around for my children": exploring motivations and barriers for weight management among minoritised communities in Medway, England

BACKGROUND

Migration-related changes in dietary patterns and other structural and individual factors affect weight-related health practices of individuals migrating from low-and-middle-income to high-income countries. Thus, individuals of ethnically diverse backgrounds may be disproportionately affected by poorer health outcomes, including weight-related health issues. Understanding how this community could be supported to adopt weight-related healthy practices such as optimum dietary and exercise behaviour is an important issue for public health research. Against this backdrop, we explored structural and individual factors that facilitate and constrain the uptake of weight management services among members of minority ethnic communities in Medway, England.

METHODS

Data were collected from audio-recorded interviews with 12 adult community members from minoritised ethnic communities using a semi-structured interview guide. Participants were recruited through a purposive and convenient sampling technique. Generated data were transcribed, coded into NVivo and analysed using the reflexive thematic analytical technique.

RESULTS

Results showed that social support and health benefits of weight management were the main motivating factors for weight management among the study participants. Conversely, systemic barriers, family commitment and caring responsibilities, changes in dietary patterns post-migration and cultural norms were major factors constraining participants from adopting weight management behaviours.

CONCLUSION

The results of this study indicate that structural and person-level factors serve as both facilitators and barriers to weight management among ethnically diverse communities in Medway, England. While our study is exploratory and opens doors for more studies among the population, we conclude that these minoritised communities could benefit from more equitable, tailored weight management programmes to support them in adopting weight-related practices.

Use of Adolescent "Community Researchers" to Address Obesity Among Mexican Immigrant Families

Background: Mexican-American immigrants have a disparate prevalence of overweight/obesity, and obesogenic illness. One approach is to train immigrant adolescents as "community researchers." Aims: (1) Design a program to train community researchers to address obesity among Mexican immigrant families and (2) identify the key components of a successful program. Methods: The content included an overview of community research/citizen science; obesity and food insecurity; study design and data collection and analysis for nutrition and physical activity. The students concluded by analyzing the results of group concept mapping (GCM) activities. Results: Post-session class discussions reflected an increased understanding of weekly topics. Analysis of GCM data suggests that members of the Mexican immigrant community may use emotional eating as a way to manage structural stigma, eventually leading to truncal obesity, T2DM and increased cardiovascular risk. Conclusions: Adolescents of Mexican heritage can have a major impact in promoting healthy lifestyles in their communities.

The influence of immigrant background and parental education on overweight and obesity in 8-year-old children in Norway

BACKGROUND

Little is known about the prevalence of overweight/obesity and socio-economic position (SEP) in children with immigrant background in Scandinavia. The purpose of this study is to examine the prevalence of overweight/obesity by immigrant background among children in Norway and to explore the role of SEP in explaining differences in weight status.

METHODS

Anthropometric data from 8,858 children (age 8.3 years) from the population-based Norwegian Childhood Growth Study were used. Information about immigrant background, country of origin, and parental education (used as an indicator of SEP) were provided by Statistics Norway. For children with immigrant background, regional background was determined based on country of origin. Prevalence ratios (PR) were estimated for overweight/obesity and weight-to-height-ratio (WHtR) ≥ 0.5 by immigration and regional background, using generalized estimating equation log-binominal models adjusting for sex, age, survey year (model 1), residential area, population density (model 2) and parental education (model 3).

RESULTS

Children with immigrant background had a higher prevalence of overweight/obesity and WHtR ≥ 0.5 than non-immigrant background children. Adjusted for parental education, children with an immigrant background from Southern and Eastern Europe, Asia except South-Asia, and Africa had a higher prevalence of overweight/obesity [PR: 1.37 (95% confidence interval (CI): 1.10-1.72), 1.28 (1.05-1.57), 1.47 (1.13-1.91), respectively] than children with a non-immigrant background. Children originating from Asia except South-Asia had a higher prevalence of WHtR ≥ 0.5 (PR: 1.64, CI: 1.25-2.15) compared to non-immigrant background children. The adjustment for parental education did not substantially change the results.

CONCLUSION

Children with immigrant background had higher prevalence of overweight/obesity than non-immigrant background children. The difference varied according to region of origin but not substantially according to parental education. There is a need for culturally acceptable preventative measures targeting the parents of immigrant background children.

Community Solutions to Increase the Healthfulness of Grocery Stores: Perspectives of Immigrant Parents

Grocery store environments are recognized as one of the most crucial community settings for developing and maintaining healthy nutritional behaviors in children. This is especially true for disadvantaged ethnic minority families, such as immigrants, who reside in the Detroit Metropolitan area and have historically experienced inequities that result in poor health outcomes. Rates of obesity and type II diabetes have affected Detroit 38% more than the rest of the state and nationwide. In 2019, almost 54% of children aged 0-17 in Metro Detroit lived in poverty, and 21.6% experienced food insecurity, compared with the state level of 14.2%. Moreover, nearly 50% of ethnic minority children in Metro Detroit consume sports drinks, and 70% consume soda or pop in an average week. The primary purpose of this study was to explore immigrant parents' perspectives on (1) how in-store Sugar-Sweetened Beverage (SSB) marketing impacts the purchasing behaviors of parents and the eating behaviors of toddlers, and the secondary objective was to (2) determine strategies to reduce SSB purchases and consumption within grocery environments from the viewpoints of immigrant parents. A qualitative multiple-case study design was used to achieve the aims of this study. Semi-structured individual interviews were completed with 18 immigrant parents of children aged 2 to 5 years old who were consumers in 30 independently owned full-service grocery stores within the immigrant enclaves of Detroit, Dearborn, Hamtramck, and Warren, Michigan. Three key thematic categories emerged from the parents' narratives. These themes were: (1) non-supportive grocery store environments; (2) acculturation to the American food environment; and (3) strategies to support reduced SSB consumption among young immigrant children. The findings of this study revealed widespread SSB marketing targeting toddlers within the participating independently owned grocery stores. Even if families with young children practiced healthy nutritional behaviors, the prices, placements, and promotion of SSBs were challenges to establishing and sustaining these healthy eating habits. The parents believed that planning and implementing retail-based strategies in collaboration with families and considering families' actual demands would assist in managing children's eating patterns and reducing early childhood obesity.

Obesity in Refugees post-resettlement in a high-income country: a meta-analysis

BACKGROUND

Refugees have a high prevalence of obesity post resettlement, but few studies have compared their risk of obesity to those of the host population. We systematically investigated the association between refugee status and obesity after resettlement in a high-income nation.

METHODS

We searched PubMed, Embase, OpenGrey and bibliographies of retrieved articles, with no date, location, and language restrictions, for observational studies assessing obesity rates in resettled refugees compared to the host population.

RESULTS

Nine studies were analyzed. We found no evidence of increased risk of obesity among refugees compared to the host population, with significant heterogeneity across studies. However, the risk of obesity among refugee men were significantly lower than the host population.

DISCUSSION

The heterogeneity between studies calls for more high-quality research to examine the risk of obesity among refugees compared to the host population in high-income countries. This will enable results to be pooled to provide more decisive evidence about obesity trends among refugees post migration in a high-income nation.

Obesity Stigma: Causes, Consequences, and Potential Solutions

PURPOSE OF REVIEW

This review aims to examine (i) the aetiology of obesity; (ii) how and why a perception of personal responsibility for obesity so dominantly frames this condition and how this mindset leads to stigma; (iii) the consequences of obesity stigma for people living with obesity, and for the public support for interventions to prevent and manage this condition; and (iv) potential strategies to diminish our focus on personal responsibility for the development of obesity, to enable a reduction of obesity stigma, and to move towards effective interventions to prevent and manage obesity within the population.

RECENT FINDINGS

We summarise literature which shows that obesity stems from a complex interplay of genetic and environment factors most of which are outside an individual's control. Despite this, evidence of obesity stigmatisation remains abundant throughout areas of media, entertainment, social media and the internet, advertising, news outlets, and the political and public health landscape. This has damaging consequences including psychological, physical, and socioeconomic harm. Obesity stigma does not prevent obesity. A combined, concerted, and sustained effort from multiple stakeholders and key decision-makers within society is required to dispel myths around personal responsibility for body weight, and to foster more empathy for people living in larger bodies. This also sets the scene for more effective policies and interventions, targeting the social and environmental drivers of health, to ultimately improve population health.

Modifiable Risk Factors for Dementia Among Migrants, Refugees and Asylum Seekers in Australia: A Systematic Review

While the prevalence of non-communicable disease risk factors is understood to be higher among migrants than for people born in host nations, little is known about the dementia risk profile of migrants, refugees and asylum seekers. This systematic review examines published literature to understand what is currently reported about 12 identified modifiable risk factors for dementia among migrants, refugees, and asylum seekers residing in Australia. Three literature databases (PubMed/CINAHL/MEDLINE) were systematically searched to find articles reporting excessive alcohol consumption, traumatic brain injury, air pollution, lack of education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and limited social contact in Australia's migrant, refugee and asylum seeker population samples. Papers were systematically reviewed following PRISMA guidelines. A total of 763 studies were found, of which 676 articles were excluded, and 79 articles remained. Despite wide variability in study design, size and purpose, the prevalence and correlates of modifiable risk factors of dementia appears markedly different among the studied samples. Compared with Australian-born participants, migrant samples had a higher prevalence of depression, social isolation, physical inactivity and diabetes mellitus. Insufficient information or conflicting evidence prevented inference about prevalence and correlates for the remaining dementia risk factors. A better understanding of the prevalence and correlates of modifiable dementia risk factors is needed in Australia's migrant, refugee and asylum seeker populations. This information, together with a deeper understanding of the contextual and cultural contributing factors affecting people who arrive in Australia through differing pathways is needed before preventive interventions can be realistically targeted and sensitively implemented.

A systematic review of the burden of, access to services for and perceptions of patients with overweight and obesity, in humanitarian crisis settings

INTRODUCTION

Excess body weight causes 4 million deaths annually across the world. The number of people affected by humanitarian crises stands at a record high level with 1 in 95 people being forcibly displaced. These epidemics overlap. Addressing obesity is a post-acute phase activity in non-communicable disease management in humanitarian settings. Information is needed to inform guidelines and timing of interventions. The objective of this review was to explore the prevalence of overweight and obesity in populations directly affected by humanitarian crises; the cascade of care in these populations and perceptions of patients with overweight and obesity.

METHODS

Literature searches were carried out in five databases. Grey literature was identified. The population of interest was non-pregnant, civilian adults who had experience of humanitarian crises (armed conflict, complex emergencies and natural disasters). All study types published from January 1st, 2011, were included. Screening, data extraction and quality appraisal were carried out in duplicate. A narrative synthesis is presented.

RESULTS

Fifty-six reports from forty-five studies were included. Prevalence estimates varied widely across the studies and by subgroups. Estimates of overweight and obesity combined ranged from 6.4% to 82.8%. Studies were heterogenous. Global distribution was skewed. Increasing adiposity was seen over time, in older adults and in women. Only six studies were at low risk of bias. Body mass index was the predominant measure used. There were no studies reporting cascade of care. No qualitative studies were identified.

CONCLUSION

Overweight and obesity varied in crisis affected populations but were rarely absent. Improved reporting of existing data could provide more accurate estimates. Worsening obesity may be prevented by acting earlier in long-term crises and targeting risk groups. The use of waist circumference would provide useful additional information. Gaps remain in understanding the existing cascade of care. Cultural norms around diet and ideal body size vary.

Cardiometabolic Profile and Outcomes in Migrant Populations: A Review of Comparative Evidence from Migrants in Europe in Relation to Their Country of Origin

BACKGROUND

The potential effect of migration on increasing cardiometabolic risk factors remains partially understood. We aim to synthesize the evidence comparing the burden of diabetes and adiposity of migrating populations in Europe, with that of their country of origin.

METHODS

We conducted a scoping literature review. We searched PubMed for studies investigating the effect of migration on diabetes or adiposity outcomes among migrants in countries from the European Union or the United Kingdom compared to the population in the country of origin. Studies were qualitatively synthesized in evidence tables and the demographic characteristics, study design, risk factors investigated, and outcomes were quantitatively summarized using measures of central tendency.

FINDINGS

Of 1175 abstracts retrieved, 28 studies were eligible. Most of the studies included migrating populations residing in Western (50%), Northern (39%), and Southern Europe (11%) originating from countries in Africa (46%), Asia (29%), or European overseas (25%) regions of which 85% were classified as low-middle-income countries. Most of the studies (93%) had a cross-sectional design. The median number of individuals in the country of origin was greater [917; IQR: 231-1378] than in the receiving country [249; 150-883]. Thirty-five percent of the studies investigated migration as an independent risk factor, whereas 28% contextualized migration into lifestyle changes. The majority of the studies (57%) reported both diabetes and adiposity outcomes. Within the limited evidence available, controversial results were found as some studies showed poorer outcomes for the migrating populations, while others showed the opposite.

CONCLUSION

Studies assessing the impact of migration by comparing migrating populations and the population of origin on diabetes and adiposity outcomes have gained interest. So far, the available evidence is highly heterogeneous to inform public health strategies in the receiving countries. We recommend further research including a more robust methodology and in-depth characterization of the migrant populations.

Nutritional and health status of adult Syrian refugees in the early years of asylum in Germany: a cross-sectional pilot study

BACKGROUND

Migration is usually accompanied by changes in the social, cultural, and religious environment, socioeconomic status, and housing conditions, all of which affect nutritional health. In a cross-sectional study, we assessed the dietary intake as well as nutritional and health situation in a population of Syrian refugees who have resided in Germany for at least six months up to four years since 2015. The primary aim of this pilot study was to evaluate the nutritional and health status in comparison to reference values.

METHODS

Between December 2018 and March 2020, 114 adult Syrian refugees were included in the study. The subjects filled out questionnaires on sociodemographic variables, exercise, and nutrition behavior (three-day nutrition record). After a fasting blood draw, the subjects were examined for anthropometric parameters (height, weight, body mass index, waist circumference, waist-hip ratio, and body composition via a bioelectrical impedance analyzer). Various blood markers including iron status, hematological parameters, Vitamin D status, lipid metabolism, glucose metabolism, and total homocysteine (tHcy) were measured.

RESULTS

About half of the participants (71 male, 43 female) had lived in Germany for less than three years. Over 60% of men and 30% of women were overweight (BMI 25-30 kg/m2) or obese (BMI > 30 kg/m2), while 79% of men and 74% of women observed an elevated body fat mass. The evaluation of the three-day nutrition records revealed an unfavorable supply situation for numerous critical nutrients. More than half of the women (53.5%) had depleted iron stores (serum ferritin < 15 µg/l). The 25-OH-Vitamin D blood levels showed a high prevalence of Vitamin D insufficiency (25-49.9 nmol/l: 38% of men and 21% of women) and deficiency (< 25 nmol/l: 44% of men and 70% of women). 83% of men and 67% of women showed tHcy levels in plasma > 10 nmol/l. Fasting insulin levels and the HOMA-IR index indicate a risk for insulin resistance. Hyperlipidemia was prevalent, especially in males with 24% showing hypertriglyceridemia (> 150 mg/dl) and LDL-hypercholesterolemia (> 130 mg/dl).

CONCLUSIONS

The nutritional and health status of the cohort of Syrian refugees in Germany examined in this study is unsatisfactory, and many of the investigated refugees are at risk for developing cardiovascular disease and type 2 diabetes mellitus. Further studies are required to investigate the nutritional and health situation of refugees. This is obligatory to find ways to avoid malnutrition with all its associated health, sociodemographic, and economic consequences.

Migration-Related Weight Changes among African Immigrants in the United States

(1) Background: people who migrate from low-to high-income countries are at an increased risk of weight gain, and excess weight is a risk factor for cardiovascular disease. Few studies have quantified the changes in body mass index (BMI) pre- and post-migration among African immigrants. We assessed changes in BMI pre- and post-migration from Africa to the United States (US) and its associated risk factors. (2) Methods: we performed a cross-sectional analysis of the African Immigrant Health Study, which included African immigrants in the Baltimore-Washington District of the Columbia metropolitan area. BMI category change was the outcome of interest, categorized as healthy BMI change or maintenance, unhealthy BMI maintenance, and unhealthy BMI change. We explored the following potential factors of BMI change: sex, age at migration, percentage of life in the US, perceived stress, and reasons for migration. We performed multinomial logistic regression adjusting for employment, education, income, and marital status. (3) Results: we included 300 participants with a mean (±SD) current age of 47 (±11.4) years, and 56% were female. Overall, 14% of the participants had a healthy BMI change or maintenance, 22% had an unhealthy BMI maintenance, and 64% had an unhealthy BMI change. Each year of age at immigration was associated with a 7% higher relative risk of maintaining an unhealthy BMI (relative risk ratio [RRR]: 1.07; 95% CI 1.01, 1.14), and compared to men, females had two times the relative risk of unhealthy BMI maintenance (RRR: 2.67; 95% CI 1.02, 7.02). Spending 25% or more of life in the US was associated with a 3-fold higher risk of unhealthy BMI change (RRR: 2.78; 95% CI 1.1, 6.97). (4) Conclusions: the age at immigration, the reason for migration, and length of residence in the US could inform health promotion interventions that are targeted at preventing unhealthy weight gain among African immigrants.

COVID-19 Outcomes in Minority Ethnic Groups: Do Obesity and Metabolic Risk Play a Role?

PURPOSE OF REVIEW

Globally, minority ethnic groups have been at higher risk of COVID-19 mortality and morbidity than majority populations. This review outlines factors that may interact to create these inequalities and explores the hypothesis that differing levels of cardio-metabolic risk, according to ethnic group, play a role.

RECENT FINDINGS

Two UK Biobank studies have reported that the body mass index is more strongly associated with an increased risk of COVID-19 infection and mortality in minority ethnic populations than in White populations. A study of UK patients found that the strongest association between obesity and adverse COVID-19 outcomes was in people of Black ethnicity. Differences in the prevalence of obesity and its metabolic sequelae have been shown to partly mediate ethnic inequalities in COVID-19 outcomes, although not always consistently. It is possible that ethnic differences in the consequences of obesity may explain some of the remaining disparity in COVID-19 risk.

A healthy migrant effect? Estimating health outcomes of the undocumented immigrant population in the United States using machine learning

This paper investigated whether the commonly observed immigrant health advantage persists among undocumented immigrants in the U.S. and provides nationally representative evidence on the health of this vulnerable population. Data were derived from pooled cross-sections of the National Health Interview Survey (NHIS, 2000-2018). The legal status of foreign-born NHIS respondents is imputed using a non-parametric machine learning model built based on information from the 2004, 2008 and 2014 cohorts of the Survey of Income and Program Participation (SIPP). Multivariate logistic regression analysis indicated that, despite exposure to numerous additional risk factors, the undocumented population experienced a more pronounced Healthy Migrant Effect, with lower odds of reporting fair or poor self-rated health, any physician-diagnosed chronic conditions or being obese. The observed patterns in undocumented health outcomes may be related to the additional challenges and exclusionary policies associated with undocumented migration that could in turn lead to a more pronounced selection of healthy and resilient individuals.

SKA-31-induced activation of small-conductance calcium-activated potassium channels decreased modulation of detrusor smooth muscle function in a rat model of obesity

Increased excitability and contractility of detrusor smooth muscle (DSM) cells are associated with overactive bladder (OAB), which is often induced by obesity. Small-conductance Ca²⁺-activated K⁺ (SK) channels regulate the excitability and contractility of DSM cells. Selective pharmacological activation of SK channels attenuates hyperpolarization and the decreased relaxation effect in DSM cells in obesity-induced OAB. However, additional data are needed to confirm the regulatory effect of SK channels on the function of DSM cells in obesity-related OAB. The tested hypothesis was that activation of SK channels decreases modulation of DSM function in a rat model of obesity-related OAB. Female Sprague Dawley rats were fed a normal diet (ND) or a high-fat diet (HFD), weighed after 12 weeks, and subjected to urodynamic study, patch-clamp electrophysiology, and isometric tension recording. The average body weight and incidence of OAB were increased in the HFD group. Patch-clamp studies revealed that pharmacological activation of SK channels with SKA-31 had attenuated hyperpolarization of DSM cells. In addition, isometric tension recordings indicated that SKA-31 decreased relaxation of spontaneous phasic contractions of DSM strips in the HFD group. Attenuated function of SK channels increased the excitability and contractility of DSM cells, which contributed to the occurrence of OAB, suggesting that SK channels are potential therapeutic targets for control of OAB.

Disparities in Prenatal Sexually Transmitted Infections among a Diverse Population of Foreign-Born and US-Born Women

This study examined association between foreign-born (FB) status and a sexually transmitted infection (STI) diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, or syphilis among a cohort of expecting mothers, and stratified by race/ethnicity. As a secondary analysis, subsequent adverse birth outcomes following STIs were examined. We used data from a large perinatal database to conduct a retrospective cohort study of 37,211 singleton births. Logistic regression was used to determine the association between FB status and STIs. We adjusted for maternal demographics, prior complications, and chronic disease. As a secondary analysis, we examined the association between STIs, and adverse birth outcomes stratified by FB status. FB women had lower odds of STI diagnosis (OR_adj 0.81, 95% CI 0.71-0.93); this was observed for each STI. Among Hispanic women, FB status did not reduce odds of STIs (OR_adj 0.89, 95% CI 0.76-1.04). However, FB Black women had reduced odds of STIs (OR_adj 0.53, 95% CI 0.36-0.79). Secondary analyses revealed that STIs increased odds of adverse birth outcomes among US-born Black women but not US-born Hispanic women. Among FB Black women, STIs increased odds of medically indicated preterm birth (OR_adj 3.77, 95% CI 1.19-12.00) and preeclampsia (OR_adj 2.35, 95% CI 1.02-5.42). This was not observed among FB Hispanic women. Previous studies suggest that FB women are less likely to have adverse birth outcomes; our study extends this observation to risk of prenatal STIs. However, FB status does not protect Black women against adverse birth outcomes following an STI.

Can Fasting Curb the Metabolic Syndrome Epidemic?

Metabolic syndrome (MetS) represents a cluster of metabolic abnormalities that includes hypertension, central obesity, insulin resistance, and atherogenic dyslipidemia. Due to the high prevalence (around 1/3 of the world population) economic burden of MetS, there is a need for new dietary, lifestyle, and therapeutic options. Recently, fasting emerged as a dietary method proposed for controlling metabolic risk factors. Intermittent fasting (IF), or time-restricted feeding (TRF), describes an array of feeding patterns in which calorie intake is restricted to a specific time period. Hence, this review aimed to elucidate the latest data on MetS and explore the viability of simple management options, such as IF and TRF. Preclinical studies have shown how IF/TRF exerts beneficial effects on the gut microbiota, glucose and insulin metabolism, weight and visceral fat, and lipid metabolism. However, the results obtained from human studies are somewhat conflicting, as weight loss was achieved in all studies, whereas in some studies, there was no significant effect on insulin resistance, cholesterol/lipid metabolism, or blood pressure. Nevertheless, as only very few human studies were performed, there is a need for more randomized control trials on larger cohorts of patients with MetS to gather higher-yield evidence to clarify whether IF/TRF are suitable dietary patterns for this population.

Mortality among Italians and immigrants with COVID-19 hospitalised in Milan, Italy: data from the Luigi Sacco Hospital registry

BACKGROUND

To compare differences in the probability of COVID-19-related death between native Italians and immigrants hospitalised with COVID-19.

METHODS

This retrospective study of prospectively collected data was conducted at the ASST Fatebenefratelli-Sacco Hospital in Milan, Italy, between 21 February and 31 November 2020. Uni- and multivariable Cox proportional hazard models were used to assess the impact of the patients' origin on the probability of COVID-19-related death.

RESULTS

The study population consisted of 1,179 COVID-19 patients: 921 Italians (78.1%) and 258 immigrants (21.9%) who came from Latin America (99, 38%), Asia (72, 28%), Africa (50, 19%) and central/eastern Europe (37, 14%). The Italians were significantly older than the immigrants (median age 70 years, interquartile range (IQR) 58-79 vs 51 years, IQR 41-60; p < 0.001), and more frequently had one or more co-morbidities (79.1% vs 53.9%; p < 0.001). Mortality was significantly greater among the Italians than the immigrants as a whole (26.6% vs 12.8%; p < 0.001), and significantly greater among the immigrants from Latin America than among those from Asia, Africa or central/eastern Europe (21% vs 8%, 6% and 8%; p = 0.016). Univariable analysis showed that the risk of COVID-19-related death was lower among the immigrants (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.30-0.63; p < 0.0001], but the risk of Latin American immigrants did not significantly differ from that of the Italians (HR 0.74, 95% CI 0.47-1.15; p = 0.183). However, after adjusting for potential confounders, multivariable analysis showed that there was no difference in the risk of death between the immigrants and the Italians (adjusted HR [aHR] 1.04, 95% CI 0.70-1.55; p = 0.831), but being of Latin American origin was independently associated with an increased risk of death (aHR 1.95, 95% CI 1.17-3.23; p = 0.010).

CONCLUSIONS

Mortality was lower among the immigrants hospitalised with COVID-19 than among their Italian counterparts, but this difference disappeared after adjusting for confounders. However, the increased risk of death among immigrants of Latin American origin suggests that COVID-19 information and prevention initiatives need to be strengthened in this sub-population.

Prevalence of Childhood Obesity in the United States in 1999-2018: A 20-Year Analysis

INTRODUCTION

Obesity is a public health crisis in the USA. This study aimed to estimate the prevalence of obesity and severe obesity in US children and adolescents and identify novel targetable risk factors associated with childhood obesity.

METHODS

From the US National Health and Nutrition Examination Survey from 1999 to 2018, 35,907 children aged 2-19 with body mass index (BMI) data were included. Obesity and severe obesity were defined as BMI ≥95th percentile and ≥120% of 95th percentile of US Centers for Disease Control and Prevention growth charts, respectively. Trends in the prevalence of obesity and subgroup analyses according to socioeconomic factors and language used in the interview were analyzed.

RESULTS

The prevalence of obesity and severe obesity increased from 14.7 [95% confidence interval: 12.9-17.0]% to 19.2 [17.2-21.0]% and 3.9 [2.9-5.0]% to 6.1 [4.8-8.0]% in 1999-2018, respectively (p = 0.001 and p = 0.014, respectively). In 2017-2018, the prevalence of obesity among children from Spanish-speaking households was 24.4 [22.4-27.0]%, higher than children from English-speaking households (p = 0.027).

CONCLUSION

The prevalence of childhood obesity kept increasing in 1999-2018. The problem is worse in children from Spanish-speaking households. Novel and targeted public health intervention strategies are urgently warranted to effectively halt the rising epidemic of childhood obesity.

How time in the US and race/ethnicity shape food parenting practices and child diet quality

Childhood obesity prevalence is high among children from immigrant/refugee households who live in high-income countries. Poor child dietary intake is a critical risk factor for elevated obesity prevalence and food parenting practices have been found to be associated with child dietary intake and eating behaviors. The main aim of this study was to examine the associations between migrants'/refugees' food parenting practices, the length of residence time in the US, race/ethnicity, and child diet quality. The current study included 577 families from three racial/ethnic groups that include mostly foreign-born parents (Latino, Hmong, and Somali/Ethiopian), and a comparison group of 239 non-Hispanic White families. Results showed that for Latino and Hmong parents, some food parenting practices varied by how long they had lived in the US. For example, more recently moved parents engaged in more non-directive (e.g., avoid buying sweets) practices compared with US-born parents. In contrast, Somali/Ethiopian parents engaged in different food parenting practices than White parents, regardless of time in the US. Results also showed that diet quality among Hmong children was lower if their parents were US-born compared to foreign-born. Future researchers may want to consider studying why some food parenting practices change when parents move to the US and explore whether there is a combination of food parenting practices that are most useful in promoting a healthful child's diet and weight among immigrant and refugee families.

Findings from the Hispanic Community Health Study/Study of Latinos on the Importance of Sociocultural Environmental Interactors: Polygenic Risk Score-by-Immigration and Dietary Interactions

Introduction: Hispanic/Latinos experience a disproportionate burden of obesity. Acculturation to US obesogenic diet and practices may lead to an exacerbation of innate genetic susceptibility. We examined the role of gene-environment interactions to better characterize the sociocultural environmental determinants and their genome-scale interactions, which may contribute to missing heritability of obesity. We utilized polygenic risk scores (PRSs) for body mass index (BMI) to perform analyses of PRS-by-acculturation and other environmental interactors among self-identified Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: PRSs were derived using genome-wide association study (GWAS) weights from a publicly available, large meta-analysis of European ancestry samples. Generalized linear models were run using a set of a priori acculturation-related and environmental factors measured at visit 1 (2008-2011) and visit 2 (2014-2016) in an analytic subsample of 8,109 unrelated individuals with genotypic, phenotypic, and complete case data at both visits. We evaluated continuous measures of BMI and waist-to-hip ratio. All models were weighted for complex sampling design, combined, and sex-stratified. Results: Overall, we observed a consistent increase of BMI with greater PRS across both visits. We found the best-fitting model adjusted for top five principal components of ancestry, sex, age, study site, Hispanic/Latino background genetic ancestry group, sociocultural factors and PRS interactions with age at immigration, years since first arrival to the United States (p < 0.0104), and healthy diet (p < 0.0036) and explained 16% of the variation in BMI. For every 1-SD increase in PRS, there was a corresponding 1.10 kg/m² increase in BMI (p < 0.001). When these results were stratified by sex, we observed that this 1-SD effect of PRS on BMI was greater for women than men (1.45 vs. 0.79 kg/m², p < 0.001). Discussion: We observe that age at immigration and the adoption of certain dietary patterns may play a significant role in modifying the effect of genetic risk on obesity. Careful consideration of sociocultural and immigration-related factors should be evaluated. The role of nongenetic factors, including the social environment, should not be overlooked when describing the performance of PRS or for promoting population health in understudied populations in genomics.

Acculturative stress and eating disinhibition among Asian young adults: The role of depressive symptoms and gender

Acculturative stress is associated with health behaviors that have downstream consequences for health outcomes. Eating disinhibition, a behavior characterized by eating emotionally and uncontrollably in the presence of disinhibiting stimuli, has been consistently associated with acculturative stress, but the underlying mechanism is not well-understood. The current study sought to test the role of depressive symptoms and gender on these associations. Asian undergraduate students (N = 477; 78% female) participated in an online cross-sectional study. Higher acculturative stress was associated with higher eating disinhibition (b = 3.45, 95% CI = [0.75, 6.15]), and depressive symptoms showed a partial indirect effect on this association (indirect effect = 0.57, 95% CI_boot = [0.13, 1.34]). Among male young adults (b = 0.98, 95% CI_boot = [0.24, 2.39]), the indirect correlation was stronger than among female young adults (b = 0.44, 95% CI_boot = [0.05, 1.20]; non-significant trend), implying individual differences underlying the indirect effect of depressive symptoms in the acculturative stress and eating disinhibition correlation. The Intercultural Relations dimension of acculturative stress appeared to drive the observed associations. This study is among the first highlighting the role of acculturative stress, depressive symptoms, and gender in eating disinhibition and provides evidence that can inform health professionals to target at-risk Asian individuals with eating problems.

Socio-cultural beliefs about an ideal body size and implications for risk of excess weight gain after immigration: a study of Australian residents of sub-Saharan African ancestry

Objectives: Though several studies have focused on risk factors associated with excess weight gain, little is known about the extent to which socio-cultural beliefs about body sizes may contribute to risk of excess weight gain, especially in non-Western migrant communities. Drawing on socio-cultural and attribution theories, this study mainly explored socio-cultural beliefs about an ideal body size among Australian residents who were born in sub-Saharan Africa (SSA).  Implications of body size beliefs for risk of excess weight gain after immigration have also been discussed.Design: Employing a qualitative design, 24 in-depth interviews were conducted with Australian residents who were born in SSA. Thematic content analysis was undertaken to ensure that participants' experiences and views were clearly captured.Results: According to the participants, a moderately large body size is idealised in the SSA community and post-migration weight gain is commonly regarded as evidence of well-being. While desirability of a moderately large body size was noted by some participants, others were concerned about health risks (e.g. high blood pressure) associated with excess weight gain. Moreover, body size ideals seemed to be different for men and women in the SSA community and these ideals were mainly promoted by family and friends. Participants reported that women with very slim (skinny) body sizes are often regarded as persons suffering from health problems, whereas those with 'plumpy' body types are often considered beautiful. Participants also noted that men are expected to look well-built and muscular while those with big bellies are often seen as financially rich.Conclusions: Participants' interpretation of post-migration weight gain as evidence of well-being calls for urgent intervention as risk of excess weight gain appear to be high in this immigrant group.

Children's perspectives and experiences of health, diet, physical activity and weight in an urban, multi-ethnic UK population: A qualitative study

BACKGROUND

Children from Black and South Asian ethnic groups are at risk for childhood obesity in the United Kingdom. To inform local action for childhood obesity prevention, it is crucial to explore the basis of ethnic disparities and consider the perspectives of children. This study aimed to understand cultural and contextual factors influencing childhood obesity in an ethnically diverse population using child-centred methodology.

METHODS

'Draw, write and tell' interviews were held with children aged 9-10 years in Coventry, an urban, multi-ethnic city in the United Kingdom. Data were analysed thematically using framework analysis.

RESULTS

Twenty-six children participated (85% from Black or minority ethnic groups). Children's perspectives revealed universal themes around health, diet, physical activity and weight and highlighted issues specific to ethnic groups and those living in deprived areas. An underlying feature was weight-based stigmatization and group stereotyping, and an emphasis on internal factors as the cause of obesity. Children described some experiences of social disadvantage but did not regard these as a barrier to being physically active. Children identified cultural or religious practices or experiences of migration that influenced diet and physical activity.

CONCLUSIONS

These findings allow a broad range of children's perspectives to inform future intervention design. In addition, the study was able to identify the many similarities and small amount of diversity in children's perspectives across ethnic groups.

Increasing obesity odds among foreign-born New Yorkers are not explained by eating out, age at arrival, or duration of residence: results from NYC HANES 2004 and 2013/2014

BACKGROUND

Among the foreign-born in the United States (US) dietary acculturation and eating out may increase obesity risk. Using the 2004 (N = 1952) and 2013/14 (N = 1481) New York City (NYC) Health and Nutrition Examination Surveys, we compared for the foreign-born and US-born by survey year: 1) odds of obesity; 2) association between eating out and obesity and 3) effect of age at arrival and duration of residence among the foreign-born. Weighted logistic regression estimated odds of obesity.

RESULTS

Compared to the US-born, the foreign-born had lower odds of obesity in 2004, (aOR = 0.51 (95%CI 0.37-0.70), P = <.0001). Odds were no different in 2013/14. In 2013/14 the foreign-born who ate out had lower obesity odds (aOR = 0.49 (95%CI 0.31-0.77), P = 0.0022). The foreign-born living in the US≥10 years had greater odds of obesity in 2004 (aOR = 1.73 (95%CI 1.08-2.79), P = 0.0233) but not in 2013/14.

CONCLUSIONS

Eating out does not explain increasing obesity odds among the foreign-born.

Doctors as disseminators? Practicing physicians as multipliers for community-based prevention networks in a large city in western Germany

Aim

Practicing physicians have a special position as disseminators of community-based prevention for children. However, it is unclear to what extent physicians inform parents about programs. The study investigated: To what extent do physicians disseminate information about community-based prevention for children aged 0–7? Do differences exist along family’s socioeconomic position (SEP) and immigrant background?

Subject and methods

We conducted a retrospective cohort study in a German school entrance examination. Parents were invited to participate in a survey on community-based prevention with information about their awareness and information source. SEP was measured by parental education, immigrant background by country of birth. For nine services types, we counted how often parents named physicians and other professional groups as information sources. To estimate social differences, we calculated adjusted odds ratios (OR) with 95% confidence interval (CI).

Results

Survey participants included 6480 parents (response 65.49%). Compared to other information sources, physicians were mentioned less frequently. For example, regarding language therapy, 31.2% of parents were informed by healthcare/social services, and 4.4% by physicians. Lower educated parents were less frequently informed by physicians about counseling services (OR 0.58; 95% CI 0.46–0.73) compared to higher educated parents. Parents with immigrant background were informed less often about parenting skills courses (OR 0.79; 95% CI 0.70–0.90) compared to parents without immigrant background, but more often about language therapy (OR 1.47; 95% CI 1.13–1.91). No further social differences were observed.

Conclusion

The role of physicians as disseminators for community-based prevention is expandable. They should promote parenting skills courses in a socially sensitive way.

Pre- and Post-Migration Influences on Weight Management Behaviours before and during Pregnancy: Perceptions of African Migrant Women in England

The prevalence of overweight/obesity is high among Black women in England, who also face high risks of pregnancy and childbirth complications. This study explored African migrant women’s perceptions of pre- and post-migration influences on their weight-related behaviours and weight management support during pregnancy. Interviews were conducted with women of child-bearing age from Ghana, Nigeria, and Cameroon (n = 23). Data were analysed using thematic analysis. Four themes were identified: changing dietary behaviours after migration, changing physical activity (PA) behaviours after migration, increased discourse on obesity, and weight management advice and support received. Navigating a new food environment, interactions with other populations in England, and the need to socialise influenced changes in dietary behaviours. Participants considered that living in England ‘makes you lazy’ due to its obesogenic environment, while increased discourses on obesity heightened weight awareness. Women struggled to relate to dietary advice from midwives but found PA advice useful. Relatives provided valuable support but could influence unhealthy weight-related practices. There is a need for interventions addressing gaps in weight management support for these women, especially considering their migrant backgrounds and multicultural identities. Further research is needed to understand their unique challenges, and collaborations with relatives could inform the development of effective weight management interventions.

Early pregnancy overweight/obesity and length of residence among immigrants in Sweden: a pooled analysis of Swedish population registers between 1992 and 2012

OBJECTIVE

To examine whether the association between women's origin and early pregnancy overweight and obesity (OW/OB) varies by length of residence in Sweden.

DESIGN

This cross-sectional observational study used pooled Swedish population register data from 1992 to 2012. Logistic regression models were run to estimate odds ratios (OR) of early pregnancy OW/OB and 95 % confidence intervals (95 % CI), comparing Swedish-born and immigrants by length-of-residence categories while adjusting for covariates.

SETTING

Sweden.

PARTICIPANTS

In total, 1 771 821 pregnant women, 315 992 of whom were immigrants.

RESULTS

With longer residence in Sweden, more immigrant women from various origins exhibited higher odds of experiencing early OW/OB compared with Swedish-born women. Findings specifically showed increased odds of early pregnancy OW/OB with increasing length of residence for women born in Latin America, Europe-27 and Southeast Asia. For example, immigrant women from Latin America residing in Sweden for < 6 years showed similar odds as Swedish-born (OR≤ 5 years 0·92, 95 % CI 0·87, 0·98), while their longer residing counterparts showed higher odds than Swedish-born women (OR6-15 years1·21, 95 % CI 1·14, 1·28 and OR≥ 16 years 1·68, 95 % CI 1·59, 1·78). Mixed results were found for other origins.

CONCLUSIONS

The current study suggests that host country conditions might play an important role in explaining OW/OB among some groups of immigrant women. Although further studies are needed to disentangle the mechanisms that generate these health inequalities, policy efforts should focus on immigrant reception and early integration to prevent pregnancy-related OW/OB.

Gender Patterns in Immigrants' Health Profiles in France: Tobacco, Alcohol, Obesity and Self-Reported Health

Background: to date, little attention has been given to gender differences in the health of migrants relative to native-born. In this study, we examine the health profile of the largest immigrant groups in metropolitan France, considering several health indicators and with a special interest in the gendered patterns. Methods: The data originate from the 2017 Health Barometer survey representative of metropolitan France. A subsample of 19,857 individuals aged 18-70 years was analysed using modified Poisson regression, and risk ratio estimates (RR) were provided for the different migrant groups regarding alcohol use, current smoking, obesity and less-than-good self-reported health, adjusting for age and educational level. Results: None of the groups of male migrants differs from the native-born in terms of self-reported health, and they have healthier behaviours for alcohol (men from sub-Saharan Africa: 0.42 (0.29-0.61)) and from the Maghreb: 0.30 (0.1-0.54)) and smoking (men from sub-Saharan Africa: 0.64 (0.4-0.84)), with less frequent obesity (men from the Maghreb: 0.61 (0.3-0.95)). The latter, however, more frequently report current smoking (1.21 (1.0-1.46)). For women, less-than-good health is more frequently reported by the groups from sub-Saharan Africa (1.42 (1.1-1.75)) and from the Maghreb (1.55 (1.3-1.84)). Healthier behaviours were found for alcohol (women from overseas départements: 0.38 (0.1-0.85)) and from the Maghreb: (0.18 (0.0-0.57)) and current smoking (women from southern Europe: 0.68 (0.4-0.97), from sub-Saharan Africa: 0.23 (0.1-0.38) and from the Maghreb: 0.42 (0.2-0.61)). Conversely, some were more frequently obese (women from overseas départements: 1.79 (1.2-2.56) and from sub-Saharan Africa: 1.67 (1.2-2.23)). In the latter two groups from Africa, there is a larger relative male excess for tobacco than in the native-born (male-to-female ratios of respectively 2.87 (1.6-5.09) and 3.1 (2.0-4.65) vs 1.13 (1.0-1.20)) and there is a female excess for obesity (0.51 (0.2-0.89) and 0.41 (0.2-0.67)) in contrast with the native-born (1.07 (0.9-1.16)). The female disadvantage in terms of less-than-good self-reported health is more pronounced among migrants from the Maghreb than among the natives (0.56(0.4-0.46) vs. 0.86 (0.8-0.91)). Conclusion: Considering a set of four health indicators, we provide evidence for distinctive gender patterns among immigrants in France. Male immigrants have a healthy behavioural profile in comparison with the natives and no health disadvantage. Female immigrants have a more mixed profile, with a health disadvantage for the non-Western groups from Africa. The contribution to this discordance of socioeconomic factors and gender relations needs to be investigated.

Body mass index and gestational weight gain in migrant women by birth regions compared with Swedish-born women: A registry linkage study of 0.5 million pregnancies

Introduction

Women migrating to high-income countries may have increased risks of adverse pregnancy outcomes as compared with native-born women. However, little is known whether migrant women are more likely to have unhealthy body mass index (BMI) or gestational weight gain (GWG), which is of importance considering the well-established links between unhealthy BMI and GWG with adverse pregnancy outcomes. Hence, the aim of the study was to examine the prevalence and estimate odds ratios (ORs) of underweight and obesity in the first trimester as well as inadequate and excessive GWG across birth regions in migrant (first-generation) and Swedish-born women in a population-based sample of pregnant women in Sweden.

Methods

This population-based study included 535 609 pregnancies from the Swedish Pregnancy Register between the years 2010–2018. This register has a coverage of approximately 90% and includes data on body weight, height, birth country and educational attainment. BMI in the first trimester of pregnancy was classified as underweight, normal weight, overweight and obesity whereas GWG was classified as inadequate, adequate and excessive according to the recommendations from the National Academy of Medicine, USA. BMI and GWG were examined according to 7 birth regions and the 100 individual birth countries. Adjusted ORs of underweight, obesity as well as inadequate or excessive GWG by birth regions were estimated using multinomial logistic regression.

Results

There were large disparities in unhealthy BMI and GWG across birth regions. For instance, women born in North Africa and Middle East and Sub-Saharan Africa had 1.40 (95% CI 1.35–1.44) and 2.13 (95% CI 2.03–2.23) higher odds of obesity compared with women born in Sweden. However, women born in Sub-Saharan Africa had also considerably higher odds of underweight (OR, 2.93 [95% CI 2.70–3.18]) and inadequate GWG (OR, 1.97 [95% CI 1.87–2.07]). The limitations of the study include the lack of a validated measure of acculturation and that the study only had data on first-generation migration.

Conclusions

The large differences across the 7 regions and 100 countries highlights the importance of considering birth region and country-specific risks of unhealthy BMI and GWG in first-generation migrant women. Furthermore, inadequate GWG was common among pregnant first-generation migrant women, especially in women born in Sub-Saharan Africa, which demonstrates the need to promote adequate GWG, not only the avoidance of excessive GWG. Thus, our findings also indicate that additional support and interventions may be needed for first-generation migrant women from certain birth regions and countries in order to tackle the observed disparities in unhealthy BMI and GWG. Although further studies are needed, our results are useful for identifying groups of women at increased risk of unhealthy BMI and weight gain during pregnancy.

Physical Activity Among Immigrant Children: A Systematic Review

BACKGROUND

The health benefits of physical activity (PA) for children are well documented. However, little is known about PA patterns among immigrant children.

METHODS

The authors reviewed research on PA patterns of immigrant children. The inclusion criteria included peer-reviewed articles published from January 2010 to May 2018 in English, French, or Spanish that included primary-school-aged (6-12 y) children, and data on immigration status.

RESULTS

A total of 11 articles were included in the analyses. These studies revealed a deficit of PA among immigrant children. Immigration status (immigrant or nonimmigrant) and generation of immigration (first, second, and third), ethnic origin, and gender were associated with PA patterns. In general, PA levels were lower among first-generation immigrant children, children of Hispanic and East Asian origin, and girls. The results suggest that questionnaire measures might be biased or inaccurate among immigrant children, highlighting the need for the integration of mixed methods (objective and subjective measures).

CONCLUSIONS

A large proportion of children do not meet PA guidelines, and this might be more problematic for immigrant children. Future studies incorporating time since immigration, comparative analyses on gender, sociocultural and socioeconomic characteristics, and mixed methodology could provide a more complete portrait of PA patterns and opportunities for immigrant children.

Validation of Obesity Status Based on Self-Reported Data among Filipina and Indonesian Female Migrant Domestic Workers in Macao (SAR), China

BACKGROUND

Migrant domestic workers are at high risk of overweight and obesity. It is crucial to assess the prevalence of obesity among this migrant population, for surveillance and intervention. Self-reported height and weight are commonly used to derive body mass index (BMI) and assess the prevalence of obesity. The accuracy of BMI from self-reported height and weight in migrant populations remains unknown. The aim of this study was to assess the accuracy of BMI from self-reported measures and identify the optimal adjustment to be made to overweight and obesity cut-off points when using self-reported body mass index among migrant workers.

METHODS

Self-reported and objectively measured height and weight were obtained from 1388 female Filipina domestic workers and 369 female Indonesian domestic workers recruited using respondent-driven sampling between November 2016 and August 2017. Self-reported BMI (based on self-reported height and weight) and measured BMI (based on objectively measured height and weight) were calculated as weight in kilograms divided by the square of height in meters for all participants (kg/m2).

RESULTS

BMI derived from self-reported height and weight was underestimated for both Filipina (z = -27.5, p < 0.001) and Indonesian (z = -9.9, p < 0.001) participants. Applying the gold standard of Asian BMI cut-off points to self-reported BMI, the sensitivity in identifying overweight or obesity was 64.4% for Filipina participants and 78.6% for Indonesian participants and the specificity was 97.9% for Filipina participants and 93.8% for Indonesian participants for overweight or obesity. When self-reported measures were used, the receiver operator characteristic (ROC) curves and the corresponding area under the curve (AUC) indicated optimal cut-off points of 22.0 kg/m2 and 22.3 kg/m2 for Filipina and female Indonesian participants for overweight or obesity.

CONCLUSIONS

Although BMI derived from self-reported height and weight allows for quick and low-cost obesity screening, a considerable underestimation of overweight or obesity prevalence was observed in Filipina and female Indonesian migrant domestic workers in Macao (Special Administrative Region, SAR), China. With the best compromise between sensitivity and specificity, the new cut-off points can be used in future studies to identify overweight or obesity in these two populations using self-reported height and weight.

Fast food restaurant density and weight status: A spatial analysis among Filipina migrant workers in Macao (SAR), People's Republic of China

BACKGROUND

Female migrant populations are at high risk of being overweight or obese. Beyond individual risk factors, exposure to the neighborhood food environment may contribute to their unhealthy weight status in the host region. Incorporating spatial analysis, this study examined the association between exposure to fast food restaurants and unhealthy weight status among Filipina domestic workers in Macao (SAR), China.

METHODS AND FINDINGS

Data were collected from 1388 Filipina domestic workers recruited using respondent-driven sampling between November 2016 to August 2017. Self-reported data on demographic characteristics, residential mailing address, and health-related behaviors were collected using tablet devices. Height and weight were objectively measured at the study site. Restaurant locations and resident addresses were geocoded and integrated into a shapefile for residential locations using ArcGIS. Nearly 64% of participants were classified as being overweight or obese, with 25.02% overweight and 38.96% obese. Adjusted multivariable logistic regression indicated that increased fast food restaurant density within a 0.5-mile buffer zone around a residential address was positively associated with higher odds of being overweight and obese (aOR = 1.07; 95% CI [1.01-1.14].

CONCLUSIONS

Increased fast food restaurant density was associated with unhealthy weight status among Filipina domestic workers in Macao (SAR), China. Providing healthy working environment, including access to healthy food, is indicated to improve the health of this population.

Disease Burden, Mechanism and Management of Obesity – Where Do We Stand?

The role of increased body mass index in general morbidity and mortality is well documented. This global public health issue continues to represent a major burden and threat to health systems and the population’s wellbeing. Global statistics show that the prevalence of obesity has increased about three times since the mid-1970s, and an upward trend is still observed, not only in developed but also in developing countries. We used several databases, including PubMed, ProQuest, and Google Scholar, to perform a literature search and review on obesity. Keywords such as “obesity”, “overweight”, and “BMI” were used in combination with multiple keywords such as “mechanism”, “factors”, “socio-economic”, “environmental”, “social determinants”, “management”, “treatment”, “non-traditional treatment”, “alternative therapies”, “non-pharmaceutical treatment” etc. and related phrases. According to the literature, the management of obesity is difficult due to the complex nature of this problem in terms of its course, complications, risks, and etiological factors. The role of alternative therapies in obesity management is still unclear, and further research is needed in this area. Recently introduced weight-loss and -management devices can also help in losing excess bodyweight. The present article summarizes relevant information related to obesity, collected from different regions of the world, and discusses diverse interventional approaches to treat obesity.

Associations of socio-demographic factors with adiposity among immigrants in Norway: a secondary data analysis

BACKGROUND

Obesity is becoming an important public health challenge, especially among immigrants coming from low and middle income to high-income countries. In this study we examined the relationship between overweight/obesity and various socio-demographic indicators among different immigrant groups in Norway.

METHODS

We used data from the Living Conditions Survey among Immigrants 2016, conducted by Statistics Norway. Our study sample included 4194 immigrants from 12 different countries. Participants were asked about a number of topics including health, weight, height, demographic factors, length of residence and employment. We ran logistic regression analysis to determine the odds ratio (OR) of the associations between socio-demographic factors with adiposity among immigrants.

RESULTS

Approximately 53% of the sample was overweight/obese. There was a significant difference in overweight/obesity by gender, age, country of origin and marital status. Overall immigrant men were almost 52% more likely to be overweight/obese than women. Women from Somalia had the highest odds (13.1; CI: 7.4-23.1) of being overweight/obese, followed by Iraq (8.6; CI: 4.9-14.9), Pakistan (7.5; CI: 4.2-13.4), Kosovo (7.0; CI: 4.1-12.1), and Turkey (6.8; CI: 4.0-11.6) as compared to the women from Vietnam (reference). Whereas men from Turkey had the highest odds (5.2; CI: (3.2-8.3)) of being overweight/obese, followed by Poland (4.2; CI: 2.7-6.1), Bosnia (4.1; CI: (2.6-6.5) and Kosovo (3.9; CI: 2.5-6.1). The odds for obesity increased with age and odds were highest in the eldest group 45-66 years (4.3; CI: 3.2-5.8) as compared to reference group16-24 years. The odds of being overweight/obese was higher among married (1.6; CI: 1.3-1.9) and divorced/separated/widowed (1.5; CI: 1.1-2.0) as compared to singles. Education, employment status, physical activity and length of residence were not associated with the odds of being overweight/obese.

CONCLUSION

The findings of this study call attention to the importance of a greater understanding of the processes leading to obesity among certain immigrant groups in Norway. Moreover, there is a need for culturally adapted prevention strategies targeting immigrant men and women with high rates of overweight/obesity.

Attenuated regulatory function of the small-conductance Ca2+-activated K+ channel in detrusor smooth muscle cells excitability in an obese rat model

PURPOSE

Overactive bladder (OAB) is related to detrusor overactivity (DO), which is caused by the increased detrusor smooth muscle (DSM) cells excitability. Small-conductance Ca²⁺-activated K⁺ (SK) channels is a fundamental regulator of excitability and contractility in DSM cells. Obesity-related OAB is associated with the decreased expression and regulatory function of SK channels in DSM layer. However, the regulation role of SK channels in obesity-related OAB DSM cell excitability is still unknown. Here, we tested the hypothesis that obesity-related OAB is associated with reduced expression and activity of SK channels in DSM cells.

METHODS

Female Sprague-Dawley rats were fed a normal diet (ND) or a high-fat diet (HFD) and weighed after 12 weeks. We performed urodynamic study, single-cell quantitative reverse transcription-polymerase chain reaction (qRT-PCR), and patch-clamp electrophysiology.

RESULTS

Increased average body weights and urodynamically demonstrated OAB were observed in HFD rats. Single-cell qRT-PCR experiments discovered the decreased mRNA expression level of SK channel in DSM cell from HFD rats. Patch-clamp studies revealed that NS309, a SK channel activator, had an attenuated effect on membrane potential hyperpolarization in HFD DSM cells. In addition, the reduced whole cell SK channel currents were recorded in HFD DSM cells.

CONCLUSIONS

Attenuated SK channels expression and function, which results in the increased DSM cells excitability and contributes to DO, is discovered in obesity-related OAB DSM cells, suggesting that SK channels might be potential therapeutic targets to control OAB.

Built Environment and Childhood Weight Status: A Multi-Level Study Using Population-Based Data in the City of Hannover, Germany

In recent years, built environmental characteristics have been linked to childhood overweight, but the results remain inconsistent across studies. The present study examines associations between several built environmental features and body weight status (BMI) z-score among a large sample of preschool children in the city of Hannover, Germany. Walkability (Index), green space availability, and playground availability related to preschool children's home environments were measured using data from OpenStreetMap (OSM). These built environment characteristics were linked to the data from the 2010-2014 school entry examinations in the Hannover city (n = 22,678), and analysed using multilevel linear regression models to examine associations between the built environment features and the BMI z-score of these children (4-8 years old). No significant associations of built environmental factors on children's BMI were detected, but the effect between green space availability and BMI was modified by the parental educational level. In children with lower compared to higher educated parents, a higher spatial availability of greenspace was significantly associated with reduced body weight. Future research should continue to monitor the disparities in diverse built environment features and how these are related to children's health.

Longitudinal Trends and Risk Factors for Obesity Among Immigrants in Massachusetts

INTRODUCTION

Little is known about the longitudinal trends and factors associated with obesity and overweight among U.S. immigrants and ethnic minorities.

METHODS

At a large safety net health system in Massachusetts, 7,973 adults were followed retrospectively for 42.0 months on average from 2011 to 2016. Multivariate analyses were performed to identify factors associated with obesity (BMI ≥30 kg/m²) and overweight (BMI ≥25 kg/m²). Data were collected and analyzed in 2018-2019.

RESULTS

Obesity prevalence and trends were highest among Mexican/Central American men (32.6% in 2011 to 42.5% in 2016, p=0.03) and Haitian/black Caribbean women (37.5% to 51.5%, p<0.01). Mexican/Central American men had 564% (OR=5.64, 95% CI=4.02, 7.91) and women had 432% (OR=4.32, 95% CI=2.99, 6.23) higher odds of obesity compared with white, non-Hispanic men and women, respectively. Baseline age, weight, and duration of follow-up were associated with obesity among men (OR=1.02, 95% CI=1.02, 1.03; OR=1.16, 95% CI=1.15, 1.17; and OR=1.17, 95% CI=1.06, 1.30, respectively) and women (OR=1.01, 95% CI=1.01, 1.02; OR=1.18, 95% CI=1.17, 1.19; and OR=1.44, 95% CI=1.29, 1.61, respectively). East/Southeast Asians had the lowest obesity burdens. Most weight gains (63% among men and 75% among women) took place within 3 years.

CONCLUSIONS

Longitudinal obesity and overweight trends increased among all immigrants and ethnic minorities, primarily within the first 3 years, but significant variations existed. Mexican/Central American men and Haitian/black Caribbean women were disproportionately affected, approaching or exceeding U.S. rates. Targeted early prevention and treatment strategies are needed to reduce health disparities in obesity and unhealthy weight gain among immigrants.

Obesity and cardiovascular disease risk among Africans residing in Europe and Africa: the RODAM study

BACKGROUND

The association between anthropometric variables and cardiovascular disease (CVD) risk among Africans is unclear. We examined the discriminative ability of anthropometric variables and estimate cutoffs for predicting CVD risk among Africans.

METHODS

The Research on Obesity and Diabetes among African Migrants (RODAM) study was a multisite cross-sectional study of Africans in Ghana and Europe. We calculated AHA/ACC Pooled Cohort Equations (PCE) scores for 3661 participants to ascertain CVD risk, and compared a body shape index (ABSI), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), Relative Fat Mass (RFM), and Waist to Height Ratio (WHtR). Logistic regression and receiver operating curve analyses were performed to derive cutoffs for identifying high predicted CVD risk (PCE score ≥7.5%).

RESULTS

Among men, WC (adjusted Odds Ratio (aOR): 2.25, 95% CI; 1:50-3:37) was strongly associated with CVD risk. Among women, WC (aOR: 1.69, 95% CI: 1:33-2:14) also displayed the strongest association with CVD risk in the BMI-adjusted model but WHR displayed the strongest fit. All variables were superior discriminators of high CVD risk in men (c-statistic range: 0.887-0.891) than women (c-statistic range: 0.677-0.707). The optimal WC cutoff for identifying participants at high CVD risk was 89 cm among men and identified the most cases (64%). Among women, the recommended WC cutoff of 94 cm or WHR cutoff of 0.90 identified the most cases (92%).

CONCLUSIONS

Anthropometric variables were stronger discriminators of high CVD risk in African men than women. Greater WC was associated with high CVD risk in men while WHR and WC were associated with high CVD risk in women.

Food Insecurity and Major Diet-Related Morbidities in Migrating Children: A Systematic Review

Children of migrant families are known to be at a higher risk of diet-related morbidities due to complex variables including food insecurity, cultural and religious beliefs, and sociodemographic factors like ethnicity, socioeconomic status, and education. Several studies have assessed the presence of specific diseases related to dietary issues in migrant children. This systematic review aims to highlight the existing body of work on nutritional deficiencies in the specific vulnerable pediatric population of immigrants. Refugees were intentionally excluded because of fundamental differences between the two groups including the reasons for migration and health status at the time of arrival. A total of 29 papers were included and assessed for quality. Most of them described a strong correlation between obesity and migration. A high prevalence of stunting, early childhood caries, iron and vitamin D deficiency was also reported, but the studies were few and heterogeneous. Food insecurity and acculturation were found important social factors (nevertheless with inconclusive results) influencing dietary habits and contributing to the development of morbidities such as obesity and other metabolic disorders, which can cause progressive unsustainability of health systems. Public health screening for diet-related diseases in migrant children may be implemented. Educational programs to improve children’s diet and promote healthy-living behaviors as a form of socioeconomic investment for the health of the new generations may also be considered.

Hyperuricaemia and its association with 10-year risk of cardiovascular disease among migrant and non-migrant African populations: the RODAM study

OBJECTIVE

In the advent of rapid urbanisation, migration and epidemiological transition, the extent to which serum uric acid (sUA) affects cardiovascular disease (CVD) risk among Africans is not well understood. We assessed differences in sUA levels and associations with CVD risk among migrant Ghanaians in Europe and non-migrant Ghanaians in rural and urban Ghana.

METHODS

Baseline data from 633 rural, 916 urban and 2315 migrant participants (40-70 years) from the cross-sectional RODAM study were analysed. Hyperuricaemia was defined as sUA >7 mg/dl in men and >6 mg/dl in women. The 10-year risk of atherosclerotic cardiovascular disease (ASCVD) was calculated using the American College of Cardiology (ACC)/American Heart Association (AHA) risk score which takes into account ethnic minority populations. High CVD risk was defined as ASCVD risk scores ≥7.5%. Logistic regressions were used to assess associations between hyperuricaemia and CVD risk.

RESULTS

Prevalence for hyperuricaemia in rural, urban and migrant participants was 17.4%, 19.1% and 31.7% for men, and 15.9%, 18.2% and 33.2% for women, respectively. Hyperuricaemia was positively associated with elevated CVD risk among rural residents (adjusted OR for men 3.28, 95% CI: 1.21-8.96, 6.36, 95% CI: 2.98-13.56 for women), urban residents (1.12, 95% CI: 0.45-2.81 for men, 2.11, 95% CI: 1.26-3.52 for women) and migrants (1.73, 95% CI: 1.01-2.96 for men, 4.61, 95% CI: 3.05-6.97 for women).

CONCLUSION

Our study shows variations of sUA levels in different African contexts. Hyperuricaemia is associated with elevated 10-year CVD risk in both migrants and non-migrants. Further studies should identify factors driving associations between sUA and CVD risk in Africans.

Understanding local ethnic inequalities in childhood BMI through cross-sectional analysis of routinely collected local data

BACKGROUND

Local-level analysis of ethnic inequalities in health is lacking, prohibiting a comprehensive understanding of the health needs of local populations and the design of effective health services. Knowledge of ethnic disparities in child weight status is particularly limited by overlooking both the heterogeneity within ethnic groupings; and the complex ecological contexts in which obesity arises. This study aimed to establish whether there was variation in childhood BMI across ethnic groups in Coventry, and the influence of individual, school and neighbourhood contexts, using routinely collected local data.

METHODS

National Child Measurement Programme data were compiled for the period 2007/8-2014/15 and combined with routinely collected local data reflecting school performance and demographics, and school and neighbourhood physical environments. Multi-level modelling using Monte Carlo Markov Chain methods was used to account for the clustering of children within schools and neighbourhoods. Ethnic group differences in BMI z-score (zBMI) were explored at 4-5 years and 10-11 years for girls and boys alongside individual, school and neighbourhood covariates.

RESULTS

At age 4-5 years (n = 28,407), ethnic group differences were similar for boys and girls, with children from South Asian, White other, Chinese and 'any other' ethnic groups having a significantly lower zBMI, and Black African children having a higher zBMI, versus White British (WB) children. Patterns differed considerably at age 10-11 years (n = 25,763) with marked sex differences. Boys from White other, Bangladeshi and Black African groups had a significantly higher zBMI than WB boys. For girls, only children from Black ethnic groups showed a significantly higher zBMI. Area-level deprivation was the only important school or neighbourhood covariate, but its inclusion did not explain ethnic group differences in child zBMI.

CONCLUSION

This analysis contributes to the existing literature by identifying nuanced patterns of ethnic disparities in childhood adiposity in Coventry, supporting the targeting of early obesity prevention for children from Black African groups, as well as girls from Black Caribbean and Black other ethnic backgrounds; and boys from Bangladeshi and White other ethnic backgrounds. It also demonstrates the utility of exploring routinely collected local data sets in building a comprehensive understanding of local population needs.

Cohort profile: the Health of Philippine Emigrants Study (HoPES) to examine the health impacts of international migration from the Philippines to the USA

PURPOSE

The Health of Philippine Emigrants Study (HoPES) longitudinally investigates over 3 years whether migrating from the Philippines to the USA results in increased risk for obesity relative to non-migrants in the Philippines. The study is designed to test the healthy immigrant hypothesis by collecting health measures from migrants starting from a pre-migration baseline and enrolling a non-migrant cohort matched on age, gender and education for comparison.

PARTICIPANTS

A migrant cohort (n=832; 36.5% of eligible individuals) was recruited from clients of the Commission on Filipinos Overseas prior to exiting the Philippines. A non-migrant cohort (n=805; 68.6% eligible individuals) was recruited from community households in municipalities throughout the cities of Manila and Cebu. By intention, these two cohorts are comparable demographically, including urban/rural status of residency in the Philippines at baseline.

FINDINGS TO DATE

At baseline, compared with non-migrants, migrants report significantly better self-rated health and less depression, and have significantly larger hip circumference and lower waist-to-hip ratio, as well as significantly higher mean systolic blood pressure and higher mean level of apolipoprotein B. Baseline results can offer insight into the health status of both migrant and non-migrant populations and may be useful for obesity prevention efforts.

FUTURE PLANS

Longitudinal data collection is scheduled to be completed in December 2020 when the final data collection wave (36 months after baseline) will conclude. Both migrant and non-migrant cohorts will be maintained beyond the current prospective study, so long as research funding allows and emerges for new study questions. Findings from future longitudinal analyses can inform the need and design of health-related/relevant interventions, whether clinical, behavioural, educational, or policy, that can be implemented at the individual or population level.

Confounding effect of ethnic diversity on booking-in body mass index and prevalence of gestational diabetes and hypertensive disorders in pregnant women in western Sydney 1997-2016

BACKGROUND

Maternal obesity is a key risk factor for morbidity in pregnancy. Accurate data on trends in obesity are required in high-risk populations such as in western Sydney to implement effective policy.

AIMS

This study examines multi-site public hospital data on maternal ethnicity, body mass index (BMI), gestational diabetes mellitus (GDM) and hypertension across 20 years in Western Sydney Local Health District (WSLHD).

MATERIALS AND METHODS

This is a retrospective cohort study of all women who delivered a live birth beyond 20 weeks at Westmead, Blacktown and Auburn Hospitals (WSLHD) between 1 January 1997 and 31 December 2016.

RESULTS

There were 112 308 pregnant women included. Between 1997 and 2006, mean booking-in BMI climbed from 24.9 (median 23.9) to peak at 26.2 (24.9). It then fell to 25.3 (24.1) in 2012 before rising to 25.6 (24.4) in 2016. Rates of hypertensive disorders changed little over the period, with a small fall in pre-eclampsia. In contrast, there was a progressive upward trend in the prevalence of GDM, accelerating considerably after 2010. These trends were associated with a shifting ethnic profile with proportions of Australia/New Zealand-born women falling from 56.9% to 36.8%, while those from South Asia increased from 4.5% to 26.3%.

CONCLUSIONS

Western Sydney booking-in BMI fluctuated between 1997 and 2016, reaching its peak in 2006. Despite this, rates of GDM progressively rose, with one in six mothers in western Sydney now diagnosed with some form of the condition. Both patterns are associated with a notable shift in the ethnic profile of patients booking-in to antenatal care in the region.

Unraveling common threads in obesity risk among racial/ethnic minority and migrant populations

BACKGROUND

Epidemic obesity poses a major threat to global health. This phenomenon reflects the inability of the average person to cope, biologically and behaviorally, with environmental contexts that promote caloric overconsumption and inadequate caloric expenditure. There is still much to be learned about how to improve these contexts nationally and within-countries for sociodemographic groups with above-average obesity risks.

METHODS

Higher obesity risks relative to respective white majority populations were identified among diverse indigenous, other native-born, or migrant 'racial' or ethnic minority (hereafter, ethnic minority) populations in the United States, Canada, Australia, New Zealand, and the Netherlands, using publicly available national survey data or other sources. Cross-national comparisons were of interest for identifying common risk pathways associated with social and economic inequities. Potential explanations were explored through a narrative review of peer-reviewed literature, informed by the World Health Organization's Conceptual Framework for Action on The Social Determinants of Health.

MAIN FINDINGS

Identifying viable solutions to the high risk of obesity in ethnic minority populations in these high-income countries requires examination of national-level social, economic, and health system contexts, food systems, and built environments for physical activity, as well as patterns of social stratification and cultural biases related to ethnicity, migration, and other determinants of social disadvantage. These factors can be linked to mediators of exposure or vulnerability to obesity-related risks, such as poverty, being an 'outsider', stress and trauma resulting from historical and current oppression, exposure to bias and discrimination, related biological or behavioral consequences, and inadequate health and social care.

CONCLUSIONS

Focusing on ethnic minority populations in high-income countries is critical for public health efforts to address epidemic obesity. Mitigating intersecting risk pathways arising from stratification and bias based on ethnicity and migrant status should be prominent in these efforts.

'The hunger trap hypothesis': New horizons in understanding the control of food intake

The global obesity epidemic continues to present significant challenges to individuals and healthcare providers. Public health initiatives to tackle the rise in overweight and obesity in developed and developing nations have largely failed to tackle the problem and research into the underlying causes is of increasing importance. Central to understanding overconsumption of calories is an appreciation of the mechanisms of hunger and satiety. Research to date has revealed considerable detail regarding meal size, macronutrient composition of the diet and control of energy balance via adipose store derived signalling. It is clear however that such control mechanisms are overwhelmed in a significant proportion of the population. We hypothesize the hitherto under-researched possibility that micronutrient status may have an important role in energy balance. Poor vitamin and mineral profiles in the diets of the obese may potentiate overconsumption of calories due to an insufficiency of micronutrient intake relative to macronutrient consumption, a situation aggravated by increased requirements in the obese state. Amongst the multiplicity of metabolic and biochemical processes dependent upon micronutrients and which are impacted by their relative insufficiency, there may be triggers for increased food consumption in an attempt to bridge the gap between high energy consumption and low co-factor availability. This 'hunger trap' will continue as long as low nutrient density foods represent the mainstay of the diet. The accepted paradigm of variety seeking leading to vitamin and mineral adequacy of diets may not apply in the context of highly processed foods which use technological means to mimic organoleptic properties of nutrient density without delivering the same at the level of metabolism.