Obesity and labor market outcomes among legal immigrants to the United States from developing countries

This paper studies the association between weight and labor market outcomes among legal immigrants to the United States from developing countries using the first nationally representative survey of such individuals. We find that being overweight or obese is associated with a lower probability of employment among women who have been in the U.S. less than five years, but we find no such correlation among men who have been in the U.S. less than five years, or among women or men who have been in the U.S. longer than five years. We generally find no significant association between weight and either wages, sector of employment, or work limitations for either women or men. Possible explanations for these findings are discussed.     

Age at arrival and risk of obesity among US immigrants

Although immigrants are a rapidly growing subgroup, little is known about overweight/obesity among the foreign-born in the United States, especially regarding the effect of age at arrival. This study determined whether overweight/obesity prevalence is associated with age at arrival of immigrants to the United States. We analyzed data on 6,421 adult immigrants from the New Immigrant Survey (NIS), a study that is nationally representative of adult immigrants with newly acquired legal permanent residence (LPR). Multiple regression analyses tested the effects of duration of residence and age at arrival on overweight/obesity, defined by BMI of > or = 25 kg/m(2), and self-reported dietary change score. We found the relationship between duration of residence and overweight/obesity prevalence varied by age at arrival (P < 0.001). Immigrants < or = 20-years old at arrival who had resided in the United States > or = 15 years were 11 times (95% confidence interval: 5.33, 22.56) more likely to be overweight/obese than immigrants < 20-years old at arrival who had resided in the United States < or = 1 year. By comparison, there was no difference in overweight/obesity prevalence by duration among immigrants who arrived at >50 years of age. Higher self-reported dietary change is also associated with overweight/obesity. In conclusion, immigrants younger than 20 at arrival in the United States may be at higher risk of overweight/obesity with increasing duration of residence than those who arrive at later ages. Obesity prevention among young US immigrants should be a priority.     

Height and BMI of Italian immigrants to the USA, 1908–1970

We analyze self-reported anthropometric data pertaining to 2140 adults who emigrated to the United States, mainly from southern Italy, between 1908-1928 and 1960-1970. The mean height of immigrant men was 165.5 cm: they were taller than contemporary southern Italian men by 0.5-7.3 cm in different periods. The mean height of the Italian immigrant women born before 1952 was 157.6 cm, less than the national average. At the end of the 1990s, national women average height was 162 cm, 159.5 cm for southern women. There were age-related increases of weight and BMI: overweight was more prevalent in the 40-49 years age category. In the male sample, the mean values of BMI were within the overweight range in all age classes. The prevalence of obesity was higher in the male sample than among US men, whereas it was virtually identical in the women's sample and much higher than the values reported for several European countries for the period 1970-1980.     

Human variation and body mass index: a review of the universality of BMI cut-offs, gender and urban-rural differences, and secular changes

Use of BMI as a surrogate for body fat percentage is debatable and universal BMI cut-off points do not seem appropriate; lower cut-off points than currently recommended by WHO should be used in some populations, especially in Asia. The adult WHO BMI database indicates that, on average, women are more obese than men, while men are more likely to be pre-obese than women. Urban rates of overweight and obesity are generally higher than rural rates in both sexes. The trend in pre-obesity and obesity over time is generally upward, with very marked increases in the USA and UK in both sexes over the last 10 years.     

From “Overweight” to “About Right”: Evidence of a Generational Shift in Body Weight Norms

In this article, we describe differences in the self‐perception of weight status in the United States between the two most recent National Health and Nutrition Examination Survey (NHANES) periods (1988–1994 and 1999–2004), and test the hypothesis that secular increases in adult mean BMI, adult obesity, and childhood obesity contributed to changes over time in weight perceptions. We find that the probability of self‐classifying as overweight is significantly lower on average in the more recent survey, for both women and men, controlling for objective weight status and other factors. Among women, the decline in the tendency to self‐classify as overweight is concentrated in the 17–35 age range, and is more pronounced among women with normal BMI than those with overweight BMI. Among men, the shift away from feeling overweight is roughly equal across age groups. Overweight men exhibit a sharper decline in feeling overweight than normal weight men. Despite the declines in feeling overweight between surveys, weight misperception did not increase significantly for men and decreased by a sizable margin among women. We interpret the findings as evidence of a generational shift in social norms related to body weight. As a result, people may be less likely to desire weight loss than previously, limiting the effectiveness of public health campaigns aimed at weight reduction. On the other hand, there may be health benefits associated with improved body image.     

The association of BMI with functional status and self-rated health in US adults

Objective: To examine the association of BMI with functional status and self‐rated health among US adults and how the association differs by age and sex. Methods and Procedures: All analyses are based on the National Health Interview Survey (NHIS), 1997–2005, a yearly, representative study of the US household population. We pooled all survey years and fitted logistic regression for the two sexes and three age strata (ages 18–44, 45–64, and ≥65). Results: Our study found that although underweight and severe obesity are consistently associated with increased disability and poorer health status, overweight and moderate obesity show associations that vary considerably by age and sex. For men, the adjusted odds ratios (ORs) for disability and poor/fair self‐rated health tended to be lowest among overweight persons, especially for ages ≥45. Among men with moderate obesity, the risk of disability was elevated for ages 18–44 but lower for ages ≥65. For women, the adjusted ORs for disability and poor/fair self‐rated health tended to be lowest among normal‐weight persons, particularly for ages ≤45. Compared to normal‐weight counterparts, overweight women aged ≥65 had a lower risk of disability but a somewhat elevated risk of poor/fair self‐rated health. Discussion: The results suggest that the association of BMI with functional status and self‐rated health varies significantly across ages and sexes. The variations in the association of BMI with functional status and self‐rated health suggest that a single “ideal body weight category” may not be appropriate for all persons or all health outcomes.     

Minimum Wage and Overweight and Obesity in Adult Women: A Multilevel Analysis of Low and Middle Income Countries

Objectives

To describe the relationship between minimum wage and overweight and obesity across countries at different levels of development.

Methods

A cross-sectional analysis of 27 countries with data on the legislated minimum wage level linked to socio-demographic and anthropometry data of non-pregnant 190,892 adult women (24–49 y) from the Demographic and Health Survey. We used multilevel logistic regression models to condition on country- and individual-level potential confounders, and post-estimation of average marginal effects to calculate the adjusted prevalence difference.

Results

We found the association between minimum wage and overweight/obesity was independent of individual-level SES and confounders, and showed a reversed pattern by country development stage. The adjusted overweight/obesity prevalence difference in low-income countries was an average increase of about 0.1 percentage points (PD 0.075 [0.065, 0.084]), and an average decrease of 0.01 percentage points in middle-income countries (PD -0.014 [-0.019, -0.009]). The adjusted obesity prevalence difference in low-income countries was an average increase of 0.03 percentage points (PD 0.032 [0.021, 0.042]) and an average decrease of 0.03 percentage points in middle-income countries (PD -0.032 [-0.036, -0.027]).

Conclusion

This is among the first studies to examine the potential impact of improved wages on an important precursor of non-communicable diseases globally. Among countries with a modest level of economic development, higher minimum wage was associated with lower levels of obesity.

Research Highlights

• Many economic factors are known to influence overweight and obesity, yet evidence on policy-related determinants is scant.
• We examined national minimum wage levels and measured overweight/obesity using multilevel models for 27 developing countries.
• We found a weak but significant lower probability of being overweight or obese associated with higher levels of minimum wage in more developed countries, and a small increase in prevalence in the least developed countries.
• Results suggested a potential societal effect of minimum wage on overweight and obesity that should be examined longitudinally to determine its potential as a structural intervention.

     

Stigmatized Students: Age,Sex, and Ethnicity Effects in the Stigmatization of Obesity

Objective: To assess the stigmatization of obesity relative to the stigmatization of various disabilities among young men and women. Attitudes across ethnic groups were compared. In addition, these findings were compared with data showing severe stigmatization of obesity among children. Research Methods and Procedures: Participants included 356 university students (56% women; mean age, 20.6 years; mean BMI, 23.3 kg/m²; range, 14.4 to 45.0 kg/m²) who ranked six drawings of same‐sex peers in order of how well they liked each person. The drawings showed adults with obesity, various disabilities, or no disability. These rankings were compared with those obtained through a similar procedure with 458 fifth‐ and sixth‐grade children. Results: Obesity was highly stigmatized relative to physical disabilities. African‐American women liked obese peers more than did African‐American men, white men, or white women [F (1, 216) = 4.02, p < 0.05]. Overweight and obese participants were no less stigmatizing of obesity than normal weight participants. Adults were more accepting than children of their obese peers [t (761) = 9.16, p < 0.001]. Discussion: Although the stigmatization of obesity was high among participants overall, African‐American women seemed to have more positive attitudes toward obesity than did white women, white men, or African‐American men. Participants’ weight did not affect their stigmatization of obesity: obese and overweight adults were as highly stigmatizing of obesity as non‐overweight adults. Such internalized stigmatization could help to explain the low self‐esteem and poor body image among obese young adults. However, adults seemed to have more positive attitudes about obesity than children. An understanding of the factors that limit the stigma of obesity among African‐American women could help efforts to reduce stigma.     

Relationships between neighborhoods, physical activity, and obesity: a multilevel analysis of a large canadian city

In Canada, there is limited research examining the associations between objectively measured neighborhood environments and physical activity (PA) and obesity. The purpose of this study was to determine the relationships between variables from built and social environments and PA and overweight/obesity across 86 Ottawa, Canada neighborhoods. Individual-level data including self-reported leisure-time PA (LTPA), height, and weight were examined in a sample of 4,727 adults from four combined cycles (years 2001/03/05/07) of the Canadian Community Health Survey (CCHS). Data on neighborhood characteristics were obtained from the Ottawa Neighbourhood Study (ONS); a large study of neighborhoods and health in Ottawa, Canada. Binomial multivariate multilevel models were used to examine the relationships between environmental and individual variables with LTPA and overweight/obesity using survey weights in men and women separately. Within the sample, ~75% of the adults were inactive (<3.0 kcal/kg/day) while half were overweight/obese. Results of the multilevel models suggested that for females greater park area was associated with increased odds of LTPA and overweight/obesity. Greater neighborhood density of convenience stores and fast food outlets were associated with increased odds of females being overweight/obese. Higher crime rates were associated with greater odds of LTPA in males, and lower odds of male and female overweight/obesity. Season was significantly associated with PA in men and women; the odds of LTPA in winter months were half that of summer months. Findings revealed that park area, crime rates, and neighborhood food outlets may have different roles with LTPA and overweight/obesity in men and women and future prospective studies are needed.     

Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic

We projected future prevalence and BMI distribution based on national survey data (National Health and Nutrition Examination Study) collected between 1970s and 2004. Future obesity-related health-care costs for adults were estimated using projected prevalence, Census population projections, and published national estimates of per capita excess health-care costs of obesity/overweight. The objective was to illustrate potential burden of obesity prevalence and health-care costs of obesity and overweight in the United States that would occur if current trends continue. Overweight and obesity prevalence have increased steadily among all US population groups, but with notable differences between groups in annual increase rates. The increase (percentage points) in obesity and overweight in adults was faster than in children (0.77 vs. 0.46-0.49), and in women than in men (0.91 vs. 0.65). If these trends continue, by 2030, 86.3% adults will be overweight or obese; and 51.1%, obese. Black women (96.9%) and Mexican-American men (91.1%) would be the most affected. By 2048, all American adults would become overweight or obese, while black women will reach that state by 2034. In children, the prevalence of overweight (BMI >/= 95th percentile, 30%) will nearly double by 2030. Total health-care costs attributable to obesity/overweight would double every decade to 860.7-956.9 billion US dollars by 2030, accounting for 16-18% of total US health-care costs. We continue to move away from the Healthy People 2010 objectives. Timely, dramatic, and effective development and implementation of corrective programs/policies are needed to avoid the otherwise inevitable health and societal consequences implied by our projections .     

Access to medical care for documented and undocumented Latinos in a southern California county.

To determine local access to medical care among Latinos, we conducted telephone interviews with residents of Orange County, California. The survey replicated on a local level the national access surveys sponsored by the Robert Wood Johnson Foundation. We compared access among Latino citizens of the United States (including permanent legal residents), undocumented Latinos, and Anglos, and analyzed predictors of access. Among the sample of 958 respondents were 137 Latino citizens, 54 undocumented Latinos, and 680 Anglos. Compared with Anglos, Latino citizens and undocumented immigrants had less access to medical care by all measures used in the survey. Although undocumented Latinos were less likely than Latino citizens to have health insurance, by most other measures their access did not differ significantly. By multivariate analysis, health insurance status and not ethnicity was the most important predictor of access. Because access to medical care is limited for both Latino citizens and undocumented immigrants, policy proposals to improve access for Latinos should consider current barriers faced by these groups and local differences in access to medical care.     

Relationships of Psychiatric Disorders with Overweight and Obesity in an Adult General Population**

Objective: To explore relationships of smoking and risk drinking status, nicotine and alcohol dependence, and anxiety, depressive, and somatoform disorders with overweight and obesity. Research Methods and Procedures: A probability sample was drawn that was representative for the adult general population, 18 to 64 years of age, in one region of Germany; the participation rate was 70.2%. After excluding those who were pregnant or had a current eating disorder according to the DSM‐IV, 4063 individuals remained. Overweight and obesity were defined according to the BMI that was assessed in the face‐to‐face in‐home standardized interview (Composite International Diagnostic Interview) on psychiatric disorders. Results: Men with a former nicotine dependence had higher odds of being overweight than men who never had a nicotine dependence (adjusted odds ratio, 1.5; confidence interval, 1.1 to 2.1). Men at current risk for drinking and current alcohol‐dependent or abusing men had lower odds of being overweight compared with men who never were alcohol dependent, abusing, or at risk for drinking (adjusted odds ratio, 0.3; confidence interval, 0.8 to 0.9). Effect sizes were small. No relationship of overweight with depressive, anxiety, or somatoform disorders was found in the multivariate analysis. Discussion: There is a relationship between being overweight and nicotine and alcohol dependence or abuse among men but not among women. Even though one reason for women to refrain from quitting smoking is the fear of weight gain, these results do not support this. This information could help convince women to try to quit smoking.     

Immigration and obesity among lower income blacks

Objective: Our objective was to examine the associations of nativity, immigrant generation, and language acculturation with obesity among lower income black adult men and women. Research Methods and Procedures: Data from 551 black adult men and women were collected from participants in the Healthy Directions‐Health Centers Study. Race/ethnicity and nativity were self‐reported. Language acculturation was defined using participants’ first language, preferred reading language, and language spoken at home. Mixed model logistic regression models were estimated to account for within‐health center clustering. Results: Foreign‐born blacks had a lower obesity risk, compared with all U.S.‐born participants, in multivariable analyses [odds ratio (OR) = 0.57, 95% confidence interval (CI), 0.38, 0.84]. Among U.S.‐born participants, those with foreign‐born parents were significantly less likely to be obese than individuals with U.S.‐born parents (OR = 0.54; 95% CI, 0.37, 0.80). Low‐moderate language acculturation also decreased the odds of being obese (OR = 0.45; 95% CI, 0.23, 0.88). Discussion: Our findings suggest a protective effect of foreign‐born status and low‐moderate language acculturation on obesity risk among lower income black immigrants. These data highlight the importance of more frequently examining nativity in obesity‐related research conducted among blacks.     

BMI and health status among adults with asthma

Background: A convincing body of literature links obesity with a higher risk for developing adult‐onset asthma. The impact of obesity on asthma severity among adults with pre‐existing asthma, however, is less clear. Methods and Procedures: In a prospective cohort study of 843 adults with severe asthma, we studied the impact of BMI on asthma health status. Results: The prevalence of obesity and overweight were 44% (95% confidence interval (CI) 41–47%) and 28% (95% CI 25–32%). The obese BMI group was associated with a higher risk for daily or near daily asthma symptoms than was the normal BMI group (odds ratio (OR) 1.81; 95% CI 1.10–2.96). Compared to the normal BMI group, generic physical health status was worse in the overweight (mean score decrement ?2.42 points; 95% CI ?4.39 to ?0.45) and the obese groups (?6.31 points; 95% CI ?8.14 to ?4.49). Asthma‐specific quality of life was worse in the underweight (mean score increment 8.66 points; 95% CI 2.53–14.8) and obese groups (4.51 points; 95% CI 2.21–6.81), compared to those with normal BMI. Obese persons also had a higher number of restricted activity days that past month (5.05 days; 95% CI 2.90–7.19 days). Discussion: It appears that obesity has a substantive negative effect on health status among adults with asthma. Further work is needed to clarify the precise mechanisms. Clinicians should counsel dietary modification and weight loss for their overweight and obese patients with asthma.     

Trends in the prevalence of abdominal obesity and overweight in English adults (1993-2008)

The rising prevalence of generalized obesity is well documented, but less is known about trends in abdominal obesity. Levels of abdominal obesity and overweight are reported for adults in the Health Survey for England (HSE) by survey year and age for 1993-2008. HSE is a nationally representative cross-sectional population survey using an interviewer-administered questionnaire and measurement of waist circumference (WC) by nurse, allowing calculation of abdominal overweight and obesity (≥94 cm and ≥102 cm in men, and ≥80 cm and ≥88 cm in women). A total of 40,001 men and 46,397 women aged 18-67 provided data on WC in this period. Between 1993 and 2008 abdominal overweight rose from 44.9% to 62.3% in men, and from 46.6% to 66.8% in women, while abdominal obesity rose from 19.2% to 35.7% in men, and from 23.8% to 43.9% women. However, the rates of increase over time in England appear to be slowing down: curves with a less than linear increase each year were a better fit to the data than a linear trend. There was some variation across the age range in the time trend in abdominal obesity and overweight, in that the absolute increases over time were slightly less for younger adults.     

Parental misclassification of child overweight/obese status: The role of parental education and parental weight status

Childhood overweight and obesity is a major public health challenge for policymakers in many countries. As the most common supervisors of children’s activities, parents have a potentially important role to play in obesity prevention. However, a precondition for parents to improve their children’s diets, encourage them to be more physically active, or take them to see a doctor about their weight is for the parent to first recognize that their child is overweight or obese. This paper examines the extent of parental misclassification of child weight status, and its correlates, focusing on the role of parental education and the parent’s own obesity status. We find evidence that, among non-obese parents, those who are better-educated report their child’s weight status more accurately, but among obese parents, the better-educated are 45.18% more likely than parents with lower secondary education to give a false negative report of their child’s overweight/obesity; this may reflect social desirability bias.     

Prevalence and Covariates of Obesity in Lebanon: Findings from the First Epidemiological Study

Objective: To estimate the prevalence of overweight and obesity and examine associated covariates in the Lebanese population. Research Methods and Procedures: A cross‐sectional survey of a representative sample of 2104 individuals, 3 years of age and older. Anthropometric measurements and dietary assessments were conducted following standard methods and techniques. Overweight and obesity (classes I to III) were defined according to internationally standardized criteria for classification of BMI. Results: For children 3 to 19 years of age, prevalence rates of overweight and obesity were higher overall for boys than girls (22.5% vs. 16.1% and 7.5% vs. 3.2%, respectively). For adult men and women (age ≥ 20 years), the prevalence of overweight was 57.7% and 49.4%, respectively. In contrast, obesity (BMI ≥ 30 kg/m²) was higher overall among women (18.8%) than men (14.3%), a trend that became more evident with increasing obesity class. BMI, percentage of body fat, and waist circumference increased to middle age and declined thereafter. Whereas lack of exercise associated significantly with obesity among children, obesity in older adults was more prevalent among the least educated, nonsmokers, and those reporting a family history of obesity. Discussion: The results from this national population‐based study in Lebanon show high prevalence rates of overweight and obesity comparable with those observed in developed countries such as the United States. While further studies are needed to examine the underlying social and cultural factors associated with lifestyle and nutritional habits, now is the time to institute multicomponent interventions promoting physical activity and weight control nationwide.     

The Bright Side and Dark Side of Workplace Social Capital: Opposing Effects of Gender on Overweight among Japanese Employees

Background

A growing number of studies have sought to examine the health associations of workplace social capital; however, evidence of associations with overweight is sparse. We examined the association between individual perceptions of workplace social capital and overweight among Japanese male and female employees.

Methodology/Principal Findings

We conducted a cross-sectional survey among full-time employees at a company in Osaka prefecture in February 2012. We used an 8-item measure to assess overall and sub-dimensions of workplace social capital, divided into tertiles. Of 1050 employees, 849 responded, and 750 (624 men and 126 women) could be linked to annual health check-up data in the analysis. Binomial logistic regression models were used to calculate odds ratios and 95% confidence intervals for overweight (body mass index: ≥25 kg/m², calculated from measured weight and height) separately for men and women. The prevalence of overweight was 24.5% among men and 14.3% among women. Among men, low levels of bonding and linking social capital in the workplace were associated with a nearly 2-fold risk of overweight compared to high corresponding dimensions of social capital when adjusted for age, sleep hours, physiological distress, and lifestyle. In contrast, among women we found lower overall and linking social capital to be associated with lower odds for overweight even after covariate adjustment. Subsequently, we used multinomial logistic regression analyses to assess the relationships between a 1 standard deviation (SD) decrease in mean social capital and odds of underweight/overweight relative to normal weight. Among men, a 1-SD decrease in overall, bonding, and linking social capital was significantly associated with higher odds of overweight, but not with underweight. Among women, no significant associations were found for either overweight or underweight.

Conclusions/Significance

We found opposite gender relationships between perceived low linking workplace social capital and overweight among Japanese employees.     

Trends in Overweight and Obesity in Portugal: The National Health Surveys 1995–6 and 1998–9

Objective: To assess overweight and obesity trends in the Portuguese population. Research Methods and Procedures: National Health Surveys, conducted in 1995–6 (17, 989 men; 20, 249 women) and 1998–9 (17, 923 men; 20, 302 women), were used. Results: In men, the prevalence of overweight and obesity increased from 39.9% (95% CI: 39.2 to 40.6) and 10.3% (95% CI: 9.9 to 10.7), respectively, in 1995–6, to 42.5% (95% CI: 41.8 to 43.2) and 11.5% (95% CI: 11.0 to 12.0), respectively, in 1998–9. In women, prevalence of obesity increased from 12.7% (95% CI: 12.2 to 13.2) in 1995–6 to 14.2% (95% CI: 13.7 to 14.6) in 1998–9, whereas the prevalence of overweight remained stable: 32.2% (95% CI: 31.6 to 32.9) in 1995–6 and 32.3% (95% CI: 31.6 to 32.9) in 1998–9. In men, prevalence of overweight and obesity were higher among former smokers and educational group of 6 to 12 years, and prevalence of obesity was higher in the Lisbon region. In women, prevalence of overweight and obesity were higher among never smokers, and prevalence of obesity was higher among educational group of ?6 years. Prevalence of obesity was higher in the Alentejo region, and overweight was higher in the Center region. Finally, prevalence of obesity increased in both sexes for all strata studied (age, smoking status, educational level, and geographic region), whereas prevalence of overweight increased only in men. Discussion: In Portugal, overweight and obesity levels are related to sociodemographic factors; the increase in obesity levels stresses the need for preventive measures.     

Sex differences in obesity rates in poor countries: Evidence from South Africa

Globally, men and women face markedly different risks of obesity. In all but of handful of (primarily Western European) countries, obesity is much more prevalent among women than men. We examine several potential explanations for this phenomenon. We analyze differences between men and women in reports and effects of potential underlying causes of obesity—childhood and adult poverty, depression, and attitudes about obesity. We evaluate the evidence for each explanation using data collected in an urban African township in the Cape Town metropolitan area. Three factors explain the greater obesity rates we find among women. Women who were nutritionally deprived as children are significantly more likely to be obese as adults, while men who were deprived as children face no greater risk. In addition, women of higher adult socioeconomic status are significantly more likely to be obese, which is not true for men. These two factors - childhood circumstances and adult SES - can fully explain the difference in obesity rates between men and women that we find in our sample. More speculatively, in South Africa, women's perceptions of an ‘ideal’ female body are larger than men's perceptions of the ‘ideal’ male body, and individuals with larger ‘ideal’ body images are significantly more likely to be obese.