Longitudinal Trends and Risk Factors for Obesity Among Immigrants in Massachusetts

Inequities in routine preventive care utilization among persons with overweight/obesity in the United States: An analysis of nativity, racial and ethnic identity, and socioeconomic status

Extant literature documented various health disparities among immigrants and racial and ethnically marginalized individuals in the United States. However, health disparities in the intersection of nativity and race are generally less visited. This cross-sectional study assessed utilization of routine preventive care among adults with overweight/obesity at the junction of their nativity, racial/ethnic identity, and socioeconomic status (i.e., income and education). Pooling data on 120,184 adults with overweight/obesity from the 2013-2018 waves of the National Health Interview Survey (NHIS), we estimated modified Poisson regressions with robust standard errors to obtain adjusted prevalence rates of preventive care visit, receiving flu shot, and having blood pressure, cholesterol and blood glucose screened. We found that immigrant adults with overweight/obesity had lower rates of utilization of all five preventive care services. However, these patterns varied by racial and ethnic sub-populations. While White immigrants had comparable rates of cholesterol and blood glucose screening, they had 2.7%, 2.9%, and 14.5% lower rates of preventive care visit, blood pressure screening, and getting a flu shot respectively, compared to native-born Whites. These patterns were similar for Asian immigrants as well. Black immigrants, on the other hand, had comparable rates of getting a flu shot and blood glucose screening, and had 5.2%, 4.9%, and 4.9% lower rates of preventive care visit, blood pressure screening, and cholesterol screening respectively. Lastly, the rates of utilization among Hispanic immigrants were significantly lower (ranging from 9.2% to 20%) than those of their native-born counterparts for all five preventive care services. These rates further varied by education, income, and length of stay in the US, within the racial and ethnic subgroups. Our findings thus suggest a complex relationship between nativity and racial/ethnic identity in relation to preventive care utilization among adults with overweight/obesity.

Impact of the COVID-19 pandemic lockdown on weight status and factors associated with weight gain among adults in Massachusetts

The study aims to examine the impact of the coronavirus disease-2019 (COVID-19) pandemic lockdown on weight, overweight and obesity, and identify factors associated with weight gain. At a safety net health system in Massachusetts, 11 534 adults were retrospectively followed within 3 months of the COVID-19 lockdown. Chi-square and 95% confidence intervals (CI) were reported for categorical and continues variables, respectively. Multivariate analyses were performed to identify factors associated with weight gain (≥0.01 kg and 5%). During the lockdown period, greater proportion of women gained weight compared to men (46.1% vs 40.6%, P < .01). The obesity rate after the lockdown increased among women (40.7%-41.7, P < .01) but decreased among men (39.6%-38.6, P < .01) compared to before the lockdown. Post-lockdown obesity rates increased among Haitian (51.2%-55.0%, P < .01) and Hispanic women (50.7%-51.8%, P < .01). More than 5% weight gain was associated with 18 to 39 vs ≥60 years of age (OR = 1.45, 95% CI = 1.07, 1.97), food and housing insecurity (OR = 1.44, 95% CI = 1.05, 1.97) and tobacco use (OR = 1.38, 95% CI = 1.07, 1.78) among men; and 18 to 39 vs ≥60 years of age (OR = 1.55, 95% CI = 1.25, 1.91), Hispanics (OR = 1.25, 95% CI = 1.01, 1.54), Brazilians (OR = 1.22, 95% CI = 1.03, 1.45), and tobacco use (OR = 1.36, 95% CI = 1.10, 1.69) among women. During the COVID-19 lockdown, significant proportion of participants gained weight, but subgroup variations existed. Our study can inform healthcare professionals about the impact of the lockdown on unhealthy weight gain and identify vulnerable populations. Strategies are needed to combat unhealthy weight gain during and beyond the pandemic.

Association among length of residence, physical activity, and obesity in the US immigrants: A regression-based mediation analysis

OBJECTIVES

To examine the mediated relationship between objectively measured obesity, accelerometer-based moderate-to-vigorous physical activity (MVPA), and length of residence among US immigrants.

METHODS

A total of 885 adults (≥18 years) who were born outside the United States from the 2003 to 2006 National Health and Nutrition Examination Survey were included in the analysis. The participants were categorized into two groups (i.e., living in the United States ≥15 years vs. <15 years). MVPA time (minutes/day) was measured by ActiGraph accelerometry. Obesity was defined as body fat percentage measured by dual-energy X-ray absorptiometry. Regression-based mediation analysis was conducted using SURVEY procedures in SAS version 9.4.

RESULTS

When controlling for covariates, immigrants living in the United States for ≥15 years were significantly less likely to spend time participating in MVPA (c; β = -4.50, p = .04), and more likely to be at high risk of obesity (a; β = 1.70, p = .01) compared to those living in the United States for <15 years. Also, the relationship between obesity and MVPA was statistically significant (b; β = -0.80, p = .003). Length of residence was indirectly associated with MVPA (ab; β = -1.37, p = .03), suggesting that obesity mediated the association of length of residence on MVPA (c'; β = -3.13, p = .20).

CONCLUSIONS

Obesity mediated the association between length of residence and MVPA in the US immigrants. These findings may encourage long-term US immigrants to prevent and treat obesity for increasing the amount of MVPA time.