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 ≥25 kg/m2, 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 ≤20‐years old at arrival who had resided in the United States ≥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 ≤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.

As the number of immigrants in the USA continues to rise, it becomes increasingly important to understand how their health differs from native-born individuals. Obesity is a public health concern and a component of health that may differ and change in important ways in immigrants. This research synthesizes the current literature on the relationship between immigrant duration of residence in the USA and body weight. Five databases from the health and social sciences were searched for all pertinent publications. Fifteen articles met inclusion criteria, 14 of which reported a significant, positive relationship between body mass index and duration of residence in the USA (all P-values <0.10). Two studies reported a threshold effect of weight gain after 10 years of US residence, and another study reported that body mass index peaks after 21 years of duration for men and after 15 years for women. The results of this review suggest that weight gain prevention programmes would be beneficial for many immigrants within the first decade of residence in the USA. Prevention efforts may be more successful if nativity and acculturation are considered in addition to race/ethnicity. Future research is needed to identify the specific mechanisms through which living in the USA may adversely affect health outcomes.

OBJECTIVETo compare diabetes prevalence among Asian Americans by World Health Organization and U.S. BMI classifications.RESEARCH DESIGN AND METHODSData on Asian American adults (n = 7,414) from the National Health Interview Survey for 1997–2005 were analyzed. Diabetes prevalence was estimated across weight and ethnic group strata.RESULTSRegardless of BMI classification, Asian Indians and Filipinos had the highest prevalence of overweight (34–47 and 35–47%, respectively, compared with 20–38% in Chinese; P < 0.05). Asian Indians also had the highest ethnic-specific diabetes prevalence (ranging from 6–7% among the normal weight to 19–33% among the obese) compared with non-Hispanic whites: odds ratio (95% CI) for Asian Indians 2.0 (1.5–2.6), adjusted for age and sex, and 3.1 (2.4–4.0) with additional adjustment for BMI.CONCLUSIONSAsian Indian ethnicity, but not other Asian ethnicities, was strongly associated with diabetes. Weight classification as a marker of diabetes risk may need to accommodate differences across Asian subgroups.

Considerable heterogeneity in both prevalence of overweight and diabetes by region of birth highlights the importance of making this distinction among US immigrants to better identify subgroups with higher risks of these conditions.

Although at arrival, US immigrants have a lower prevalence of overweight compared to native born individuals, prevalence increases with increased length of residence. It is unknown whether length of residence similarly affects diabetes. Data on adults aged 18-74 years from the National Health Interview Survey were pooled from 1997 to 2005 (n = 33,499). Diabetes prevalence by length of residence was estimated by multivariable logistic regression. Diabetes prevalence was higher with increased length of residence in the US, independent of age and body mass index (<5 years residence: 3.3%; 5-<10 year, 3.4%; 10-<15 year, 4.5%; 15+ year, 5.3%; P for trend <0.001). Length of residence had the largest effect on diabetes prevalence among immigrants who arrive at 25-44 years of age (prevalence: 1.4% for <5 year vs. 11.1% for 15+ year; odds ratio = 9.7 (95% CI: 5.2-18.1)). Despite differences in the associations between diabetes prevalence and length of residence by age at immigration, diabetes prevalence at 10-≤15 and 15± years was statistically similar in each age at immigration strata. Diabetes prevalence increased with length of residence, independent of age and obesity, and was modified by age at immigration. Diabetes prevalence reaches a plateau at 10+ years of residence and diabetes prevention efforts should, therefore, start soon after migration.

ObjectiveState-level estimates of obesity based on self-reported height and weight suggest a geographic pattern of greater obesity in the Southeastern US; however, the reliability of the ranking among these estimates assumes errors in self-reporting of height and weight are unrelated to geographic region.Design and MethodsWe estimated regional and state-level prevalence of obesity (body mass index ≥ 30 kg/m2) for non-Hispanic black and white participants aged 45 and over were made from multiple sources: 1) self-reported from the Behavioral Risk Factor Surveillance System (BRFSS 2003-2006) (n = 677,425), 2) self-reported and direct measures from the National Health and Nutrition Examination Study (NHANES 2003-2008) (n = 6,615 and 6,138 respectively), and 3) direct measures from the REasons for Geographic and Racial Differences in Stroke (REGARDS 2003-2007) study (n = 30,239).ResultsData from BRFSS suggest that the highest prevalence of obesity is in the East South Central Census division; however, direct measures suggest higher prevalence in the West North Central and East North Central Census divisions. The regions relative ranking of obesity prevalence differs substantially between self-reported and directly measured height and weight.ConclusionsGeographic patterns in the prevalence of obesity based on self-reported height and weight may be misleading, and have implications for current policy proposals.

Objective: To examine (i) the prevalence of and associations between breastfeeding initiation and continuation by maternal diabetes status and (ii) the reasons for not initiating and/or continuing breast-feeding by maternal diabetes status. Design: Secondary data analyses of a population-based cross-sectional study were conducting using data from the US Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System (PRAMS), 2009-2011. Multivariable logistic regression was used to investigate the associations between breast-feeding initiation and continuation by diabetes status. Setting: Thirty states and New York City, USA. Subjects: Mothers of recently live-born infants, selected by birth certificate sampling. Results: Among 72 755 women, 8·8 % had gestational diabetes mellitus (GDM) and 1·7 % had pregestational diabetes mellitus (PDM). Breast-feeding initiation was similar among GDM and no diabetes mellitus (NDM) women (80·8 % v. 82·2 %, respectively, P = 0·2), but continuation was lower among GDM (65·7 % v. 68·8 %, respectively, P = 0·01). PDM women had lower initiation and continuation compared with NDM (78·2 %, P = 0·03 and 60·4 %, P < 0·01, respectively). In adjusted analyses, current smoking status was a significant effect modifier for initiation, but not for continuation. Conclusions: Differences in breast-feeding initiation and continuation prevalence by maternal diabetes status may reflect differences in prenatal education, indicating the need for increased efforts among PDM women. Additionally, nonsmoking women with PDM or GDM would benefit from additional breast-feeding education.

This systematic review synthesizes data published between 1988 and 2009 on mean BMI and prevalence of overweight, obesity, and type 2 diabetes among Asian subgroups in the U.S. We conducted systematic searches in PubMed for peer-reviewed, English-language citations that reported mean BMI and percent overweight, obesity, and diabetes among South Asians/Asian Indians, Chinese, Filipinos, Koreans, and Vietnamese. We identified 647 database citations and 23 additional citations from hand-searching. After screening titles, abstracts, and full-text publications, 97 citations remained. None were published between 1988 and 1992, 28 between 1993 and 2003, and 69 between 2004 and 2009. Publications were identified for the following Asian subgroups: South Asian (n=8), Asian Indian (n=20), Chinese (n=44), Filipino (n=22), Korean (n= 8), and Vietnamese (n=3). The observed sample sizes ranged from 32 to 4245 subjects with mean ages from 24 to 78 years. Among samples of men and women, the lowest reported mean BMI was in South Asians (22.1 kg/m2), and the highest was in Filipinos (26.8 kg/m2). Estimates for overweight (12.8 - 46.7%) and obesity (2.1 – 59.0%) were variable. Among men and women, the highest rate of diabetes was reported in Asian Indians with BMI ≥ 30 kg/m2 (32.9%, age and sex standardized). This review suggests heterogeneity among U.S. Asian populations in cardiometabolic risk factors, yet comparisons are limited due to variability in study populations, methods, and definitions used in published reports. Future efforts should adopt standardized methods to understand overweight, obesity and diabetes in this growing U.S. ethnic population.