Pre-acculturation as a risk factor for obesity: Findings from the Health of Philippine Emigrants Study (HoPES)

Abstract

Immigrants to the United States may have an advantage in terms of healthier weight, but tend to gain excessive weight after arrival, and may suffer from obesity and related health conditions. Acculturation theory suggests that this increase in obesity risk is due to adoption of unhealthy western dietary behaviors, and assumes that “eastern/traditional” dietary behaviors prior to migration are healthier. While this assumption is supported by studies conducted several decades ago, the phenomenon of globalization that has risen since the 1990s has increased exposure to western ideas and behaviors in communities worldwide. Hence, today's immigrants are more likely to have already adopted less healthy behaviors that increase obesity risk prior to their arrival in the U.S., a phenomenon we term “pre-acculturation.” The present study investigates the role of pre-acculturation in obesity development among immigrants from the Philippines.Data come from the Health of Philippine Emigrants Study, fielded in 2017 (n = 1632). Pre-acculturation was measured with English proficiency, preparation to migrate, receiving care packages, texting, telephone, or internet contact with friends/family in the U.S. Outcomes included the body mass index (BMI, kg/m2), waist circumference (WC, cm), waist-to-height ratio (WHtR) and waist-to-hip-ratio (WHR). Covariates included age, gender, education, financial strain, physical activity, and diet.Migrants reported greater English proficiency, preparation, and a slightly lower WHtR than non-migrants, but did not differ on BMI, WC, or WHR. Preparation was associated with greater BMI, WC, and WHtR, and the effects of preparation status differed by migration status. Among migrants, more preparation was associated with greater BMI, WC, and WtHR. Further, among non-migrants, texting and telephone communications was related to lower BMI, WC, and WHR.In summary, pre-acculturation may be a risk factor for obesity in the Philippines, suggesting that binary notions of “Western” versus “eastern/traditional” cultures may be too simplistic.

Migrating Populations and Health: Risk Factors for Cardiovascular Disease and Metabolic Syndrome

“…The study found that immigrants to the USA tended to be healthier upon arrival than their native-born counterparts, but that their health deteriorated with time. Additional analyses of the HoPES data suggest that pre-acculturation (the process by which one becomes familiar with the culture of a country before moving to it) may be a risk factor for obesity in Philippine migrants to the USA [89]. Pre-acculturation was associated with increases in BMI, waist circumference, and waist to height ratio.…”

Acculturation and Cardiometabolic Abnormalities Among Chinese and Korean Americans

“…One recent review found that among Latinx and South Asians in the United States (US), longer length of residence in the US was associated with greater cardiovascular risk and mortality across several studies [3]. Research has begun to link acculturation with metabolic abnormalities known to increase risk for cardiovascular disease, such as higher body mass index [4,5], abdominal obesity [6,7], and type II diabetes [8,9]. However, fewer studies have examined this association using biomarkers of metabolic abnormalities such as lipid, cholesterol, and glucose levels in the blood that provide more objective measurement of arteriosclerosis risk and type II diabetes.…”

Acculturation and Self-rated Health Among Asian Immigrants: The Role of Gender and Age

“…Asian Americans are a group of considerable heterogeneity, composed of people who come from approximately 19 regions across East Asia, Southeast Asia, and the Indian subcontinent with varying socioeconomic statuses and proportions foreign born (Pew Research Center 2019). Furthermore, the existence of remote acculturation (Ferguson and Bornstein 2012) or pre-acculturation (Gee et al 2019), fueled by globalization, signals that the extent to which migrating Asians are already exposed to U.S. culture may vary across these regions. Thus, a larger sample is needed for future research in order to better understand how acculturation is associated with self-rated health among such various Asian ethnic groups.…”