Under- and Over-Nutrition among Refugees in San Diego County, California

Background: Each year 50,000-90,000 refugees arrive in the U.S. They are often malnourished, with little knowledge of nutrition or available food choices in the host country. We explored nutrition-related issues relevant to recent refugee arrivals in San Diego County — the third largest California resettlement site, receiving ~1000 refugees a year — as part of a health needs assessment to identify healthcare concerns within the first 5 years of resettlement.

Methods: A total of 40 guided, in-depth interviews were conducted with a targeted sample of informants (refugees, health care practitioners, refugee serving organizations). Content analysis identified nutrition-related themes.

Results: Unhealthy weight gain after refugee arrival, especially among youth, was the most commonly identified theme in the analysis. Peer pressure and diminishing parental control over children's food choices were thought to be the primary factors contributing to adolescent weight gain. Among adults, weight gain was attributed primarily to an increasingly sedentary lifestyle and, in some cases, the higher status associated with larger physiques. Conversely, undernutrition was a concern of health care providers seeing pregnant refugees and young children. Acculturation difficulties, such as unfamiliarity with available foods and limited knowledge of nutrition, were thought to exacerbate the problem.

Conclusions: The nutritional concerns encountered by refugees during resettlement in San Diego are common in cities throughout the U.S. and are aggravated by availability of high-calorie, low nutrient-density foods and sedentary lifestyles. Research into malnourishment and later weight gain in refugees arriving in the U.S. is needed to tailor current nutritional programs to better meet refugee health needs.