Acculturation and Prevalence of Obesity among Hispanic Adults in the United States, 1999-2004

OBJECTIVE: Prospective studies have shown that prevalence of obesity increases faster for immigrants in the U.S. compared to native-born citizens. We sought to determine if socioeconomic status, access to health care, physical activity, and dietary factors were responsible for this trend.

METHODS: We studied 4776 Hispanic adult participants in the National Health and Nutrition Examination Survey, 1999-2004. We adjusted for age and sex for all analyses. Our primary predictor was acculturation, as measured by a validated scale that focused on language ability and use. Our primary outcome was obesity, defined as BMI >30 m/kg2 calculated from measured height and weight. All analyses were weighted and adjusted for design effects using SUDAAN.

RESULTS: Hispanic participants with high acculturation were more likely to be better educated, have better access to health care, engage in more physical activity, but have worse indicators of dietary macronutrient intake (p<.001). After adjustment for age and sex, participants with high acculturation were more likely to be obese [odds ratio (OR)=2.1, CI 1.5-2,9]. Further adjustment for education, insurance status, having a usual source of medical care, physical activity, and dietary factors did not substantially diminish the difference in obesity prevalence between acculturation groups [odds ratio (OR)=2.0, CI 1.4-2.9]

CONCLUSIONS: Hispanic adults with high acculturation were more likely to be obese than their less acculturated counterparts. Differences in obesity prevalence were not accounted for by socioeconomic status, health care access, physical activity, or dietary factors. Further investigation is required to determine the underlying cause for increased obesity as immigrants acculturate in the U.S.