Physical Activity and Overweight

Weight and Obesity The Prevalence of Overweight and Obesity in Immigrant Women from Sub-Saharan Africa Living in Grande Prairie, Alberta In spite of the increased prevalence of overweight and obesity in the general population, little attention has been paid to immigrant communities, which are at a greater risk of weight gain compared to the majority. This is quite disturbing given the increased rate of migration from low-income countries.

Lack of epidemiological data relating to overweight and obesity is particularly true for women of sub-Saharan African origin living in Grande Prairie, Alberta, Canada. This study will involve a cross-sectional survey, to fill this gap in literature. A sample of 100 subjects is deemed to be representative of the target population. Knowledge of the prevalence of overweight and obesity in this population will be important for designing weight management interventions for this group, thereby reducing the risk of overweight and obesity as well as associated co-morbidities.

Introduction and Background The prevalence of overweight and obesity has been on the rise in the last few decades, with physical inactivity and other lifestyle factors playing a crucial role (Singh, Kogan & Yu, 2009). Measured by body mass index (BMI) (body weight divided by the square of body height in metres), overweight and obesity generally denote an imbalance between energy intake and expenditure in the body (Labree et al., 2015). The ideal body weight should be 18.5-25 kg/m2 (Menigoz, Nathan & Turrell, 2016). Anything beyond this is considered overweight or obesity.

Overweight and obese immigrants bear a greater burden compared to the rest of the population (Choi, 2012; Gele & Mbalilaki, 2013). Regrettably, most developed countries lack substantive documentation of the epidemiology of overweight and obesity among immigrants (Menigoz, Nathan & Turrell, 2016). This imposes significant morbidity, mortality, economic, and psychological burden on such immigrants. More importantly, immigrants increasingly comprise a significant portion of the population in developed countries, especially North America (Menigoz, Nathan & Turrell, 2016).

The scarcity of epidemiological data relating to overweight and obesity in immigrants is particularly true for women in Canada. The few studies in Canada pay attention to immigrants in general, with little or no information about variations in overweight and obesity by gender, ethnic background, and region (e.g. McDonald & Kennedy, 2005; Adhikari, 2014). Kirchengast & Kilaf (2014) show that immigrant women are at a greater risk of developing overweight and obesity compared to immigrant men and the rest of the population.

Furthermore, women from certain ethnic backgrounds face a greater risk of overweight and obesity compared to others (Choi, 2012). The researcher found that so far no research has been conducted to document the prevalence of overweight and obesity in women of sub-Saharan African origin living in Grande Prairie, Alberta, Canada. The present study proposes to fill this gap in literature.

The study will specifically seek to answer the following question: Are immigrant women from sub-Saharan Africa, 25 to 50 years old, who have lived in Grande Prairie, Alberta, Canada for 5 years and above at increased risk of excessive weight gain due to inactive lifestyle, compared to immigrant women from sub-Saharan Africa of the same age group who have lived in Grande Prairie for 2 years and below? Pertaining to the above, five important variables are evident: overweight, obesity, immigrant (migrant status), duration of residence, and physical activity.

Denoting weight gain, overweight and obesity comprise the dependent variables, while migrant status, duration of residence, and physical activity will represent the independent variables. In this study, overweight will be defined as BMI in the range of 25 to 29 kg/m2, while obesity will be defined as BMI in the range of 30 kg/m2 and above. An immigrant will be defined as an individual born outside and living permanently in the host country. This will particularly relate females of sub-Saharan African origin aged 25-50 years living in Grande Prairie, Alberta, Canada.

Duration of residence denote the length in years the individual has lived in the host country. Finally, physical activity will be defined as moderate to vigorous physical movement of the body that consumes energy, such as brisk walking, jogging, cycling, dancing, aerobics, swimming, as well as sports such as tennis and basketball. Theoretical Framework Though there are numerous theories underpinning research on overweight and obesity within the context of immigration, acculturation model provides an appropriate theoretical foundation.

Acculturation generally denotes changes in an individual's cultural patterns as a result of interaction with the environment, lifestyle, and culture of the host country (Menigoz, Nathan & Turrell, 2016). Studies conducted in most developed countries have extensively demonstrated that immigrants have lower BMI, overweight, and obesity upon arrival compared to natives (McDonald & Kennedy, 2005; Choi, 2012; Gele & Mbalilaki, 2013; Goulao, Santos & Carmo, 2015). Nonetheless, as they become acculturated into the host country, their BMI and prevalence of overweight and obesity increase.

They change their lifestyle behaviours and become more exposed to obesogenic environments, consequently increasing the risk of weight gain (Kirchengast & Kilaf, 2014). Literature Review Literature has extensively documented the prevalence of obesity and overweight in immigrants. A study involving a nationally representative sample of Australian adults (n = 13,047) found that immigrants had substantially higher BMIs compared to the majority population (Menigoz, Nathan & Turrell, 2016). The large sample used is a major strength of the study.

A systematic review of 39 articles further found a consistent positive link between immigration and weight gain (Goulao, Santos & Carmo, 2015). Other studies have also reported similar findings (McDonald & Kennedy, 2005; Choi, 2012; Gele & Mbalilaki, 2013; Adhikari, 2014). Overweight and obesity mainly result from an enduring energy balance in the body (Goulao, Santos & Carmo, 2015). The consumption of high-calorie foods results in high intake of energy, a problem compounded by physical inactivity and a sedentary life.

A sedentary life often means low energy expenditure, which creates an imbalance between the excess energy taken in and the low energy consumed by the body. It is, however, important to note that other factors may also increase the risk of overweight and obesity: socioeconomic background, age, psychological factors, ethnicity, genetics, environmental factors (obesogenic environments), and immigrant status (Kirchengast & Kilaf, 2014; Labree et al., 2015). Immigrant status may be a particularly important risk factor for overweight and obesity (Adhikari, 2014).

Migrating from low-income to high-income countries is often a risk factor for overweight and obesity as majority of immigrants are usually characterised by lower educational attainment and poorer socioeconomic status compared to the majority population (Kirchengast & Kilaf, 2014). These factors predispose immigrants to unhealthy weight gain. For instance, low income hinders access to healthy food, compelling most immigrants to resort to fast foods and other unhealthy dietary habits. In fact, low socioeconomic status is significantly associated with health risks (Choi, 2012).

The increased risk of overweight and obesity as a result of migrating to a high-income country may further be compounded by subsequent changes in physical activity as well as Westernised dietary habits (Labree et al., 2015). These changes occur in the process of acculturation, meaning immigrants with a lengthier stay in the host country are more likely to be overweight or obese compared to those with a shorter stay (Goulao, Santos & Carmo, 2015).

Indeed, length of residence in the host country is an important moderating factor as far as the relationship immigrant status and weight gain is concerned. In Menigoz, Nathan & Turrell's (2016) immigrants who had lived in the host country for 15 years or more had remarkably higher BMIs compared to those who had lived for less than 5 years. It is, however, important to note that acculturation may not always result in negative health consequences (Goulao, Santos & Carmo, 2015). The risk for overweight and obesity may be further compounded by ethnic background.

For instance, as shown in a survey of immigrants in the U.S., Latin immigrants had a greater incidence of overweight and obesity compared to other immigrant groups (Choi, 2012). Off all immigrant groups, women are at a greater risk of becoming overweight or obese.

In their study, which involved 198 immigrant girls and 145 immigrant women from Turkey living in Austria, Kirchengast & Kilaf (2014) found that the occurrence of overweight and obesity was higher in Turkish women than Austrian women, with older women and those with a longer duration of residence in Austria being the most affected.

While this study provides valuable insights about the prevalence of overweight and obesity in immigrant women, and the moderating impact of the duration of residence in the host country, it may not be readily generalised to other immigrant communities elsewhere, especially sub-Saharan African immigrants in Canada. The present research will seek to close this gap in literature. Methodology The aim of the proposed study is to examine the prevalence of overweight and obesity in women of sub-Saharan African origin living in Grande Prairie, Alberta.

The quantitative approach presents the most appropriate route for achieving this objective. As against qualitative research, quantitative research can be readily generalised to the larger population (Jacobsen, 2017). This aspect will be particularly important in the present paper. Using the quantitative method will result in findings that can be generalised to the population of sub-Saharan African immigrant women living in Grande Prairie, Alberta. The study will specifically take the form of a cross-sectional survey.

A cross-sectional study basically entails collecting and analysing data from a population or a section of the population at a given point in time (Jacobsen, 2017). A survey enables the researcher to collect data from a large sample with less time, effort, and cost. According to the researcher, there is no official record of the number of immigrants of sub-Saharan African origin living in Grande Prairie, Alberta. This presents some difficulty in determining the right sample for the study.

However, the 2015 municipal census report indicates that there were 2,149 permanent residents and 1,246 naturalised citizens in Grande Prairie as of 2015 (City of Grande Prairie, 2015). This means that the population of sub-Saharan African immigrants in the city is most likely below 1,000 as majority of immigrants in Alberta come from Asia, Europe, and Latin America. Based on this estimate, a sample of 100 would be sufficiently representative of the target population. This will include 50 subjects with a duration 5 years and above in Canada and 50 subjects with a duration of 2 years and below.

The unavailability of a sample frame means that random sampling would not be possible. Accordingly, snowball sampling will be used to recruit subjects for the study. In this technique, the existing subjects provide access to future subjects (Jacobsen, 2017). In other words, knowledge of one or two subjects from the target population leads to more subjects in their social circles. Though this technique is often associated with bias, it is the most appropriate for this study.

The sample will include women of sub-Saharan African origin aged 25-50 years permanently living in Grande Prairie. There will be no exclusion on the basis of level of education, occupation, and marital status. A structured questionnaire (see appendix 2) will be administered to the recruited subjects at their preferred location, whether at home, work, or an outdoor setting. The questionnaire will include demographic information such as age, duration of residence, marital status, occupation, and education.

It will also focus on lifestyle factors, particularly in relation to the type and frequency of physical activity as well as dietary habits. Anthropometrical aspects (height and weight) will be measured as per the guidelines of the International Society for the Advancement of Kinanthropometry (ISAK). This will be useful in calculating BMI, and thus overweight and obesity. The research will be conducted in accordance to the relevant ethical guidelines. First, permission to conduct the study will be sought from the Institutional Review Board (IRB).

More importantly, participation in the study will be voluntary and based on informed consent. Prior to data collection, participants will be familiarised with the objective of the study as well as their right to withdrawal at any point without consequences. Participants will also be assured that any confidential and personally identifiable information will be treated as per the relevant data privacy guidelines (see appendix 1). Data Analysis The collected data will be analysed using SPSS version 17. The analysis will involve descriptive and statistical analysis.

Descriptive analysis will entail summarising demographic information such as age and duration of residence as well as anthropometric data using percentages, frequencies, averages, and standard deviations displayed in tables, charts, and graphs. Statistical analysis will involve regression analysis, focusing on the association between duration of residence and BMI, and between physical activity and BMI. Applicability to Nursing This research will have important implications for nursing. Nurses play a crucial in health promotion. They help individuals embrace and maintain healthy lifestyle behaviours. Achieving this requires epidemiological data.

With access to data about the prevalence of overweight and obesity in sub-Saharan African immigrant women in Grande Prairie, nurses will be better equipped to design weight management interventions for this population. Nursing within the contexts of metabolic and cardiovascular complications such as heart disease and diabetes will also benefit from this study given the connection between overweight and obesity and these morbidities. Conclusion Overall, knowledge about the prevalence of overweight and obesity in immigrants is important.

This is particularly true for women of sub-Saharan African origin living in Grande Prairie, Alberta, Canada. So far, there is no epidemiological data about this population, especially in terms of overweight and obesity. From a practice perspective, this knowledge is crucial for designing appropriate weight management interventions for this population. The aim is to minimise the risk of not only overweight and obesity but also co-morbidities such as hypertension and diabetes, through a knowledgeable and better nursing intervention. References Adhikari, A., (2014). Prevalence of obesity among immigrants living in Canada.

American Journal of Sports Science and Medicine, 2(1): 35-39. Choi, J. (2012). Prevalence of overweight and obesity among US immigrants: results of the 2003 New Immigrant Survey. Journal of Immigrant and Minority Health, 14(6), 1112-1118. City of Grande Prairie (2015). Census population. Retrieved from: http://www.cityofgp.com/index.aspx?page=2507 Gele, A., & Mbalilaki, A. (2013). Overweight and obesity among African immigrants in Oslo. BMC Research Notes, 6: 119. Goulao, B., Santos, O., & Carmo, I. (2015). The impact of migration on body weight: a review. Cadernos de Saude Publica, 31(2): 229-245. Jacobsen, K. (2017). Introduction to health research methods.

2nd ed. Burlington: Jones & Bartlett Learning. Kirchengast, S., & Kilaf, E. (2014). High prevalence of overweight and obesity among Turkish migrant girls and women in Vienna, Austria -- A review of the Viennese Obesity and Migration Project. Austin Journal of Endocrinology and Diabetes, 1(6): 1028. Labree, W., van de Mheen, D., Rutten, F., Rodenburg, G., Koopmans G., & Foets, M. (2015). Differences in overweight and obesity among children from migrant and native origin: the role of physical.