Obesity Prevalence in Sub-Saharan African Immigrant Women

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 corresponds to a BMI of 18.5–25 kg/m² (Menigoz, Nathan & Turrell, 2016). Anything beyond this range is considered overweight or obese.

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 gap imposes significant morbidity, mortality, economic, and psychological burdens on such immigrants. Moreover, immigrants increasingly comprise a significant portion of the population in developed countries, especially in North America (Menigoz, Nathan & Turrell, 2016).

The scarcity of epidemiological data relating to overweight and obesity in immigrants is particularly pronounced for women in Canada. The few studies conducted in Canada focus on immigrants in general, with little or no attention to variations in overweight and obesity by gender, ethnic background, or 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 compared to others (Choi, 2012).

No research has been conducted to date 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 the 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 five years and above at increased risk of excessive weight gain due to an inactive lifestyle, compared to immigrant women from Sub-Saharan Africa of the same age group who have lived in Grande Prairie for two years or less?

Five important variables are evident from this question: overweight, obesity, immigrant (migrant status), duration of residence, and physical activity. Overweight and obesity comprise the dependent variables, while migrant status, duration of residence, and physical activity represent the independent variables. In this study, overweight is defined as a BMI in the range of 25 to 29 kg/m², while obesity is defined as a BMI of 30 kg/m² and above. An immigrant is defined as an individual born outside and living permanently in the host country — specifically, females of Sub-Saharan African origin aged 25–50 years living in Grande Prairie, Alberta. Duration of residence denotes the length of time, in years, that the individual has lived in the host country. Physical activity is defined as moderate to vigorous physical movement of the body that consumes energy, including brisk walking, jogging, cycling, dancing, aerobics, swimming, and sports such as tennis and basketball.

Theoretical Framework

Although numerous theories underpin research on overweight and obesity within the context of immigration, the 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 rates upon arrival compared to native-born residents (McDonald & Kennedy, 2005; Choi, 2012; Gele & Mbalilaki, 2013; Goulao, Santos & Carmo, 2015). Nonetheless, as immigrants become acculturated into the host country, their BMI and the 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

The literature has extensively documented the prevalence of obesity and overweight among 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 that 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 reported similar findings (McDonald & Kennedy, 2005; Choi, 2012; Gele & Mbalilaki, 2013; Adhikari, 2014).

Overweight and obesity mainly result from an enduring energy imbalance in the body (Goulao, Santos & Carmo, 2015). The consumption of high-calorie foods results in high energy intake, a problem compounded by physical inactivity and a sedentary lifestyle. A sedentary lifestyle typically means low energy expenditure, creating an imbalance between the excess energy consumed and the low energy burned. It is, however, important to note that other factors may also increase the risk of overweight and obesity, including socioeconomic background, age, psychological factors, ethnicity, genetics, environmental factors, 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 because the majority of immigrants are typically 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 many immigrants to resort to fast food and other unhealthy dietary habits. Low socioeconomic status is significantly associated with elevated health risks (Choi, 2012).

The increased risk of overweight and obesity resulting from migration to a high-income country may be further compounded by subsequent changes in physical activity and 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 in the relationship between immigrant status and weight gain. In Menigoz, Nathan & Turrell's (2016) study, immigrants who had lived in the host country for 15 years or more had remarkably higher BMIs compared to those who had lived there for fewer than 5 years. It is, however, important to note that acculturation does 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, a survey of immigrants in the United States found that Latin immigrants had a greater incidence of overweight and obesity compared to other immigrant groups (Choi, 2012).

Of all immigrant groups, women are at a greater risk of becoming overweight or obese. In their study involving 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 in 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 duration of residence, its findings may not be readily generalised to other immigrant communities, especially Sub-Saharan African immigrants in Canada. The present research will seek to close this gap.

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, no epidemiological data exist for this population with respect to overweight and obesity. From a practice perspective, this knowledge is crucial for designing appropriate weight management interventions. The aim is to minimise the risk of not only overweight and obesity but also associated co-morbidities such as hypertension and diabetes, through more knowledgeable and effective 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

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 activity, dietary intake, and sleep duration. PLoS ONE, 10(6), e0123672.

McDonald, J., & Kennedy, S. (2005). Is migration to Canada associated with unhealthy weight gain? Overweight and obesity among Canada's immigrants. Social Science & Medicine, 61(12), 2469–2481.

Menigoz, K., Nathan, A., & Turrell, G. (2016). Ethnic differences in overweight and obesity and the influence of acculturation on immigrant body weight: evidence from a national sample of Australian adults. BMC Public Health, 16, 932.

Singh, G., Kogan, M., & Yu, S. (2009). Disparities in obesity and overweight prevalence among US immigrant children and adolescents by generational status. Journal of Community Health, 34(4), 271–281.

Appendices

Informed Consent Form for immigrant women of Sub-Saharan African origin living in Grande Prairie, Alberta, Canada, who are being requested to take part in research relating to the prevalence of overweight and obesity.

This form is divided into two parts. Part I provides information about the study, and Part II is a certificate of consent. You will be provided with a copy of this consent form.

Objective of the Research: The aim of this research is to study the prevalence of overweight and obesity in immigrant women, with a particular focus on women of Sub-Saharan African origin living in Grande Prairie, Alberta, Canada. This information is expected to aid in the design and implementation of weight management and health promotion interventions for this group.

Voluntary Participation: Participation in this research is entirely voluntary, and you have the right to withdraw at any point without consequences.

Nature of Data Needed: You will be expected to provide information about your age, duration of residence in Canada, marital status, level of education, occupation, body weight, height, and physical activity.

Description of the Process: The data collection process will take no more than 30 minutes of your time. The researcher will meet you at your preferred location within Grande Prairie. After a brief introduction, you will self-report the requested demographic information. The researcher will then record your body weight and height.

Reimbursements: No incentive, financial or non-financial, will be provided for participating in the study.

Confidentiality: The information collected from this research will be treated as confidential.

I have read and understood the preceding information. Any concerns, questions, and requests for clarification relating to the research have been satisfactorily addressed. I voluntarily consent to participate in this study.

Name of Participant: _______________________

This questionnaire has three parts. In Part I, you are expected to provide information relating to the listed demographic aspects. In Part II, you will provide information about the type and frequency of physical activities you participate in. Part III will be completed by the researcher upon measuring your body weight and height.

(Please tick appropriately)

1. Age (in years)
25–30   31–40   40–50

2. Duration of residence in Canada
2 years and below   5 years and above   Other (please specify): _______

3. Marital Status
Single   Married   Divorced   Separated   Widowed

4. Occupation
Formal employment   Informal employment   Self-employed   Unemployed

5. Level of Education
High school   Degree   Master's   PhD

(Please tick appropriately)

1. How often do you participate in brisk walking?
Never   Once a month   Once a week   Twice a week   Daily

2. How often do you participate in jogging?
Never   Once a month   Once a week   Twice a week   Daily

3. How often do you participate in dancing?
Never   Once a month   Once a week   Twice a week   Daily

4. How often do you participate in aerobic activities?
Never   Once a month   Once a week   Twice a week   Daily

5. How often do you participate in swimming?
Never   Once a month   Once a week   Twice a week   Daily

6. How often do you participate in tennis?
Never   Once a month   Once a week   Twice a week   Daily

7. How often do you participate in basketball?
Never   Once a month   Once a week   Twice a week   Daily

8. Do you attend a gym?
Never   Once a month   Once a week   Twice a week   Daily

9. Which other physical activity do you participate in?
Never   Once a month   Once a week   Twice a week   Daily
If any, please indicate the activity and frequency: _______________________

(To be completed by the researcher)

1. Participant body weight: _______ (kg)
2. Participant body height: _______ (m)