Moving to the Land of Milk and Cookies: Obesity among the Children of Immigrants
Moving to the Land of Milk and Cookies: Obesity among the Children of Immigrants
Many immigrants hope for better lives for themselves and their children. Yet adapting to life in the United States can be risky even among the most economically successful immigrants. Poor nutrition, low levels of physical activity, and obesity have reached alarming levels in the United States.
Past studies on obesity among immigrants have focused almost exclusively on adults and adolescents. Much less work has examined young children, and the studies on children have used small, locally drawn samples.
In a new study funded by the Foundation for Child Development, we used a large, nationally representative sample to document the prevalence and patterns of obesity among young children of immigrants. We discovered that children of newly arrived immigrants are particularly vulnerable to this growing health problem.
The U.S. Food Environment
When immigrants come to the United States, they enter an environment in which they and their children are inundated with advertisements and opportunities to purchase food that is relatively cheap and of low nutritional quality.
The impact of food marketing on children is particularly prominent. A study conducted by the Kaiser Family Foundation in 2007 found that children ages 2 to 7 view an average of 12 television commercials for food each day, and children ages 8 to 12 view nearly twice that many.
Further studies have found that 98 percent of the television ads children see are for products high in fat, sodium, and sugar.
And it's not just television. High-calorie, low–nutrient foods and beverages are marketed and sold to children in schools. In 2006, economists Patricia Anderson and Kristin Butcher reported that 43 percent of elementary schools, 74 percent of middle schools, and 98 percent of high schools sold such food and beverages to students through vending machines, school stores, or a la carte in the cafeteria.
Numerous public and private schools have signed "pouring rights" contracts that permit snack and soft drink companies to advertise to children on school vending machines, scoreboards, book covers, t-shirts, and news programs shown on televisions in the classroom.
Fast food restaurants directly market to children by associating their food with toys, playgrounds, and cartoon characters.
Many experts blame the U.S. food environment for the growing child obesity epidemic (see Box 1 for how obesity is measured). In the past 25 years in the United States, the prevalence of obese children quadrupled, increasing from roughly 4 to 16 percent.
Box 1. Measuring Child Obesity
The most recent estimates suggest that 36.2 percent of 6- to 11-year-olds are either overweight or obese, and 18.8 percent are obese.
The disturbing increase in obesity has led to its classification as one of the most serious public health problems of the 21st century. Experts have shown that the rise in obesity-related health conditions may even decrease U.S. life expectancy for current and future generations of Americans.
Beyond its impact on physical health, obesity is related to difficulties in social adjustment, poor mental health, and lower academic achievement. Thus, obesity has wide-ranging implications for children's quality of life and productivity as adults.
Children of Immigrants: A High-Risk Group
The health ramifications of immigration and settlement in the United States may be very different for children than adults. Among adult immigrants, the U.S. food environment does not take its toll immediately.
Box 2. Data on Children's Weight
Many studies of adult immigrants have found that obesity rates tend to be low at first but then steadily increase as immigrants spend more time in the country. This pattern is consistent with the idea that acculturation, or the "Americanization" of health behaviors, leads to obesity.
However, we find a strikingly different pattern among children: acculturation does not appear to be related to obesity. Rather, children from the newest, least acculturated immigrant families tend to be the most at risk of obesity, particularly boys.
To draw these conclusions, we relied on a unique and valuable data source, the Early Childhood Longitudinal Study (ECLS-K), which permits us to track children from kindergarten through eighth grade; the study ran from fall 1998 to fall 2006 (see Box 2 for study details).
The study included information on the birthplace of the parents, the race/ethnicity of children, the social-economic status of the parents (their income level, educational attainment, and occupations), and the English-language ability of the parents. We examined all of these factors to assess which ones correlate with obesity among children of immigrants.
Generational Status and Obesity
We classified children in the study according to their parents' generational status. Children of immigrants included both U.S.-born and foreign-born children with at least one foreign-born parent.
Among children of immigrants, we distinguished children of the 1.0 generation (meaning those whose immigrant parent(s) came to the country after age 12 as adolescents or as adults), from children of the 1.5 generation (whose immigrant parent(s) arrived in the United States before age 12). In other words, the 1.0 generation is a proxy for new arrivals and the 1.5 generation is a proxy for settled immigrants.
Among girls, parents' generational status is unrelated to weight status (see Figure 1). Among boys, however, sons of natives are the least likely to be overweight or obese while the sons of the 1.0 generation are the most likely.
As early as kindergarten, 34 percent of sons of immigrants (1.0 and 1.5 generation alike) are overweight or obese compared with 25 percent among sons of natives. By eighth grade, the percentage increases to 49 percent among the sons of the 1.0 generation compared to only 33 percent among the sons of natives.
Racial and Ethnic Variation
The finding that boys in immigrant families weigh more than girls cuts across all major national origin groups. However, the generational pattern in which children of the newest arrivals weigh more than others, is found primarily among non-Hispanic white and Hispanic children.
Among non-Hispanic whites and Hispanics, children of the newest arrivals (the 1.0 generation) tend to weigh more than other children (see Figures 2 and 3). These generational differences widen as children grow older among non-Hispanic white children, but converge among Hispanics. About two-thirds of the Hispanic children in the ECLS-K study are of Mexican descent.
However, the patterns are quite different for blacks and Asians. Most black immigrants originate from the Caribbean while Asian immigrants come from many countries, including China, Korea, India, and Vietnam. Black children of immigrants are no more likely to be overweight or obese than black children of natives, and may be less likely be overweight or obese by the time they reach eighth grade (see Figure 4).
Among Asians, the percentage overweight or obese is higher for children of the 1.5 generation (settled immigrants) than children of the 1.0 generation (new arrivals), particularly among fifth-grade children (see Figure 5). This is the opposite of what we observed for non-Hispanic white and Hispanic children.
Unfortunately, the ECLS-K sample does not include enough black children of immigrants and Asian children of natives to show the results for these groups in greater detail.
Economic Success Is Not Protective
For any number of reasons, newly arrived immigrant parents may have difficulties protecting their children from the risk of obesity. One possibility is that these parents face economic challenges that make it difficult to provide children adequate supervision, healthy food, and opportunities for physical activity.
Immigrant families tend to be poor. Based on his analysis of 2000 census data, sociologist Donald Hernandez reported that 21 percent of children of immigrants lived in families with incomes less than the poverty threshold compared with 14 percent of children of natives.
Nearly one-third (30.8 percent) of Mexican children of immigrants lived in poverty in 2000, a level that was similar to children of native blacks (32.9 percent) and more than three times as high as non-Hispanic white children (8.7 percent). Does poverty explain the high rates of obesity among children of immigrants?
Surprisingly, the answer is no. We ranked children according to their family's social and economic status (SES), measured with a combination of parents' income, education, and occupational status. We then divided the children into equal thirds corresponding with high, medium, and low SES.
For all children, regardless of generational status, children in the high SES group tend to have lower rates of obesity than children in the medium or low SES groups.
However, when we look within each SES grouping, we find that children of immigrants still tend to weigh more than other children, as can be seen among kindergarteners (see Figure 6). This suggests that poverty or low income cannot fully explain the high levels of obesity among children of immigrants.
It is especially alarming that economic success fails to protect children of immigrants. Among children from the most economically successful families, children of the 1.0 generation (newly arrived) are significantly more likely to be overweight or obese than other children (see Figure 7). This disadvantage persists as children grow older.
Children of Non-English-Speaking Parents Are at Higher Risk
Another possible explanation for the high rates of obesity among children of immigrants is that their parents are ill-equipped to protect children from health risks in the United States. For example, newly arrived immigrants may be unfamiliar with U.S. foods and grocery stores, unaware of the health risks of American junk food, and less aware of opportunities for their children to participate in sports and other after-school activities.
In addition, immigrant parents may be less concerned about the health risks of obesity in children. Many immigrants originate from countries in which food insecurity and stunting pose significant health risks to children, so they may be unaccustomed to protecting children from the opposite problem that comes from overeating.
Although more research is needed, some evidence supports these ideas. One important clue comes from looking at obesity prevalence by English proficiency.
English proficiency is the most commonly used indicator of acculturation in research on immigrant health. Speaking one's native language at home is an important dimension of ethnic cultural identification and may reflect attachment to and active maintenance of cultural norms.
In this study, parents were asked to assess their ability to speak, read, and write English. We averaged these three indicators to measure English proficiency.
Among children of immigrants, those whose immigrant parents have low and medium levels of English proficiency weigh more than those whose parents have high English proficiency (see Figure 8). This difference is particularly large for boys. This suggests that obesity among children of immigrants derives from parents' lack of experience in the United States rather than from acculturation.
We do not yet know why this effect is more pronounced for boys than girls. Based on research about gender ideology in developing countries, however, we speculate that immigrant parents may be more likely to indulge their sons than their daughters and grant sons more freedom to choose what and how much to eat.
Children of the newest, least acculturated immigrants tend to have the highest obesity rates. This finding cuts across socioeconomic-status groups, but it is most pronounced among boys, whites, and Hispanics.
Such findings do not bode well for the future. Child obesity has far-reaching negative consequences for adult health, mortality, and status attainment, and may therefore hinder immigrants' future social and economic incorporation.
What can be done? A big part of the solution lies in making wholesale changes in children's environments that would benefit all children. These include limiting or eliminating advertising targeted to children; establishing community programs that promote physical activity among children; and altering school lunch programs to support a healthy dietary environment.
Some schools and communities have already begun implementing such strategies in response to efforts from the Centers for Disease Control and Prevention and other organizations.
It is important that any strategy against childhood obesity include interventions that specifically target the children of immigrant families. A Canada-based team of public health specialists conducted a major review of interventions, published in 2006, and found none aimed at children of immigrants.
Preventing child obesity among this growing population will require a careful analysis of how programs targeted to all families might differ among immigrant families with various sociocultural characteristics and life circumstances. One possible direction would be to emphasize diet and health issues in family literacy classes that enroll newly arrived immigrant families.
Reaching immigrant parents and communicating with them about diet and physical activity in culturally appropriate ways is likely to be challenging, but may be an important first step in improving their children's health.
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