Fitting in; Overweight and obesity in children of Australian Immigrants from low-and-middle-income countries

Abstract

Overweight/obesity rates in children of immigrants from low-and-middle-income-countries not only eclipse rates in their origin countries, they also exceed rates in their host nation. My mixed-method research seek to understand this conundrum, to inform a more effective, and equitable prevention agenda. Using representative data from Birth cohort of the "Longitudinal Study of Australian Children", I quantified the prevalence and predictors of overweight/obesity in Australian-born children by maternal immigrant status. For the qualitative component, I interviewed immigrant mothers and their children, to understand how conflicts of culture and acculturation in the host countries contribute to greater risk in these children. My first paper confirmed that not only do the children of mothers from low-and-middle-income-countries matched the overweight/obesity rates of children of Australian-born mothers, they superseded them at most ages. The difference was significantly higher in boys at 8-9 and girls at 4-5 years. Furthermore, this excess risk was not simply due to family socioeconomic-position, as is commonly assumed. My second paper explored the reasons for this excess risk. Unhealthy diet and insufficient physical activity were pronounced in children of mothers from low-and-middle-income-countries. This difference in risk factors- particularly in boys - appeared to explain part of their excess risk relative to children of Australian-born mothers, signalling potential cultural and gendered reasons for this difference. My third paper explored differences in BMI-trajectories, questioning association of this excess risk with different developmental patterning. Children of mothers from low-and-middle-income-countries were more likely to have high-and moderate-risk BMI-trajectories and less likely to have low-risk BMI-trajectories. Factors associated with high-moderate risk BMI-trajectories were high birthweight, low socioeconomic position, high screen time and non-participation in organized sports. The dramatic changes in some BMI-trajectories between the ages of 4-7 years reveal how important this period may be for prevention. In the fourth mixed method paper using a more child-centred lens, I explored how children's body image and culture may be linked. Approximately three-quarters of children aged 10-11 years had body image dissatisfaction and were trying to manage their weights. This proportion was even higher in children of mothers from low-and-middle-income-countries. Maternal body image standards were drawn from their origin countries - heavier bodies were considered healthy for younger children and adolescent boys but thinner bodies for adolescent girls. Their children, however, perceived heavier bodies undesirable and unpopular. Finally, I explored acculturation challenges amongst mothers and children. At home, origin countries traditions were followed. Culturally meaningful celebratory foods, often high in sugar and fats, were frequently consumed. Mothers prioritised education, religious and cultural activities over sports. Children wanted to be as physically active as Australian peers, but felt restricted by maternal fear of racism and discrimination. The restrictions were higher for girls. In summary, unhealthy diet and low physical activities expose these immigrant children to adiposity from an early age. Cultural differences increases risk because physical activity and food is imbued with culturally important (and gendered) meanings fundamental to identity. Preventive strategies must go beyond simplistic health messages by accounting for diverse cultural framings of health, food, weight and activity among immigrants. Early engagement of immigrants with more nuanced, culturally respectful, gender specific, preventive health messages is required. Show more