Abstract
Introduction:
Little is known about the longitudinal trends and factors associated with obesity and overweight among U.S. immigrants and ethnic minorities.
Methods:
At a large safety net health system in Massachusetts, 7,973 adults were followed retrospectively for 42.0 months on average from 2011 to 2016. Multivariate analyses were performed to identify factors associated with obesity (BMI ≥30 kg/m2) and overweight (BMI ≥25 kg/m2). Data were collected and analyzed in 2018–2019.
Results:
Obesity prevalence and trends were highest among Mexican/Central American men (32.6% in 2011 to 42.5% in 2016, p=0.03) and Haitian/black Caribbean women (37.5% to 51.5%, p<0.01). Mexican/Central American men had 564% (OR=5.64, 95% CI=4.02, 7.91) and women had 432% (OR=4.32, 95% CI=2.99, 6.23) higher odds of obesity compared with non-Hispanic white men and women, respectively. Baseline age, weight, and duration of follow-up were associated with obesity among men (OR=1.02, 95% CI=1.02, 1.03; OR=1.16, 95% CI=1.15, 1.17; OR=1.17, 95% CI=1.06, 1.30) and women (OR=1.01, 95% CI=1.01, 1.02; OR=1.18, 95% CI=1.17, 1.19; OR=1.44, 95% CI=1.29, 1.61). East/South East Asians had the lowest obesity burdens. The majority of weight gains (63% among men and 75% among women) took place within 3 years.
Conclusions:
Longitudinal obesity and overweight trends increased among all immigrants and ethnic minorities, primarily within the first 3 years, but significant variations existed. Mexican/Central American men and Haitian/black Caribbean women were disproportionately affected, approaching or exceeding U.S. rates. Targeted early prevention and treatment strategies are needed to reduce health disparities in obesity and unhealthy weight gain among immigrants.
INTRODUCTION
The increase in the global burden of obesity and overweight in the past few decades has been alarming. From 1980 to 2013, the number of overweight and obese individuals increased from 857 million to 2.1 billion worldwide.1 In the U.S., obesity now affects nearly 40% of the population or 93 million adults.2 Obesity is associated with higher rates of morbidity and mortality.3 Obesity has been linked to heart disease, stroke, hypertension, diabetes, cancer, and mental illness.4 In the U.S., the annual healthcare costs associated with obesity are estimated to be more than $190 billion.5 Additionally, there are costs from disability and unemployment, including up to $6.4 billion annual cost due to obesity-related job absenteeism in the U.S.6 If obesity rates were to remain at 2010 levels, the projected savings would be $549.5 billion in the next 2 decades.7
As of 2016, there are more than 43 million (13.4%) immigrants living in the U.S.8 By 2050, one in five U.S. residents are estimated to be immigrants compared with one in eight in 2005.9 As of 2015, a total of 1.1 million or 16.1% of Massachusetts residents are immigrants.10 Immigrants from Haiti, Brazil, India, Dominican Republic, and China accounted for 5.1%, 5.6%, 6.0%, 7.4%, and 8.8% of foreign-born population in the state, respctively.10 Given the signifncant health and cost implications of obesity, understanding obesity trends and identifying high-risk subgroups among immigrants is of great importance. Yet, very little is known about the longitudinal trends of obesity and overweight among immigrants and ethnic minorities in the U.S.
Prior studies that have looked at obesity among immigrant populations have largly been cross-sectional studies or focused on specific subpopulations. A cross-sectional study based on the National Health Interview Survery showed higher prevalence of overweight among Mexican and Central American immigrants.11 Other studies have found African-born blacks have lower odds of obesity compared with U.S.-born non-Hispanic blacks intitially, but unhealthy weight gain increased with longer duration of residence.12 Although acculturation and socioeconomic factors have been proposed as possible explanations for such observations, there is lack of evidence in large, diverse, and longitudinal studies.13
Given the substatial gap in the literature, this study aims to examine longitudinal trends in obesity and overweight and identify high-risk subgroups among immigrants and ethnic minorities at a large safety net health system in Massachusetts from 2011 to 2016.
METHODS
A retrospective study of patients was conducted using electronic medical records at Cambridge Health Alliance (CHA) in Massachusetts between January 1, 2011 and December 31, 2016. CHA is a large safety net health system serving >140,000 patients in Cambridge and Boston’s metro-north region, mostly immigrants, ethnic minorities, and underserved communities. Participants were followed retrospectively annually from their initial outpatient primary care visits in 2011 to their last follow-up visits in 2016.
Study Population
All patients who had their initial new patient visits in 2011 at any of the CHA outpatient primary care centers were included in this study. Patients whose initial new patient visits were not in 2011 and those whose initial visits were at specialty clinics (including obstetrics and gynecology), emergency department, mental health clinics, and inpatient settings were excluded. Furthermore, children and pregnant women were excluded. Initially, 11,499 adults (aged ≥18 years) were identified. A total of four were excluded for lack of information on height, weight, or both and 18 were excluded because of pregnancy. From the remaining 11,477 participants, 3,504 did not follow-up for at least 1 month after their initial visits, leaving 7,973 adults in the final analyses. The study was approved by the IRB of the CHA.
Measures
Anthropometric data obtained during each clinic visits were used. BMI was determined by dividing weight in kilograms (kg) over the square of height in meters (m). Obesity was defined as BMI ≥30 kg/m2 and overweight was defined as BMI ≥25 kg/m2.
Demographic information of age and gender were obtained from the electronic medical record. Ethnic/racial categories were based on self-reported background information collected routinely during registration and primary languages patients chose for communications. The main ethnic/racial minorities and immigrant categories were: Haitian/non-Hispanic black Caribbean, African, Mexican/Central American (Hispanic), South American/Caribbean (Hispanic), Brazilian, South Asian, East/South East Asian, and Middle East/North African. European/North American (non-Hispanic whites) and African American (non-Hispanic blacks) were included in the analysis as reference groups. Results for African Americans are not reported here as the focus of the study was immigrants. The ethnic/racial categorization was in part based on the WHO’s sub-regional classifications as well as sociocultural differences.14 Duration of follow-up was categorized into <3.0 or ≥3.0 years, based on time interval from initial visits to establish primary care to last follow-up clinic visits.
Statistical Analysis
The prevalence of obesity and overweight were compared for each year participants were followed from 2011 to 2016. Chi-square or Fisher’s exact tests were used for independent categorical variables. McNemar’s or binomial tests were utilized for paired categorical variables. ANOVA was used to examine differences by gender and ethnic/racial backgrounds for continuous variables. The overall cumulative incidences of obesity and overweight were calculated based on new cases and population at risk over average follow-up period. Mean changes in weight and 95% CIs were calculated for each follow-up year relative to their initial weight in 2011. The mean change in weight was significant if the 95% CI did not include 0. The outcome variables were also compared between those who followed up after 1 month (69.5%) and those who did not (Appendix Table 1).
Generalized estimating equation analyses were computed with obesity or overweight as outcome variables after adjusting for confounding factors and other covariates. Potential confounders were identified based on priori and our conceptual framework. Confounders included in the final models were age, initial weight, and duration of follow-up stratified by gender. Two-tailed statistical significance was assessed at α<0.05. Data analyses were conducted using SAS, version 9.4. Data were collected and analyzed in 2018–2019.
RESULTS
Basic characteristics of the study population are shown in Table 1. Women accounted for 53.0% of participants. Baseline mean age were 38.8 (SD=13.5) years for men and 38.0 (15.3) years for women. Average age ranged from 36.5 (12.6) years among Mexican/Central Americans to 41.0 (16.2) years among Haitian/black Caribbean individuals (p<0.01) (Appendix Table 2). The overall minimum and maximum ages were 18.0 and 97.4 years, respectively. Of the 7,973 participants, 13.8%, 8.2%, 6.3%, 5.7%, and 5.1% identified as Brazilians, Haitian/black Caribbean, Mexican/Central Americans, South Asians, and South American/Caribbean, respectively (Table 1). As the reference group, non-Hispanic whites accounted for 48.9%. Mean length of follow-up was 42.0 (21.1) months.
Table 1.
Basic Characteristics of Participants at a Safety-net Health System in Massachusetts, 2011–2016
| Variables | All | Men | Women |
|---|---|---|---|
| All participants, n (%) | 7,973 (100.0) | 3,748 (47.0) | 4,225 (53.0) |
| Race/ethnicity, n (%) | |||
| European/North American | 3,895 (48.9) | 1,793 (46.0) | 2,102 (54.0) |
| Haitian/Black Caribbean | 652 (8.2) | 277 (42.5) | 375 (57.5) |
| African | 207 (2.6) | 99 (47.8) | 108 (52.2) |
| Mexican/Central American | 498 (6.3) | 267 (53.6) | 231 (46.4) |
| South American/Caribbean | 410 (5.1) | 193 (47.1) | 217 (52.9) |
| Brazilian | 1,102 (13.8) | 542 (49.2) | 560 (50.8) |
| South Asian | 456 (5.7) | 224 (49.1) | 232 (50.9) |
| East/South East Asian | 357 (4.5) | 143 (40.1) | 214 (59.9) |
| Middle East/North African | 195 (2.5) | 107 (54.9) | 88 (45.1) |
| Age at baseline in years, mean (SD) | 38.4 (14.5) | 38.8 (13.5) | 38.0 (15.3) |
| Length of follow up in months, mean (SD) | 42.0 (21.1) | 42.1 (20.8) | 41.8 (21.5) |
| Initial BMI kg/m2, mean (SD) | 27.2 (5.9) | 27.5 (5.3) | 26.8 (6.3) |
| Initial weight in kg, mean (SD) | 76.6 (18.9) | 83.9 (17.9) | 69.9 (17.2) |
kg, kilogram; m, meter.
Figure 1 shows longitudinal change in obesity and Figure 2 shows changes in overweight rates. Overall obesity and overweight trends increased among all immigrant/ethnic minority groups. Among immigrants, initial obesity prevalence and trends were highest among Mexican/Central American men (32.6% in 2011 to 42.5% in 2016, p=0.03) and Haitian/black Caribbean women (37.5% in 2011 to 51.5% in 2016, p<0.01) (Figure 1).
Figure 1.
Obesity (%) trends by gender and race/ethnicity at a safety-net health system in Massachusetts, 2011–2016.
Figure 2.
Overweight (%) trends by gender and race/ethnicity at a safety-net health system in Massachusetts, 2011–2016.
Overweight prevalence and trends were highest among Mexican/Central American men (80.2% in 2011 to 90.8% in 2016, p<0.01) and Haitian/black Caribbean women (72.0% in 2011 to 82.2% in 2016, p<0.01) (Figure 2). Although East/South East Asians had the lowest obesity burdens, their rates increased by 2.4-fold among women (5.6% in 2011 to 13.4% in 2016, p=0.01) and by 1.5-fold among men (8.0% in 2011 to 12.3% in 2016, p=0.29); however, this was not statistically significant (Figure 2). East/South East Asians women had the lowest prevalence of overweight, but their rates increased more than any other group by 1.7-fold (from 20.9% in 2011 to 35.4% in 2016, p=0.01) (Figure 2).
Within the first 3 years of follow-up, 63% (1.5 kg/2.4 kg) and 75% (1.8 kg/2.4 kg) of the overall net weight gains had already occurred among men and women, respectively (Appendix Table 3). South American/Caribbean men, South Asian men, and South Asian women had already gained 96%, 79%, and 89% of their overall net weight, respectively, within the first 3 years. By contrast, East/South East Asian men and Middle East/North African women reached only 23% and 18% of their overall net weight gain, respectively, during the same follow-up period. Haitian women had high overall incidence of obesity at 130, while Haitian men had high incidence of overweight at 313 per 1,000 population over an average of 42.0 months (Appendix Table 4).
Table 2 shows factors associated with obesity and overweight. After adjusting for baseline age, weight, and duration of follow-up, Mexican/Central American men had 564% (OR=5.64, 95% CI=4.02, 7.91) higher odds of obesity compared with non-Hispanic white men, while Mexican/Central American women had 432% (OR=4.32, 95% CI=2.99, 6.23) higher odds of obesity compared with non-Hispanic white women. Compared with non-Hispanic white men, Mexican/Central American men (OR=6.39, 95% CI=4.37, 9.33) had highest odds of overweight, followed by South American/Caribbean (OR=2.87, 95% CI=1.86, 4.45) men. Among women, Mexican/Central American women (OR=6.30, 95% CI=4.26, 9.33) had highest odds of overweight, followed by South Asian (OR=4.87, 95% CI=3.46, 6.85) women (Table 2). Baseline age, weight, and duration of follow-up >3 years were associated with obesity among men (OR=1.02, 95% CI=1.02, 1.03; OR=1.16, 95% CI=1.15, 1.17; OR=1.17, 95% CI=1.06, 1.30, respectively) and women (OR=1.01, 95% CI=1.01, 1.02; OR=1.18, 95% CI=1.17, 1.19; OR=1.44, 95% CI=1.29, 1.61).
Table 2.
Factors Associated With Obesity and Overweight at a Safety-net Health System in Massachusetts, 2011–2016
| Obesity | Overweight | |||
|---|---|---|---|---|
| Men | Women | Men | Women | |
| Variable | AOR (95% CI) | AOR (95% CI) | AOR (95% CI) | AOR (95% CI) |
| Age at baseline, years | 1.02 (1.02, 1.03) | 1.01 (1.01, 1.02) | 1.02 (1.02, 1.03) | 1.02 (1.02, 1.03) |
| Initial weight, kilograms | 1.16 (1.15, 1.17) | 1.18 (1.17, 1.19) | 1.17 (1.16, 1.18) | 1.20 (1.19, 1.23) |
| Length of follow up, years | ||||
| <3.0 | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) |
| ≥3.0 | 1.17 (1.06, 1.30) | 1.44 (1.29, 1.61) | 1.32 (1.19, 1.23) | 1.39 (1.26, 1.53) |
| Race/Ethnicity | ||||
| European/North American | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) | 1.00 (ref) |
| Haitian/Black Caribbean | 1.19 (0.83, 1.71) | 1.84 (1.39, 2.42) | 1.75 (1.28, 2.40) | 3.0 (2.17, 4.21) |
| African | 1.79 (1.02, 3.15) | 1.43 (0.79, 2.59) | 1.56 (0.90, 2.71) | 2.22 (1.30, 3.78) |
| Mexican/Central American | 5.64 (4.02, 7.91) | 4.32 (2.99, 6.23) | 6.39 (4.37, 9.33) | 6.30 (4.26, 9.33) |
| South American/Caribbean | 2.60 (1.71, 3.94) | 2.24 (1.48, 3.39) | 2.87 (1.86, 4.45) | 3.18 (2.24, 4.52) |
| Brazilian | 1.44 (1.10, 1.88) | 0.97 (0.74, 1.28) | 2.31 (1.82, 2.93) | 1.88 (1.51, 2.34) |
| South Asian | 1.58 (0.99, 2.53) | 2.32 (1.56, 3.39) | 2.81 (1.99, 3.96) | 4.87 (3.46, 6.85) |
| East/South East Asian | 1.19 (0.62, 2.27) | 1.88 (1.06, 3.32) | 1.99 (1.35, 2.95) | 1.60 (1.14, 2.24) |
| Middle East/North African | 0.98 (0.95, 1.64) | 1.69 (0.98, 2.92) | 1.90 (1.10, 3.29) | 1.91 (1.07, 3.44) |
Notes: Boldface indicates statistical significance (p<0.05). Using generalized estimating equations (GEE).
DISCUSSION
This study found that trends in obesity and overweight increased among all immigrants and ethnic minorities, but significant subgroup variations existed. Obesity and overweight trends were highest among Mexican/Central American men and Haitian/black Caribbean women. Although East/South East Asians had the lowest obesity and overweight burden, their obesity rates increased by 1.5 times among men, and by 2.4 times among women during the study period. The majority of the weight gains occurred within the first 3 years. This study also found that baseline age, weight, and duration of follow-up were associated with obesity and overweight.
Among immigrants, Mexican/Central American men had the highest obesity and overweight burden. This finding is similar to those of other studies, which found that U.S. Hispanic immigrants from Mexico and Central America tend to have one of the highest overweight rates.11,15 This could be a reflection of the relatively high baseline prevalence of obesity and overweight in their countries of origin. Ng et al.1 reported Mexico has a relatively high overweight burden, at 66.8% in men and 71.4% in women. In this study, the 90.8% overweight rate at follow-up among immigrant Mexican/Central American men exceeds the corresponding rate of 78.6% U.S. Hispanic men.16 Prior studies have found that acculturation to unhealthy Western lifestyle and diet contributes to unfavorable weight distributions among Mexican American men.17 In addition to acculturation, SES has also been associated with less favorable body fat distribution among Mexican American men.17
Among women, the authors found a significant burden of overweight in immigrants from Haiti (72.0% in 2011 to 82.2% in 2016, p<0.01). Although there is a paucity of research in this subpopulation, a cross-sectional study in Miami-Dade County reported similarly high obesity (27.8%) and overweight (77.2%) rates among Haitian Americans.18 This finding is much higher than the 30.8% prevalence of overweight among women in Haiti, but similar to the high overall overweight prevalence of 82.0% among non-Hispanic black women in the U.S.1,16 The authors found East/South East Asians had the lowest obesity and overweight burden. However, among East/South East Asian women, longitudinal obesity rates increased more than any other group by 2.4-fold (5.6% in 2011 to 13.4% in 2016, p=0.01) and overweight rates increased by 1.7-fold (20.9% in 2011 to 35.4% in 2016, p=0.01). These initial rates correspond more with the obesity and overweight rates of the population in East and South East Asia.1 By contrast, the follow-up rates in 2016 approached the obesity (11.4%) and overweight (34.4%) rates of non-Hispanic Asian women in the U.S.16 The findings support unhealthy weight gains likely occur following adaptation of unhealthy U.S. diet and lifestyle, but could vary among subpopulations based on baseline factors and the acculturation process in their new environment.19,20
The overall initial obesity and overweight rates among immigrants in the study were relatively lower than their U.S. counterparts, but higher than the prevalence in their corresponding regions of origin. After 5 years of follow-up, the final obesity and overweight rates among African, Brazilian, Haitian/black Caribbean, Mexican/Central American, South American/Caribbean men, South Asian, East/South East Asian, and Middle East/North African individuals either exceeded or approached the corresponding U.S. rates. This finding concurs with other studies where length of residence in the U.S. has been associated with increase in risk of obesity among foreign-born U.S. residents.15,19,20 However, this study is unique in that it is conducted at a different geographic location in the U.S. with different set of immigrant populations. Furthermore, this study sheds light into the annual obesity and overweight trends among immigrants.
Interestingly, it was found that most of the weight gains as well as the obesity and overweight rate increases occurred within the first 3 years of follow-up. However, subgroup differences were noted, whereby overall women, South American/Caribbean men, and South Asians reached their overall net weight gain quicker than men, East/South East Asian men, and Middle East/North African women. This may reflect slower acculturation to unhealthy U.S. diet and lifestyle among some immigrant groups, which may lead to slower transition to the higher U.S. obesity rates.21 Assimilation to the host culture may vary among different subgroups, and could depend on strong ties to their native cultures as well as living in areas where immigrants are concentrated.13,22 Similarly, a study among child refugees in the U.S. has shown that a significant portion of the weight gain takes place during the first few years of resettlement and plateaus soon thereafter.23 A large cross-sectional study based on the 2000 National Health Interview Survey also found that a substantial weight gain among immigrants transpired within the first 5 years of living in the U.S.24
Prior studies have reported on the healthy immigrant effect—that immigrants initially tend to be healthier and have lower obesity burden than the native-born population.13,22,25 However, over time, immigrants will lose their health advantages and their obesity rates will approach or surpass those of the native-born population.19,22 Acculturation to a more sedentary and unhealthy Western lifestyle and diet has been attributed to unhealthy weight gain among immigrants.13,22,26 Socioeconomic disadvantages and chronic stress experienced by immigrants, along with unique epigenetic factors and genetic predispositions, have also been proposed as possible explanations for the variations in unhealthy weight gain among immigrants.13,21,22 In some cultures, being overweight is also associated with beauty and high social status, and there is preference or tolerance of larger female body sizes.13,27 Furthermore, immigrants in the U.S. are less likely to receive preventive care and counseling on diet and exercise.24
Though marginally significant, this study showed that older baseline age was associated with obesity and overweight. In a prior cross-sectional study based on the New Immigrant Survey, Roshania and colleagues15 reported that immigrants aged <20 years at arrival in the U.S. were at higher risk of obesity/overweight. This is likely due to early exposure and adaptability of younger immigrants to unhealthy lifestyles in the U.S. Younger immigrants are more likely to go to U.S. schools and report dietary changes than their older counterparts.15,28 The difference could be due to the fact that this study was conducted in clinical setting, where participants are more likely to have obesity and comorbidities compared with study participants in community settings.
Limitations
The study has several limitations. One of these is loss to follow-up. Participants who followed up tended to be slightly older, and women with higher baseline BMI. The study was conducted in a patient population in Massachusetts, which may affect its generalizability. As the study is based on medical records, country of origin or immigrations status could not be ascertained. Furthermore, information on timing and type of immigration to the U.S. was not available. BMI could underestimate body fat and risk of disease outcomes, particularly among Asians.29,30 Therefore, caution must be taken and these factors must be considered when interpreting the study findings.
Notwithstanding these limitations, the study has several strengths. One of the strengths of this study is that participants were followed annually over a 5-year period. The large sample size allows for subgroup analyses. The study contributes to the substantial gap in the current literature regarding the trends and between-group differences of obesity among immigrant and ethnic minorities in the U.S, particularly among subpopulations who have not been well studied, such as immigrants from Brazil and Haiti. Further longitudinal investigations are needed to ascertain and better understand underlying reasons behind subgroup differences in studies that can assess acculturation, dietary adaptations, and other contributing factors.
CONCLUSIONS
Although longitudinal obesity and overweight trends increased among all immigrants and ethnic minorities in this study, significant subgroup variations existed. Mexican/Central American men and Haitian/black Caribbean women were affected disproportionately, approaching or surpassing the corresponding U.S. rates. Although immigrant women from Asia tended to have lower obesity and overweight burden, their longitudinal obesity rates increased more than other groups. Baseline age, weight, and longer duration of follow-up were associated with obesity. Most of the weight gains as well as the obesity rate increases occurred within the first 3 years, which could present a unique window of opportunity to implement early obesity prevention and treatment programs.
ACKNOWLEDGMENTS
This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, NIH Award UL 1TR002541) and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the author and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the NIH.
No financial disclosures were reported by the author of this paper.
Appendix Table 1.
Characteristics for Those Who Followed-up Versus Those Who Did Not Follow-up After 1 Month
| Variable | Lost to follow-up (n=3,504) |
Followed-up (n=7,973) |
|---|---|---|
| Gender | ||
| Men | 52.3 | 47.0 |
| Women | 47.7 | 53.0 |
| Age at baseline, years | 36.1 (14.3) | 38.4 (14.5) |
| Initial BMI kg/m2 | 26.4 (5.6) | 27.2 (5.9) |
| Race/Ethnicity | ||
| European/North American | 55.0 | 48.9 |
| Haitian/Black Caribbean | 5.1 | 8.2 |
| African American | 2.5 | 2.5 |
| African | 2.8 | 2.6 |
| Mexican/Central American | 5.0 | 6.3 |
| South American/Caribbean | 4.7 | 5.1 |
| Brazilian | 11.5 | 13.8 |
| South Asian | 4.9 | 5.7 |
| East/South East Asian | 5.8 | 4.5 |
| Middle East/North African | 2.7 | 2.5 |
Notes: Mean (SD) or % presented. Boldface indicates statistical significance (p<0.05). Using chi square or Fisher test and t-test for independent variables.
Appendix Table 2.
Mean Age, SD, Minimum and Maximum Range Across Ethnic Groups
| Variable | Mean age, years (SD) | Minimum | Maximum |
|---|---|---|---|
| All | 38.4 (14.5) | 18.0 | 97.4 |
| Race/Ethnicity | |||
| European/North American | 38.2 (15.2) | 18.0 | 97.4 |
| Haitian/Black Caribbean | 41.0 (16.2) | 18.0 | 95.6 |
| African American | 37.5 (12.3) | 18.1 | 79.6 |
| African | 38.2 (13.9) | 18.4 | 75.3 |
| Mexican/Central American | 36.5 (12.6) | 18.1 | 86.5 |
| South American/Caribbean | 40.1 (14.6) | 18.1 | 94.9 |
| Brazilian | 37.2 (11.1) | 18.0 | 87.6 |
| South Asian | 37.3 (13.9) | 18.0 | 84.2 |
| East/South East Asian | 40.5 (16.4) | 18.5 | 88.4 |
| Middle East/North African | 39.6 (14.5) | 19.2 | 91.5 |
Notes: Boldface indicates statistical significance (p<0.01). Among study participants at a safety-net health system in Massachusetts, 2011–2016 using ANOVA.
Appendix Table 3.
Trends of Mean Change in Weight From Their 2011 Baseline Weight by Gender and Ethnicity
| Race/Ethnicity | Mean change in weight in kilograms (95% CI) from baseline | |||||
|---|---|---|---|---|---|---|
| Follow-up | 2012 | 2013 | 2014 | 2015 | 2016 | |
| Men | ||||||
| All | 1.8 (1.5, 2.0) | 0.7 (0.5, 0.9) | 1.0 (0.7, 1.3) | 1.5 (1.2, 1.9) | 2.1 (1.7, 2.5) | 2.4 (1.9, 2.8) |
| European/North American | 1.4 (1.0, 1.8) | 0.6 (0.3, 0.9) | 0.8 (0.4, 1.3) | 1.5 (0.9, 2.1) | 1.7 (0.9, 2.4) | 1.9 (1.1, 2.7) |
| Haitian/Black Caribbean | 2.7 (1.9, 3.5) | 0.8 (0.1, 1.5) | 1.6 (0.7, 2.4) | 2.2 (1.2, 3.3) | 3.4 (2.2, 4.6) | 3.7 (2.4, 5.0) |
| African | 2.1 (1.0, 3.3) | 0.5 (−0.7, 1.7) | 0.3 (−1.2, 0.8) | 0.2 (−1.1, 1.6) | 0.7 (−0.8, 2.2) | 3.4 (1.3, 5.5) |
| Mexican/Central American | 2.3 (1.7, 3.0) | 1.0 (0.4, 1.5) | 1.9 (1.1, 2.7) | 1.7 (0.9, 2.5) | 2.9 (1.8, 3.9) | 3.1 (2.1, 4.1) |
| South American/Caribbean | 2.1 (0.9, 3.3) | 1.8 (0.9, 2.7) | 1.1 (−0.3, 2.5) | 2.3 (0.3, 4.3) | 2.4 (0.6, 4.2) | 2.4 (0.5, 4.3) |
| Brazilian | 2.3 (1.7, 3.0) | 0.5 (0.9, 1.0) | 1.0 (0.5, 1.6) | 1.8 (1.2, 2.4) | 2.3 (1.5, 3.0) | 3.2 (2.3, 4.1) |
| South Asian | 2.6 (1.9, 3.4) | 0.9 (0.2, 1.6) | 1.5 (0.6, 2.3) | 2.2 (1.4, 3.1) | 3.4 (2.3, 4.5) | 2.8 (1.8, 3.8) |
| East/South East Asian | 1.5 (0.6, 2.3) | 0.2 (−0.5, 1.0) | 0.1 (−0.8, 1.0) | 0.3 (−0.7, 1.3) | 1.2 (−0.1, 2.5) | 1.3 (0.1, 2.5) |
| Middle East/North African | 0.5 (−1.4, 2.4) | 0.2 (−1.2, 1.5) | 0.0 (−2.0, 1.9) | −1.7 (−4.6, 1.3) | 0.9 (−2.3, 4.1) | 0.2 (−2.6, 2.9) |
| Women | ||||||
| All | 1.7 (1.5, 1.9) | 0.6 (0.4, 0.8) | 0.9 (0.7, 1.2) | 1.8 (1.4, 2.1) | 2.2 (1.8, 2.6) | 2.4 (2.1, 2.8) |
| European/North American | 1.2 (0.9, 1.6) | 0.3 (0.0, 0.5) | 0.5 (0.1, 0.9) | 1.7 (1.1, 2.2) | 1.7 (1.1, 2.3) | 2.1 (1.4, 2.8) |
| Haitian/Black Caribbean | 2.8 (2.0, 3.6) | 0.9 (0.3, 1.4) | 1.9 (1.1, 2.6) | 2.6 (1.7, 3.5) | 3.3 (2.1, 4.4) | 3.6 (2.5, 4.7) |
| African | 3.5 (2.1, 4.9) | 2.1 (1.0, 3.2) | 3.3 (1.3, 5.2) | 2.8 (0.8, 4.8) | 3.7 (1.6, 5.7) | 4.0 (1.8, 6.3) |
| Mexican/Central American | 3.0 (2.0, 3.6) | 1.7 (0.9, 2.5) | 1.8 (0.8, 2.9) | 1.8 (0.7, 2.9) | 3.3 (1.8, 4.7) | 3.3 (2.1, 4.5) |
| South American/Caribbean | 1.4 (0.3, 2.4) | 1.0 (0.2, 1.8) | 1.1 (−0.2, 2.4) | 1.0 (−0.6, 2.6) | 1.5 (−0.2, 3.3) | 1.6 (0.1, 3.1) |
| Brazilian | 1.7 (1.0, 2.3) | 0.5 (0.0, 1.0) | 0.9 (0.3, 1.5) | 1.3 (0.6, 2.1) | 2.5 (1.7, 3.3) | 2.2 (1.3, 3.1) |
| South Asian | 2.5 (1.7, 3.3) | 1.1 (0.5, 1.7) | 1.3 (0.5, 2.0) | 2.5 (1.5, 3.4) | 2.4 (0.9, 3.6) | 2.8 (1.5, 3.9) |
| East/South East Asian | 1.3 (0.8, 1.9) | 0.4 (−0.1, 0.9) | 0.5 (−0.3, 1.3) | 1.2 (0.4, 1.9) | 2.0 (1.1, 2.8) | 2.2 (1.1, 3.2) |
| Middle East/North African | 1.8 (0.4, 3.1) | 0.4 (−0.8, 1.6) | −0.2 (−1.7, 1.4) | 0.8 (−0.6, 2.2) | 2.0 (0.0, 3.9) | 2.9 (1.0, 4.7) |
Notes: Follow-up based on the last or most recent follow up visits.
Appendix Table 4.
Cumulative Incidence per 1,000 Population Over Average of 42.0 Months by Gender and Ethnicity
| Race/Ethnicity | Cumulative incidence per 1,000 population | |
|---|---|---|
| Obesity | Overweight | |
| Men | ||
| European/North American | 20 | 104 |
| Haitian/Black Caribbean | 42 | 313 |
| African | 60 | 152 |
| Mexican/Central American | 113 | 289 |
| South American/Caribbean | 126 | 273 |
| Brazilian | 70 | 180 |
| South Asian | 22 | 171 |
| East/South East Asian | 48 | 87 |
| Middle East/North African | 0 | 43 |
| Women | ||
| European/North American | 26 | 54 |
| Haitian/Black Caribbean | 130 | 291 |
| African | 97 | 214 |
| Mexican/Central American | 110 | 242 |
| South American/Caribbean | 38 | 221 |
| Brazilian | 22 | 115 |
| South Asian | 24 | 184 |
| East/South East Asian | 28 | 40 |
| Middle East/North African | 58 | 200 |
Note: Overall average follow-up duration of 42.0 months at a large safety-net health system in Massachusetts, 2011–2016.
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