Skip to main content
NCBI home page
PMC Canada Author Manuscripts logoLink to PMC Canada Author Manuscripts
. Author manuscript; available in PMC: 2013 Nov 20.
Published in final edited form as: Eur J Epidemiol. 2009 Jul 30;24(10):611–623. doi: 10.1007/s10654-009-9373-4

CONVERGENCE OF BODY MASS INDEX OF IMMIGRANTS TO THE CANADIAN-BORN POPULATION: EVIDENCE FROM THE NATIONAL POPULATION SURVEY (1994–2006)

Amélie Quesnel-Vallée 1, Maninder Singh Setia 2, Michal Abrahamowicz 3, Pierre Tousignant 4, John Lynch 5
PMCID: PMC3833856  CAMSID: CAMS3274  PMID: 19642002

Introduction

Canada is one of the major immigrant countries in the world, and admits more than 200,000 ethnically diverse new permanent residents every year.243 Partly due to mandatory medical examinations, and also ostensibly because of selection effects (younger, healthier people are more likely to undertake migration as economic class immigrants), at the time of entry new immigrants have fewer chronic conditions and better average health compared with the Canadian-born population.5, 243–245 This ‘healthy immigrant effect’ has also been described in other countries (United States and Australia).6–7 Previous Canadian studies on immigrant health demonstrate that duration of stay in Canada is an important predictor of poor health among immigrant - recent immigrants had better self-rated and functional health than did those who had immigrated more than 10 years earlier.5, 198

People migrate for various reasons - better economic opportunities, safer political systems, flight from regions of conflict and war, or to experience new cultures and societies.244 Whatever the reason, immigration can be a stressful process. It has been shown that on arrival new immigrants in Canada are more likely to be poor than Canadian born individuals 9, 87; this may have an effect on their access to health resources as well as to leisure activities such as exercising in the gym or practicing sports. Even though immigrants may have lower income on arrival, with time they tend to find suitable jobs and their incomes increase, sometimes even faster than the host populations. 88 With time in adopted country, immigrants may also start adopting native behaviours – diet related, smoking, drinking, and exercise.92, 96, 246 Beiser has termed these as ‘the resettlement stress paradigm’ and ‘the convergence paradigm’ respectively.4 These resulting changes in living conditions, dietary habits, exercise, and in financial means may potentially impact the health of these immigrants, including an increase in their body mass index (BMI). 125

Thus with an increasing length of stay in the new adopted country, immigrants may experience obesity and their BMIs may converge towards those of the host populations. 6, 105, 247 This increase in BMI may have important cardiovascular and metabolic complications, thus making it an important public health issue.128 In support for these hypotheses, previous Canadian studies have shown that the BMI of immigrants increases with additional years in their adopted country.109, 113, 117, 245 Though these are important contributions, estimates for these analyses were from cross-sectional, pooling cross-sectional data, or synthetic cohort data. Thus, relatively little is known about the individual longitudinal changes in BMI. Certain ethnic minority immigrants may generally have lower BMIs compared with the white immigrants 248–249; however, ethnic minorities also tend to have lower physical activity compared with white immigrants 123 - this may influence the changes in BMI in these immigrant groups. Moreover, as previously mentioned, many factors that influence BMI (such as economic conditions, dietary habits, exercise) may change over time in individuals, and particularly among immigrants. Longitudinal analyses that account for these changes in individuals are necessary to examine long term changes in BMI of Canadians and immigrants over time; and assess the convergence (or lack thereof) of immigrant BMI to the Canadian levels. .

Therefore, we set the aim of the present study as the examination of the convergence of immigrant BMI to Canadian levels. To that effect, we evaluated 12-year changes in BMI (and related socio-demographic factors) among white and non-white immigrants, and Canadian-born individuals.

Methods

This study is a longitudinal analysis of secondary data originally collected by Statistics Canada in seven waves of the National Population Health Survey (NPHS). 250

Data Source

The NPHS is a longitudinal survey nationally representative of the Canadian population that prospectively collects social, demographic, economic, occupational, environmental, and health information. The first wave of NPHS was in 1994/95, and biennial surveys have been carried on since then, providing 12 years of follow-up, with seven assessments in: 1994/95, 1996/97, 1998/99, 2000/01, 2002/03, 2004/5, and 2006/7. The target population comprises household residents of ten provinces in Canada; it excludes persons living on Indian Reserves and Crown lands and in remote areas of Ontario and Québec, residents of health institutions, and those living on Canadian Force bases. The households were selected in the first cycle (1994/95) and one individual above the age of 12 years was randomly selected from each household to be the respondent for all the seven waves of the survey. The initial longitudinal sample was of 10,992 individuals; of these 5,671 were in the age group of 18–54 years at baseline. We excluded 207 individuals who lacked data for all seven waves. Thus, finally a total of 2504 males and 2960 females were included for the present analysis (refer to as cohort for future discussion). We have described the details of the sample size calculation in Figure 1. We had a total of 15860 observations (mean 6.3) for males and 18349 (mean 6.2) observations for females across the seven assessment times.

Figure 1.

Figure 1

Open in a new tab

The sample size for the current study to assess the 12-year change in body mass index according to immigrant status, National Population Health Survey, Canada (1994–2006)

The outcome variable of interest was BMI: weight (kilograms)/[height (metres)]2, based on the self reports of height and weight of individuals at each cycle. The independent variable of primary interest was the immigrant status of the individual: Canadian born, White immigrants and Non-white Immigrants. We used socio-demographics and lifestyle factors as explanatory variables in the statistical models to replicate previous research based on Berry’s framework for acculturation. 10. The socio-demographic parameters were: age, income category (classified by Statistics Canada as highest, upper middle, lower middle, and lowest), education (primary, secondary, post-secondary, and graduate), marital status (single, married, separated), living conditions (single, with a partner, family with both parents, family with single parent, and other types), province of residence (Ontario, Quebec, British Columbia, and others), and a binary indicator of linguistic minority (individuals living in Quebec and unable to speak/understand French, individuals living in other provinces and unable to speak/understand English). We also measured lifestyle variables that may confound the association between immigrant status and BMI, such were: alcohol intake (never, regular, or former), smoking pattern (never, daily, occasional, or former), and physical activity (infrequent, occasional, and regular). A calendar ‘time’ variable measured in years since 1994 was also included in the models to account for the longitudinal changes across the seven cycles during the 12 year follow-up period. Finally, we built a model that included only the immigrants to assess the effect of time since immigration on the change in BMI. This variable could not be used in the complete model with all the individuals as it would have no value for Canadian born individuals.

Statistical Analyses

We analysed data on men and women separately. Descriptive statistics included means and standard deviations (SD) for BMI calculated separately for the immigrant sub-groups, socio-demographic characteristics, and lifestyle variables for each cycle of data.

We used a random effects models (RE) for analysis of this longitudinal dataset. While ordinary least squares method is likely to yield biased estimates from data with repeated within-subject measures over time, RE models can estimate both within-individual and between-individual variance, and, thus account for the correlation of the repeated outcomes in the same subject.251 The models were built in the following sequence (all with BMI as the outcome): null model with no explanatory variables; crude estimates of changes over time in BMI for each of the variables separately; and a complete model with all the variables. Our RE models accounted for both random intercepts and slopes i.e. accounted for between-subjects variation in both baseline BMI and rate of change of BMI over time. We also used the interaction between immigrant status and time (year) to assess the difference in the rates of change of BMI between different immigrant groups over the 12 year period of data collection. We used the Akaike Information Criteria (AIC) to compare the fit of alternative models while accounting for the differences in degrees-of-freedom.252 Finally, we used a residual versus fitted values plot to evaluate the model assumptions.

About 118 (5%) males and 95 (3%) females died during the course of the 12-year data collection. After excluding individuals who died during the follow-up, about 93% observations in males and 90% observations in females in our cohort had no missing values, for any of the variables included in these models. To deal with missing data, we performed 20 imputations of the dataset (using all seven waves), without individuals who died, using the ‘Multiple Imputations with Chained Equations’ (MICE) method. 253–254 The missing values of variables are imputed based on the regression model that uses observed values of all the variables. An imputed value for the missing value is calculated using the parameters from the distribution, with the mean and standard deviation (SD) estimated based on the estimated parameters and their standard errors from this regression model. This procedure was repeated 20 times, and final results for parameters and standard errors accounted for the variation of the estimates across the 20 replications. The difference of the estimates from these models was < 0.5*Standard Error for the primary independent variable of interest. Therefore, we are only reporting the results from the complete dataset with missing data.

We used Stata (version 10) (StataCorp, College Station, Texas, USA) for analyses and conducted the imputations using the ice command in Stata. 255–257

The study was approved for secondary data analysis by the Institutional Review Board of McGill University.

Results

Of the 2504 males, 2225 (89%) were born in Canada, 174 (7%) were white immigrants, and 105 (4%) were non-white immigrants. Among the females, 2652 (89%) were born in Canada, 201 (7%) were white immigrants, and 107 (4%) were non-white immigrants. Among the 587 immigrants: 20% were from the United Kingdom, 9% were from the United States, 6% were from India, 3% from Mainland China and 4% from Hong Kong. In our study population of 212 non-white immigrants; 31% were ethnically South Asian, 27% were ethnically Chinese, and 21% were ethnically Black. Certain baseline demographic characteristics of Canadian born individuals and immigrants are discussed further in Appendix II (web based).

Descriptive data

Figure 2(a) shows the change in unadjusted mean BMI according to immigrant status over the 12-year period. At baseline, the mean BMI was very similar in white male immigrants (26.3) and in Canadian born males (26.2). In contrast, among non-white male immigrants the mean BMI was lower (24.3) than in the two other groups. Although the mean BMI increased over time in each group, the curve for non-white immigrants remained systematically below those for the other groups (Figure 2a). Even after adjusting for age, the mean BMI in non-white immigrants was about 2 units lower for each year of data collection. In women, the mean BMI at baseline was highest in Canadian born women (24.9), followed by white immigrants (24.3), while non-white immigrants had the lowest mean BMI (23.2) at baseline. This trend was maintained during all the seven waves of data collection (Figure 2b). As observed in males, even after adjusting for age, female non-white immigrants had the lowest mean BMI for each data collection point.

Figure 2.

Figure 2

Open in a new tab

Changes in Body Mass Index in 2504 men and 2960 women according to immigration status (Canadian born, White Immigrants and Non-White immigrants) in Canada from 1994–2006

The comparisons of the mean (SD) BMI according to immigrant status, socio-demographic, and lifestyle variables for each cycle of the 12-year follow-up can be found in Appendix V (web based).

Complete Cohort Models

The crude and adjusted changes in BMI over the 12-year period in the complete cohort are described in Table 1. We refer only to the adjusted estimates in the subsequent discussion.

Table 1.

Random Effects models showing the Crude and Adjusted estimates for prediction of body mass index in 2504 men and 2960 women over a 12-year period (1994–2006), Canada

Crude estimates Adjusted estimates
Males estimate (95% CI) Females estimate (95% CI) Males estimate (95% CI) Females estimate (95% CI)
Immigrant status
White Immigrants 0.08 (−0.51, 0.67) −0.74 (−1.44, −0.03) −0.32 (−91, 0.27) −1.05 (−1.74, −0.35)
Non-white Immigrants −2.10 (−2.84, −1.35) −1.50 (−2.45, −0.54) −2.28 (−3.02, −1.53) −1.84 (−2.79, −0.90)
Canadian born reference reference reference reference
Age 0.30 (0.27, 0.33) 0.27 (0.23, 0.31) 0.23 (0.20, 0.27) 0.24 (0.20, 0.29)
Age2 −0.002 (−0.003, − 0.002) −0.001 (−0.002, − 0.001) −0.002 (−0.003, − 0.002) −0.002 (−0.002, − 0.001)
Time 0.15 (0.14, 0.15) 0.17 (0.16, 0.18) 0.09 (0.07, 0.11) 0.09 (0.06, 0.11)
Education
Graduate 0.37 (0.07, 0.67) 0.11 (−0.25, 0.46) −0.02 (−0.32, 0.28) −0.24 (−0.59, 0.11)
Post-Secondary 0.15 (−0.15, 0.45) −0.10 (−0.45, 0.24) −0.07(−0.36, 0.22) −0.34 (−0.68, 0.01)
Secondary −0.26 (−0.62, 0.10) −0.40 (−0.81, 0.02) −0.21 (−0.56, 0.13) −0.28 (−0.69, 0.13)
Primary reference reference reference reference
Income category
Lowest −0.75 (−0.89, −0.60) −0.39 (−0.56, −0.23) −0.22 (−0.37, −0.07) 0.30 (0.13, 0.47)
Lower Middle −0.54 (−0.65, −0.44) −0.36 (−0.48, −0.23) −0.14 (−0.24, −0.03) 0.11 (−0.02, 0.24)
Upper Middle −0.30 (−0.38, −0.22) −−0.18 (−0.28, − 0.09) −0.05 (−0.13, 0.03) 0.08 (−0.02, 0.18)
Highest reference reference reference reference
Marital Status
Married 0.90 (0.76, 1.04) 0.80 (0.63, 0.97) 0.26 (0.09, 0.44) 0.07 (−0.15, 0.28)
Separated 0.73 (0.53, 0.92) 0.46 (0.23, 0.68) 0.11 (−0.10, 0.31) −0.13 (−0.36, 0.10)
Single reference reference reference reference
Living Condition
Partner 0.36 (0.23, 0.49) 0.39 (0.22, 0.55) 0.11 (−0.07, 0.28) 0.24 (0.03, 0.46)
Family both 0.28 (0.15, 0.40) 0.31 (0.15, 0.48) 0.12 (−0.04, 0.27) 0.28 (0.07, 0.48)
Family single −0.06, (−0.26, 0.14) −0.16 (−0.35, 0.03) −0.03 (−0.23, 0.17) −0.05 (−0.24, 0.14)
Other types 0.12 (−0.02, 0.26) 0.08 (−0.10, 0.25) 0.05 (−0.10, 0.20) 0.13 (−0.06, 0.32)
Lives alone reference reference reference reference
Province
Ontario −0.16 (−0.42, 0.10) −0.24 (−0.53, 0.05) −0.22 (−0.48, 0.03) −0.25 (−0.54, 0.04)
Quebec −0.66 (−1.01, −0.30) −0.62 (−1.01, −0.23) −0.83 (−1.19, −0.47) −0.81 (−1.21, −0.40)
British Columbia −0.05 (−0.38, 0.28) −0.66 (−1.04, −0.28) −0.17 (−0.49, 0.15) −0.67 (−1.04, −0.29)
Others reference reference reference reference
Linguistic major
Yes 0.08 (−0.09, 0.25) 0.11 (−0.10, 0.31) 0.02 (−0.16, 0.20) −0.06 (−0.27, 0.16)
No reference reference reference reference
Alcohol status
Regular alcohol 0.11 (−0.02, 0.24) −0.20 (−0.33, −0.06) 0.14 (0.01, 0.28) −0.15 (−0.28, −0.01)
Former alcohol 0.15 (0.01, 0.28) 0.00 (−0.12, 0.12) 0.20 (0.06, 0.34) 0.07 (−0.06, 0.20)
Never alcohol reference reference reference reference
Smoking status
Daily smoker −0.48 (−0.64, −0.33) −0.68 (−0.88, − 0.47)) −0.55 (−0.71, −0.39) −0.71 (−0.91, −0.50)
Occasional smoker −0.07 (−0.25, 0.12) −0.18 (−0.41, 0.05) −0.20 (−0.39, −0.02) −0.23 (−0.47, 0.00)
Former smoker 0.35 (0.23, 0.47) 0.40 (0.25, 0.56) 0.12 (−0.01, 0.24) 0.21 (0.05, 0.37)
No smoke reference reference reference reference
Physical activity
Regular −0.04 (−0.12, 0.05) −0.11 (−0.21, −0.01) −0.11 (−0.20, −0.03) −0.22 (−0.32, −0.12)
Occasional 0.08 (−0.01, 0.16) 0.00 (−0.11, 0.10) 0.05 (−0.04, 0.14) −0.02 (−0.13, 0.08)
Infrequent reference reference reference reference
Constant 26.5 (26.4, 26.7) 25.1 (25.0, 25.3) 21.1 (20.1, 22.0) 19.3 (18.3, 20.4)
AIC 66933.4 86350.8
Interaction terms
White immigrant*time 0.03 (0.00, 0.07) NS
Non−white immigrant*time −0.05 (−0.09, 0.00) NS
Open in a new tab

Adjusting for the covariates, non-white immigrants (both men and women) had lower BMI than Canadian born individuals over the 12-year period (Mean difference for males: −2.27, 95% CI −3.02 to −1.53; Mean difference for females: −1.84, 95% CI −2.79 to −0.90). In contrast, the mean values of BMI in white male immigrants were similar to Canadian born individuals over this time period (−0.32, 95% CI −0.91 to 0.27). The interaction between immigrant status and time (year) was statistically significant in men: the mean change in BMI for each year of data collection was higher in white male immigrants (0.03, 95% CI: 0.00 to 0.07) and lower in non-white male immigrants (−0.05, 95% CI: −0.09 to 0.00) when compared with the Canadian born population. The interaction between time and immigrant status was not statistically significant in women indicating that there were no systematic differences in the rate of change on BMI across the two immigrant categories.

Immigrant only models

After adjusting for other characteristics (including age), with every additional year since immigration to Canada, the BMI changed by 0.03 units (95% CI: −0.01 to 0.06). In general, across the seven waves of data, female immigrants had lower mean BMI than males (−1.61, 95% CI: −2.26 to −0.97). Even after adjusting for time since immigration, non-white immigrants had significantly lower mean BMI compared with the white immigrants (−1.21, 95% CI: −1.96 to −0.46). We tested the interactions between time-since-immigration and sex, age, and immigrant categories; none of these were statistically significant. Selected estimates for the immigrant only models are shown in Table 2.

Table 2.

Random Effects models showing the Crude and Adjusted estimates for prediction of Body Mass Index in 587 immigrants in Canada (1994–2006)*

Crude estimates estimate (95% CI) Adjusted estimates estimate (95% CI)
Immigrant status
Non-white Immigrants −1.38 (−2.05, −0.71) −1.21 (−1.96, −0.46)
White Immigrants reference reference
Age 0.20 (0.11, 0.29) 0.09 (−0.01, 0.19)
Age2 −0.001 (−0.002, 0.000) −0.001 (−0.002, 0.000)
Sex
Females −1.55 (−2.20, −0.91) −1.61 (−2.25, −0.97)
Males reference
Time 0.14 (0.12, 0.16) 0.10 (0.05, 0.14)
Time-since-immigration 0.11 (0.09, 0.12) 0.03 (−0.01, 0.06)
Education
Graduate −1.60 (−2.60, −0.58) −1.69 (−2.71, −0.68)
Post-Secondary −0.86 (−1.75, 0.32) −1.15 (−2.04, −0.27)
Secondary −0.83 (−1.72, 0.07) −1.31 (−2.20. −0.42)
Primary reference reference
Income category
Lowest −0.32 (−0.51, −0.12) 0.34 (−0.01, 0.69)
Lower Middle −0.29 (−0.55, −0.04) 0.12 (−0.14, 0.38)
Upper Middle −0.24 (−0.57, 0.10) −0.07 (−0.27, 0.12)
Highest reference reference
Marital Status
Married 0.99 (0.51, 1.46) 0.57 (0.05, 1.09)
Separated 1.03 (0.46, 1.61) 0.41 (−0.19, 1.03)
Single reference reference
Linguistic Major
Yes −0.14 (−0.65, 0.07) −0.08 (−0.70, 0.55)
No reference reference
Interaction terms
Non-white immigrants* time-since immigration NS
Females* time-since-immigration NS
AIC 16226.61
Open in a new tab
*

= The adjusted model also included variables which formed a part of the complete cohort models (living conditions, province, smoking, alcohol use, physical activity)

Discussion

Both male and female non-white immigrants had the lowest BMIs at the beginning of the study and continued to remain about 2 units lower than the Canadian born individuals, over the 12-year period (1994–2006). After adjusting for individual level socio-demographic characteristics, white male immigrants were the only sub-group whose BMIs had converged upward to the Canadian born individuals over the 12-year period. Even after adjusting for time since immigration, non-white immigrants kept their lower BMIs over the 12-year period than white immigrants.

These findings are congruent with previous research from Ross and co-workers, who found while working with the 2000/01 CCHS data, that immigrants (men and women) in general had lower BMIs irrespective of the time since immigration.111 However, another interpretation could be that these aggregate patterns are masking substantial heterogeneity within the immigrant population. Indeed, it has been postulated that ethnic minority immigrants may acculturate more slowly than those from educated urban settings with similar physical characteristics (such as skin colour).258 Thus, the levels of dietary acculturation, a strong contributor to BMI, may vary by ethnic origin. Empirical evidence does tend to support this hypothesis. For instance, McDonald and Kennedy [using the 1996 wave of NPHS and the 2000/01 wave of the Canadian Community Health Survey (CCHS)] predicted that unhealthy weight indicators in immigrants will increase beyond the native-born levels after 20–30 years of immigration.109 However, they also found that this would not apply to Chinese immigrants. A similar finding was reported by Cairney and Ostbyte: using the 1994 wave of NPHS, as they found that respondents from Asia were less overweight/obese than other ethnic groups.117

By following a cohort of immigrants over time, we found that non-white immigrants (both males and females) started and continued to be about two units lower for BMI than the Canadian born individuals - there was no convergence to the BMI levels of the Canadian-born population. By contrast, the male white immigrants appeared to converge to Canadian levels of BMI. Even in the ‘immigrant-only’ models, after adjusting for time since immigration, non-white immigrants had lower BMI than white immigrants. A potential explanation for the non-convergence of the BMI values among non-white immigrants could be the relatively short follow-up period of 12 years. However, as indicated by the interaction terms in our models, the mean BMI changed positively in white male immigrants per year of data collection and negatively in non-white male immigrants when compared with the Canadian born population - thus suggesting that the mean values in the non-white male immigrants did not appear to converge to the mean values of the Canadian born males. These differences in BMI in various ethnic groups have also been demonstrated in other settings.104, 259 However, these results should be interpreted cautiously, as individuals from certain ethnic minority groups (for example, Asian origin individuals) may have higher body fat content for similar or even lower levels of BMI when compared with their European counterparts.248–249, 260 BMI may not measure the body fat distribution appropriately; hence other measures such as waist circumference, hip circumference, waist-to-hip ratio, sagittal abdominal diameter, and skinfolds may be more appropriate to measure body fat distribution. 261 Further, while we have accounted for other variables that may potentially affect both the process of acculturation and BMI (income, education, physical activity etc.), our focus was not on health behaviours per se. Our results most definitely suggest that these are important determinants of BMI, health and potentially convergence, and they should be examined in their own right.

Two major limitations of this study were the self-reported nature of height and weight (used to calculate BMIs) and the overall small sample sizes. Though we followed the same individual over a period of 12 years, there is a possibility of over reporting of height and underreporting of weight. Moreover, these trends may also vary between men and women.262 Though BMI has its limitations in measuring body fat distribution, it is an important anthropometric measure and has a very high applicability in large population studies such as this one. 261 Further, a collaborative analysis of 57 prospective studies demonstrated that BMI is in itself a strong predictor of mortality above and below the optimum levels (22.5 to 25 kg/m2). 263 In addition, low BMI could indeed be illness-induced, rather than indicative of good health, thus carrying with it a potential health selection bias. We did not include extremes of age in our sample population. Our population composed of 18–54 year old individuals, and with a 12-year follow-up, we estimate that they are unlikely to be in the group subject to illness-induced weight loss. Another potential limitation is that non-white immigrants represent a heterogeneous group. However, because of small numbers we could not classify them further (e.g., Asian, South Asian, Black etc.). We also did not have information on the class of immigration - economic class, family class, or refugees. Future Canadian surveys should include sufficient numbers of individuals in ethnic minority groups and have information on the class of immigration. This will help us understand the differences in weight gain between these groups.

Despite these limitations, the study provides useful information. First, it adds a longitudinal dimension to the existing literature on immigrants and BMI changes in Canada. We have followed the same individuals over a period of 12 years (the longest duration of follow-up for BMI in immigrants) and estimates have accounted for both within-subject and between-subject variation of the outcome. Second, it demonstrates that though there was an increase in BMI levels in all three immigrant categories (Canadian born, white immigrants, non-white immigrants) over the 12-year period, the mean BMIs of non-white immigrants remained consistently lower than those of the Canadian born individuals or white immigrants. Among males, non-white immigrants showed a negative mean change in BMI per year compared with the Canadian born population. Thus, from an epidemiological perspective, not all immigrant groups show the loss of ‘healthy immigrant effect’ with regard to convergence of BMI values to native Canadian levels. Nevertheless, from a public health perspective, ethnic minority immigrants may continue to be at risk of developing obesity-related complications due to their high body fat content even with lower levels of BMI, as shown by other authors. 248–249, 260 Although we did not have better measures of fat distribution, future surveys should attempt to collect this information. Finally, public prevention programmes such as exercise and dietary habits should be applicable to all these groups to prevent obesity related morbidity in an increasingly multiethnic Canada.

Appendices

Table 3.

Certain baseline demographic characteristics according to immigrant status in 2504 males and 2960 females (1994), Canada

Characteristics Canadian born White Immigrants Non-white immigrants
Mean age (SD) years 36.1 (9.8) 40.2 (9.1) 37.6 (9.0)
Sex
Males 2225 (46) 174 (46) 105 (50)
Females 2652 (54) 201 (54) 107 (50)
Marital Status
Single 1242 (25) 49 (13) 44 (23)
Married 3063 (63) 282 (75) 138 (65)
Separated 572 (12) 44 (11) 26 (12)
Education
Primary 848 (17) 36 (10) 31 (15)
Secondary 804 (17) 63 (17) 33 (16)
Post-Secondary 1382 (28) 105 (28) 50 (24)
Graduate 1838 (38) 171 (46) 97 (46)
Income category
Highest 743 (16) 89 (25) 17 (8)
Upper Middle 1964 (41) 142 (40) 72 (36)
Lower Middle 1292 (27) 82 (23) 72 (36)
Lowest 746 (16) 44 (12) 41 (20)
Open in a new tab

Table 4.

Mean (SD) of body mass index in 2,504 men and 2,960 women for each year of the data collection cycle over a10-year period (1994–2006), Canada

Males Females
Multiple Imputations Adjusted estimates Estimate (95% CI) Only living Adjusted estimates Estimate (95% CI) Multiple Imputations Adjusted estimates Estimate (95% CI) Only living Adjusted estimates Estimate (95% CI)
Immigrant status
Canadian-born reference reference reference reference
White immigrants −0.37 (−0.96, 0.23) −0.35 (−0.95, 0.25) −1.09 (−1.77, − 0.41) −1.06 (−1.76, − 0.36)
Non-white immigrants − 2.11 (−2.86, − 1.36) − 2.09 (−2.85, − 1.34) −1.96 (−2.91, − 1.01) −1.93 (−2.90, − 0.95)
Age 0.23 (0.19, 0.27) 0.24 (0.20, 0.27) 0.24 (0.19, 0.29) 0.24 (0.19, 0.28)
Age2 − 0.002 (−0.003, − 0.002) −0.002 (−0.003, − 0.002) −0.002 (−0.002, − 0.001) −0.002(−0.002, − 0.001)
Time 0.09 (0.08, 0.11) 0.09 (0.08, 0.11) 0.09 (0.07, 0.11) 0.09 (0.07, 0.11)
Education
Primary reference reference reference reference
Secondary −0.39 (−0.72, −0.05) −0.23 (−0.57, 0.12) −0.29 (−0.77, 0.18) −0.26 (−0.67, 0.15)
Post-secondary −0.22 (−0.51, 0.07) −0.09 (−0.38, 0.21) −0.33 (−0.72, 0.05) −0.33 (−0.68, 0.01)
Graduate − 0.14 (−0.44, 0.15) −0.04 (−0.34, 0.26) −0.26 (−0.65, 0.12) −0.24 (−0.60, 0.11)
Province
Other provinces reference reference reference reference
Ontario −0.24 (−0.50, 0.01) −0.24 (−0.50, 0.01) −0.20 (−0.53, 0.12) −0.26 (−0.55, 0.04)
Quebec −0.82 (−1.19, −0.46) −0.83 (−1.20, − 0.47) −1.05 (−1.49, − 0.62) −0.82 (−1.22, − 0.42)
British Columbia −0.13 (−0.45, 0.19) −0.16 (−0.48. 0.16) −0.50 (−0.91, − 0.08)
Marital Status
Single reference reference reference reference
Married 0.35 (0.17, 0.52) 0.27 (0.09, 0.44) −0.03 (−0.30, 0.24) 0.06 (−0.15, 0.28)
Separated 0.18 (−0.03, 0.39) 0.11 (−0.09, 0.31) −0.26 (−0.56, 0.03) −0.14 (−0.38, 0.09)
Linguistic major
No reference reference reference reference
Yes −0.03 (−0.22, 0.15) −0.01 (−0.19, 0.18) −0.13 (−0.44, 0.18) −0.04 (−0.27, 0.18)
Income category
Highest reference reference reference reference
Upper middle −0.04 (−0.13, 0.04) −0.04 (−0.12, 0.04) 0.15 (0.02, 0.29) 0.08 (−0.02, 0.18)
Lower middle −0.11 (−0.22, 0.00) −0.13 (−0.23, − 0.02) 0.30 (0.12, 0.47) 0.12 (−0.01, 0.25)
Lowest −0.27 (−0.43, −0.10) −0.22 (−0.38, − 0.07) 0.43 (0.19, 0.66) 0.31 (0.14, 0.48)
Living Condition
Lives alone reference reference reference reference
Partner 0.06 (−0.12, 0.24) 0.11 (−0.06, 0.29) 0.15 (−0.14, 0.43) 0.25 (0.03, 0.47)
Family both 0.06 (−0.10, 0.23) 0.12 (−0.04, 0.27) 0.20 (−0.08, 0.47) 0.27 (0.07, 0.48)
Family single −0.10 (−0.31, 0.10) −0.05 (−0.25, 0.15) −0.01 (−0.27, 0.24) −0.05 (−0.24, 0.14)
Other types 0.01 (−0.14, 0.17) 0.04 (−0.11, 0.19) 0.14 (−0.12, 0.41) 0.14 (−0.05, 0.33)
Alcohol status
Never alcohol reference reference reference reference
Regular alcohol 0.11 (−0.03, 0.25) 0.15 (0.01, 0.28) −0.15 (−0.34, 0.04) −0.15 (−0.29, − 0.01)
Former alcohol 0.15 (0.00, 0.29) 0.21 (0.07, 0.35) 0.12 (−0.5, 0.29) 0.07 (−0.06, 0.19)
Smoking status
No smoke reference reference reference reference
Daily smoker −0.50 (−0.66, −0.33) −0.53 (−0.69, − 0.37) −0.55 (−0.81, − 0.29) −0.69 (−0.90, − 0.49)
Occasional smoker −0.11 (−0.30, 0.08) −0.17 (−0.35, 0.02) −0.04 (−0.36, 0.28) −0.22 (−0.45, 0.02)
Former smoker 0.17 (0.04, 0.30) 0.12 (0.00, 0.24) 0.33 (0.12, 0.53) 0.21 (0.05, 0.37)
Physical activity
Infrequent reference reference reference reference
Regular −0.11 (−0.19, −0.02) −0.12 (−0.21, − 0.04) −0.31 (−0.45, − 0.16) −0.23 (−0.33, − 0.12)
Occasional 0.06 (−0.03, 0.15) 0.04 (−0.04, 0.13) −0.13 (−0.27, 0.02) −0.03 (−0.14, 0.07)
Constant 21.4 (20.5, 22.3) 21.1 (20.2, 22.1) 19.5 (18.2, 20.7) 19.4 (18.4, 20.5)
Interaction terms
White immigrant*time 0.04 (0.01, 0.08) 0.03 (0.00, 0.07)
Non-white immigrant*time −0.03 (−0.08, 0.01) −0.05 (−0.09, 0.00)
1994 1996 1998
Males Females Males Females Males Females
n BMI n BMI n BMI n BMI n BMI n BMI
Total 2504 2960 2487 2944 2464 2925
Dead 17 16 23 19
Individual
Characteristics
Immigrant status
Canadian born 2225 26.2 (3.9) 2652 24.9 (5.2) 2210 26.5 (4.0) 2640 25.2 (5.1) 2189 26.8 (3.9) 2625 25.6 (5.3)
White
Immigrants		 174 26.3 (4.0) 201 24.3 (4.7) 174 26.5 (3.8) 201 24.4 (4.5) 173 26.8 (4.0) 199 24.8 (4.6)
Non-white
Immigrants		 105 24.3 (3.4) 107 23.2 (4.1) 103 24.5 (3.3) 103 23.6 (3.6) 102 24.8 (3.7) 101 23.6 (3.8)
Education
Primary 454 26.4 (4.2) 461 26.0 (5.5) 413 26.7 (4.2) 433 26.3 (5.2) 396 27.0 (4.2) 408 26.7 (5.3)
Secondary 408 26.2 (3.8) 492 24.7 (4.8) 378 26.6 (3.8) 461 25.1 (5.0) 356 27.0 (3.8) 439 25.5 (5.0)
Post-Secondary 681 26.1 (4.0) 856 24.6 (5.3) 707 26.3 (3.9) 872 24.7 (5.1) 687 26.7 (4.1) 846 25.4 (5.3)
Graduate 960 26.1 (3.9) 1146 24.6 (4.9) 989 26.3 (3.9) 1176 24.9 (4.9) 1024 26.6 (3.8) 1230 25.1 (5.1)
Income category
Highest 439 26.3 (3.7) 410 24.0 (4.2) 414 26.6 (3.7) 414 24.3 (4.3) 645 27.0 (3.9) 655 24.6 (4.3)
Upper Middle 1007 26.3 (3.9) 1171 24.7 (4.8) 1066 26.5 (3.9) 1147 24.8 (4.7) 1007 26.8 (3.9) 1120 25.5 (5.0)
Lower Middle 660 26.1 (4.1) 786 25.0 (5.2) 639 26.3 (4.0) 790 25.5 (5.5) 530 26.6 (4.1) 690 25.7 (5.5)
Lowest 311 25.6 (4.2) 520 25.6 (6.1) 262 25.8 (4.2) 472 25.8 (5.8) 193 26.0 (3.9) 374 26.4 (6.3)
Marital Status
Single 655 25.2 (4.0) 684 24.4 (5.4) 589 25.5 (4.1) 614 24.9 (5.6) 488 26.0 (4.0) 538 25.4 (5.8)
Married 1650 26.5 (3.9) 1833 24.9 (4.8) 1688 26.7 (3.9) 1880 25.0 (4.7) 1761 27.0 (3.9) 1924 25.4 (4.9)
Separated 199 26.3 (3.7) 443 25.4 (5.7) 210 26.3 (3.5) 450 25.6 (5.6) 215 26.5 (3.9) 463 25.8 (5.5)
Living Condition
Single 394 25.9 (4.1) 388 25.7 (6.2) 402 25.9 (4.1) 379 25.9 (6.3) 382 26.3 (4.1) 380 26.2 (6.3)
Partner 432 26.4 (4.0) 499 24.8 (4.8) 459 27.0 (4.0) 590 24.8 (4.4) 526 27.3 (4.3) 632 25.5 (4.6)
Family - both 1329 26.2 (3.9) 1402 24.6 (4.8) 1285 26.4 (3.8) 1346 24.9 (4.7) 1227 26.7 (3.7) 1278 25.2 (5.0)
Family - single 120 25.9 (3.8) 399 25.0 (5.5) 112 26.5 (3.8) 370 25.2 (5.4) 102 26.8 (3.6) 372 25.4 (5.2)
Other types 221 25.8 (4.0) 265 24.7 (5.1) 229 26.1 (4.3) 259 25.1 (5.0) 227 26.6 (4.3) 263 26.0 (5.4)
Province
Ontario 586 26.1 (4.1) 662 24.9 (5.2) 583 26.4 (4.1) 660 25.1 (5.2) 583 26.7 (4.0) 670 25.4 (5.2)
Quebec 457 25.7 (3.8) 520 23.9 (4.4) 458 25.7 (3.7) 521 23.9 (4.5) 455 26.0 (3.7) 514 24.2 (4.7)
British Columbia 231 26.0 (3.6) 284 24.1 (4.4) 234 26.1 (3.5) 289 24.5 (4.4) 237 26.4 (3.8) 286 25.1 (4.7)
Others 1230 26.4 (4.0) 1494 25.3 (5.2) 1212 26.7 (4.0) 1474 25.6 (5.2) 1189 27.1 (4.0) 1455 26.3 (5.3)
Linguistic major
Yes 2262 26.2 (4.0) 2693 24.9 (5.1) 2285 26.5 (3.9) 2710 25.2 (5.1) 2243 26.8 (3.9) 2695 25.6 (5.2)
No 242 25.6 (3.9) 267 23.9 (4.8) 202 25.6 (3.9) 234 23.8 (4.0) 221 25.9 (3.9) 228 24.5 (4.9)
Life style factors
Alcohol status
No alcohol 318 26.4 (4.5) 491 25.3 (5.5) 292 26.7 (4.4) 551 25.9 (6.0) 332 26.9 (4.3) 571 26.6 (6.0)
Regular alcohol 1870 26.0 (3.7) 1634 24.4 (4.6) 1863 26.2 (3.7) 1527 24.4 (4.6) 1787 26.7 (3.8) 1557 24.7 (4.4)
Former alcohol 315 26.8 (4.7) 835 25.5 (5.8) 329 27.0 (4.6) 864 25.7 (5.6) 343 26.8 (4.2) 796 26.3 (5.6)
Smoking status
No smoke 876 26.1 (3.8) 1146 24.7 (5.2) 835 26.3 (3.7) 1165 24.9 (5.0) 742 26.6 (3.7) 1073 25.3 (5.0)
Daily smoker 764 25.9 (3.9) 815 24.6 (5.1) 771 26.0 (4.0) 770 24.8 (5.0) 714 26.3 (4.1) 730 25.2 (5.2)
Occasional
smoker		 141 25.8 (3.6) 150 24.3 (4.5) 100 25.9 (3.6) 94 24.5 (5.3) 84 26.5 (3.6) 120 25.3 (5.0)
Former smoker 723 26.7 (4.2) 849 25.3 (5.2) 781 27.0 (4.1) 914 25.6 (5.1) 923 27.2 (4.0) 1001 26.0 (5.4)
Physical
activity
Infrequent 496 26.3 (4.4) 623 25.6 (6.1) 529 26.4 (4.4) 558 25.8 (5.9) 401 26.9 (4.5) 469 26.5 (6.1)
Regular 1264 25.9 (3.7) 1589 24.5 (4.6) 1383 26.2 (3.5) 1761 24.7 (4.7) 1506 26.6 (3.7) 1885 25.1 (4.8)
Occasional 608 26.6 (4.2) 697 25.1 (5.2) 558 26.8 (4.4) 615 25.4 (5.1) 537 26.9 (4.0) 564 26.0 (5.6)
2000 2002 2004
Males Females Males Females Males Females
n BMI n BMI n BMI n BMI n BMI n BMI
Total 2446 2910 2429 2896 2409 2882
Dead 18 14 17 14 20 14
Individual
Characteristics
Immigrant status
Canadian born 2172 27.3 (4.2) 2612 26.0 (5.5) 2157 27.6 (4.4) 2599 26.4 (5.6) 2140 27.7 (4.3) 2589 26.5 (5.7)
White
Immigrants		 172 27.5 (4.6) 199 25.2 (4.5) 170 27.7 (4.6) 198 25.5 (4.5) 165 28.1 (4.6) 194 25.6 (4.9)
Non-white
Immigrants		 102 24.8 (3.8) 99 24.1 (4.4) 102 25.2 (3.8) 99 24.9 (5.2) 101 25.2 (3.6) 99 24.7 (4.4)
Education
Primary 379 27.3 (4.2) 385 26.8 (5.3) 363 27.9 (4.6) 372 27.5 (5.6) 356 27.9 (4.4) 363 27.4 (5.6)
Secondary 341 27.6 (4.5) 409 26.0 (5.4) 335 27.8 (4.2) 397 26.4 (5.5) 312 27.7 (4.1) 384 26.7 (5.5)
Post-Secondary 663 27.3 (4.5) 821 26.0 (5.6) 662 27.6 (4.5) 790 26.4 (5.6) 650 27.7 (4.4) 777 26.6 (5.8)
Graduate 1051 26.9 (4.1) 1278 25.5 (5.3) 1055 27.2 (4.3) 1318 25.8 (5.3) 1069 27.4 (4.3) 1338 26.0 (5.5)
Income category
Highest 857 27.3 (4.2) 790 25.1 (4.7) 968 27.5 (4.0) 915 25.4 (4.8) 1090 27.7 (4.1) 1007 25.6 (5.0)
Upper Middle 954 27.3 (4.3) 1121 26.0 (5.6) 877 27.7 (4.5) 1070 26.4 (5.4) 795 27.7 (4.5) 1030 26.5 (5.6)
Lower Middle 387 26.9 (4.6) 586 26.4 (5.5) 357 27.1 (4.5) 534 26.9 (5.9) 281 27.4 (4.6) 475 27.3 (6.1)
Lowest 134 26.4 (4.1) 268 26.9 (6.3) 109 26.5 (5.0) 230 27.7 (6.8) 98 25.8 (3.6) 209 28.1 (6.9)
Marital Status
Single 432 26.3 (4.6) 461 25.9 (6.0) 385 26.7 (4.9) 396 26.8 (6.5) 348 26.7 (4.8) 350 27.2 (6.8)
Married 1791 27.4 (4.2) 1968 25.8 (5.2) 1826 27.7 (4.3) 2002 26.1 (5.2) 1826 27.8 (4.1) 2005 26.2 (5.4)
Separated 223 27.1 (3.9) 481 26.1 (5.4) 234 27.3 (4.3) 498 26.5 (5.7) 234 27.6 (4.6) 523 26.6 (5.5)
Living Condition
Single 377 26.7 (4.7) 382 26.5 (6.1) 372 27.0 (4.8) 387 27.1 (6.4) 351 27.3 (4.9) 390 27.3 (6.4)
Partner 539 27.9 (4.4) 676 26.0 (5.0) 616 28.1 (4.4) 732 26.4 (4.8) 654 28.1 (4.3) 770 26.5 (5.1)
Family - both 1216 27.1 (3.9) 1240 25.7 (5.4) 1141 27.4 (4.1) 1198 25.8 (5.4) 1105 27.5 (4.0) 1164 25.9 (5.4)
Family - single 94 26.8 (4.4) 359 25.6 (5.5) 100 27.4 (5.2) 332 26.3 (5.6) 107 27.6 (5.1) 339 26.4 (5.6)
Other types 220 27.0 (4.4) 253 26.0 (5.2) 200 27.5 (4.7) 247 26.9 (5.8) 192 27.1 (4.4) 218 27.2 (6.0)
Province
Ontario 585 27.2 (4.5) 664 25.9 (5.6) 578 27.4 (4.7) 666 26.2 (5.5) 580 27.6 (4.7) 656 26.5 (5.7)
Quebec 452 26.5 (3.9) 516 24.6 (4.9) 448 26.9 (4.2) 511 25.0 (5.0) 443 27.0 (4.0) 514 25.3 (5.1)
British Columbia 239 26.9 (3.8) 280 25.5 (5.1) 239 27.1 (3.8) 271 25.9 (5.3) 234 27.0 (3.7) 281 25.6 (5.1)
Others 1170 27.5 (4.3) 1450 26.5 (5.5) 1158 27.9 (4.4) 1443 26.8 (5.6) 1145 28.0 (4.3) 1424 27.0 (5.7)
Linguistic major
Yes 2218 27.2 (4.2) 2666 26.0 (5.4) 2217 27.6 (4.4) 2666 26.3 (5.5) 2190 27.7 (4.4) 2654 26.5 (5.6)
No 228 26.6 (4.4) 240 24.7 (4.9) 210 27.0 (4.6) 225 25.3 (5.1) 218 27.0 (4.0) 226 25.5 (5.1)
Life style factors
Alcohol status
No alcohol 323 27.4 (4.8) 559 26.6 (6.0) 288 28.0 (5.3) 504 27.1 (6.4) 331 27.8 (4.9) 533 27.4 (6.4)
Regular alcohol 1777 27.1 (4.1) 1576 25.2 (4.8) 1834 27.4 (4.2) 1649 25.4 (4.8) 1774 27.5 (4.1) 1606 25.6 (4.9)
Former alcohol 332 27.5 (4.4) 764 26.9 (5.9) 292 27.7 (4.5) 729 27.6 (6.1) 283 28.3 (5.1) 729 27.5 (6.1)
Smoking status
No smoke 699 27.0 (3.9) 1019 25.7 (5.1) 672 27.4 (4.2) 1004 26.0 (5.3) 643 27.6 (4.1) 967 26.2 (5.3)
Daily smoker 628 26.5 (4.4) 647 25.6 (5.7) 519 26.8 (4.3) 558 25.9 (5.8) 495 26.7 (4.1) 538 25.9 (5.6)
Occasional
smoker		 109 26.6 (3.5) 119 25.6 (5.7) 119 26.7 (4.2) 114 25.8 (5.1) 101 27.4 (3.9) 90 24.9 (4.6)
Former smoker 1006 27.8 (4.4) 1121 26.3 (5.4) 1099 28.0 (4.4) 1203 26.6 (5.5) 1153 28.1 (4.5) 1272 26.9 (5.8)
Physical
activity
Infrequent 470 27.3 (5.1) 518 27.0 (6.1) 364 27.5 (5.0) 405 27.7 (6.8) 388 28.0 (5.3) 447 27.5 (6.4)
Regular 1402 27.1 (3.9) 1795 25.5 (5.0) 1545 27.4 (4.0) 2026 25.9 (5.0) 1506 27.5 (4.0) 1977 26.0 (5.3)
Occasional 527 27.3 (4.4) 580 26.2 (5.9) 481 28.0 (4.8) 449 26.8 (6.0) 485 27.5 (4.2) 438 27.1 (5.9)
2006
Males Females
n BMI n BMI
Total 2386 2865
Dead 23 17
Individual Characteristics
Immigrant status
Canadian born 2120 27.9 (4.3) 2575 26.9 (5.9)
White Immigrants 165 28.0 (4.8) 193 26.2 (5.7)
Non-white Immigrants 101 25.7 (3.8) 97 24.5 (3.9)
Education
Primary 336 28.3 (4.6) 346 28.0 (5.8)
Secondary 302 28.0 (4.1) 372 27.0 (6.0)
Post-Secondary 629 27.8 (4.4) 767 26.8 (6.2)
Graduate 1070 27.7 (4.2) 1330 26.3 (5.5)
Income category
Highest 1200 27.9 (4.1) 1146 25.9 (5.1)
Upper Middle 689 27.9 (4.7) 937 26.8 (5.7)
Lower Middle 215 27.2 (4.3) 368 28.2 (7.3)
Lowest 86 27.1 (4.7) 166 28.6 (6.8)
Marital Status
Single 317 27.1 (4.9) 323 27.8 (6.9)
Married 1818 28.0 (4.2) 2020 26.5 (5.5)
Separated 251 27.7 (4.4) 521 27.1 (6.2)
Living Condition
Single 359 27.5 (4.7) 417 27.7 (6.7)
Partner 716 28.2 (4.5) 819 26.7 (5.3)
Family - both 1024 27.8 (3.9) 1123 26.1 (5.4)
Family - single 107 27.2 (5.2) 296 27.1 (6.4)
Other types 178 28.1 (4.5) 210 28.1 (6.7)
Province
Ontario 577 28.0 (4.7) 648 26.7 (6.0)
Quebec 435 27.2 (4.0) 512 26.0 (5.4)
British Columbia 237 27.5 (3.9) 286 26.0 (5.4)
Others 1126 28.1 (4.3) 1410 27.3 (5.9)
Linguistic major
Yes 2175 27.9 (4.4) 2632 26.8 (5.8)
No 210 27.4 (4.0) 230 25.8 (5.9)
Life style factors
Alcohol status
No alcohol 300 28.3 (5.1) 471 27.6 (6.7)
Regular alcohol 1753 27.7 (4.0) 1679 26.0 (5.1)
Former alcohol 261 28.5 (5.4) 637 28.3 (6.5)
Smoking status
No smoke 641 27.8 (4.2) 940 26.4 (5.5)
Daily smoker 453 27.1 (4.2) 493 26.1 (5.8)
Occasional smoker 103 27.1 (4.7) 100 27.1 (5.4)
Former smoker 1130 28.2 (4.4) 1274 27.2 (6.1)
Physical activity
Infrequent 258 28.6 (5.5) 315 28.5 (7.4)
Regular 1573 27.7 (4.1) 2075 26.4 (5.4)
Occasional 438 28.0 (4.5) 379 27.6 (6.4)
Open in a new tab

Contributor Information

Amélie Quesnel-Vallée, Department of Sociology, Department of Epidemiology, Biostatistics, McGill University.

Maninder Singh Setia, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.

Michal Abrahamowicz, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.

Pierre Tousignant, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.

John Lynch, School of Health Sciences, University of South Australia, Adelaide, Australia.

References

  • 1.Facts and figures: immigration overview permanent and temporary residents. Ottawa: Citizenship and Immigration Canada; 2006. pp. 1–114. [Google Scholar]
  • 2.Migration in interconnected world: new directions for action. Switzerland: Global Commission on International Migration; 2005. [Accessed 15 Feb 2009]. http://www.gcim.org/attachements/gcim-complete-report-2005.pdf. [Google Scholar]
  • 3.Chen J, Ng E, Wilkins R. The health of Canada’s immigrants in 1994–95. Health Rep. 1996;7(4):33–45. 37–50. [PubMed] [Google Scholar]
  • 4.Deri C. Working Papers. Department of Economics, University of Ottawa; 2004. [Accessed 15 Feb 2009]. Understanding the ‘Health Immigrant Effect’ in Canada. (Working Paper # 0502E). http://www.sciencessociales.uottawa.ca/eco/pdf/cahiers/0502E.pdf. [Google Scholar]
  • 5.Antecol H, Bedard K. Unhealthy assimilation: why do immigrants converge to American health status levels? Demography. 2006;43(2):337–60. doi: 10.1353/dem.2006.0011. [DOI] [PubMed] [Google Scholar]
  • 6.Strong K, Trickett P, Bhatia K. The health of overseas-born Australians, 1994–1996. Aust Health Rev. 1998;21(2):124–33. doi: 10.1071/ah980124. [DOI] [PubMed] [Google Scholar]
  • 7.Gee EM, Kobayashi KM, Prus SG. Examining the healthy immigrant effect in mid- to later life: findings from the Canadian Community Health Survey. Can J Aging. 2004;23(Suppl 1):S61–9. [PubMed] [Google Scholar]
  • 8.Beiser M, et al. Poverty, family process, and the mental health of immigrant children in Canada. Am J Public Health. 2002;92(2):220–7. doi: 10.2105/ajph.92.2.220. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.DeVoretz D, editor. Diminishing returns: the economics of Canada’s recent immigration policy. Toronto: C.D. Howe Institute; 2001. [Google Scholar]
  • 10.Duleep HO, Dowhan DJ. Research on immigrant earnings. Soc Secur Bull. 2008;68(1):31–50. [PubMed] [Google Scholar]
  • 11.Bethel JW, Schenker MB. Acculturation and smoking patterns among Hispanics: a review. Am J Prev Med. 2005;29(2):143– 8. doi: 10.1016/j.amepre.2005.04.014. [DOI] [PubMed] [Google Scholar]
  • 12.Varghese S, Moore-Orr R. Dietary acculturation and health-related issues of Indian immigrant families in Newfoundland. Can J Diet Pract Res. 2002;63(2):72–9. doi: 10.3148/63.2.2002.72. [DOI] [PubMed] [Google Scholar]
  • 13.Zemore SE. Acculturation and alcohol among Latino adults in the United States: a comprehensive review. Alcohol Clin Exp Res. 2007;31(12):1968–90. doi: 10.1111/j.1530-0277.2007.00532.x. [DOI] [PubMed] [Google Scholar]
  • 14.Beiser M. The health of immigrants and refugees in Canada. Can J Public Health. 2005;96(Suppl 2):S30–44. doi: 10.1007/BF03403701. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Gordon-Larsen P, et al. Acculturation and overweight-related behaviors among Hispanic immigrants to the US: the National Longitudinal Study of Adolescent Health. Soc Sci Med. 2003;57(11):2023–34. doi: 10.1016/s0277-9536(03)00072-8. [DOI] [PubMed] [Google Scholar]
  • 16.Fuentes-Afflick E, Hessol NA. Acculturation and body mass among Latina women. J Womens Health (Larchmt) 2008;17(1):67–73. doi: 10.1089/jwh.2007.0389. [DOI] [PubMed] [Google Scholar]
  • 17.Kaplan MS, et al. The association between length of residence and obesity among Hispanic immigrants. Am J Prev Med. 2004;27(4):323–6. doi: 10.1016/j.amepre.2004.07.005. [DOI] [PubMed] [Google Scholar]
  • 18.Bray GA. Medical consequences of obesity. J Clin Endocrinol Metab. 2004;89(6):2583–9. doi: 10.1210/jc.2004-0535. [DOI] [PubMed] [Google Scholar]
  • 19.Cairney J, Ostbye T. Time since immigration and excess body weight. Can J Public Health. 1999;90(2):120–4. doi: 10.1007/BF03404114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.McDonald JT, Kennedy S. Is migration to Canada associated with unhealthy weight gain? Overweight and obesity among Canada’s immigrants. Soc Sci Med. 2005;61(12):2469–81. doi: 10.1016/j.socscimed.2005.05.004. [DOI] [PubMed] [Google Scholar]
  • 21.Tremblay MS, et al. Obesity, overweight and ethnicity. Health Rep. 2005;16(4):23–34. [PubMed] [Google Scholar]
  • 22.Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63. doi: 10.1016/S0140-6736(03)15268-3. [DOI] [PubMed] [Google Scholar]
  • 23.Deurenberg P, Deurenberg-Yap M, Guricci S. Asians are different from Caucasians and from each other in their body mass index/body fat per cent relationship. Obes Rev. 2002;3(3):141–6. doi: 10.1046/j.1467-789x.2002.00065.x. [DOI] [PubMed] [Google Scholar]
  • 24.Tremblay MS, et al. Physical activity and immigrant status: evidence from the Canadian Community Health Survey. Can J Public Health. 2006;97(4):277–82. doi: 10.1007/BF03405603. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Statistics Canada. [Accessed 15 Feb 2009];National Population Health Survey. 2008 http://www.statcan.ca/cgi-bin/imdb/p2SV.pl?Function=getSurvey&SurvId=3225&SurvVer=0&InstaId=15280&InstaVer=5&SDDS=3225&lang=fr&db=IMDB&dbl=E&adm=8&dis=2.
  • 26.Berry J. Immigration acculturation and adaptation. Appl Psychol: Int Rev. 1997;46:5–33. [Google Scholar]
  • 27.Snijders TAB, Bosker RJ. Multilevel analysis: an introduction to basic and advanced multilevel modeling. London: Sage; 2004. pp. 1–266. [Google Scholar]
  • 28.Akaike H. A new look at the statistical model identification. IEEE Trans Automat Contr. 1974;19(6):716–23. [Google Scholar]
  • 29.Van Buuren S, Boshuizen HC, Knook DL. Multiple imputation of missing blood pressure covariates in survival analysis. Stat Med. 1999;18(6):681–94. doi: 10.1002/(sici)1097-0258(19990330)18:6<681::aid-sim71>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  • 30.Van Buuren S, Oudshoorn K. [Accessed 15 Feb 2009];Flexible multivariate imputation by MICE (TNO report PG/VGZ/99.054) 1999 3–19 http://www.multiple-imputation.com/ [Google Scholar]
  • 31.Carlin J, Galati J, Royston P. A new framework for managing and analyzing multiply imputed data in Stata. Stata J. 2008;8(1):49–67. [Google Scholar]
  • 32.Royston P. Multiple imputation of missing values: update. Stata J. 2005;5(2):188–201. [Google Scholar]
  • 33.Royston P. Multiple imputation of missing values: update of ice. Stata J. 2005;5(4):527–36. [Google Scholar]
  • 34.Ross NA, et al. Body mass index in urban Canada: neighborhood and metropolitan area effects. Am J Public Health. 2007;97(3):500–8. doi: 10.2105/AJPH.2004.060954. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Satia-Abouta J, et al. Dietary acculturation: applications to nutrition research and dietetics. J Am Diet Assoc. 2002;102(8):1105–18. doi: 10.1016/s0002-8223(02)90247-6. [DOI] [PubMed] [Google Scholar]
  • 36.Goel MS, et al. Obesity among US immigrant subgroups by duration of residence. JAMA. 2004;292(23):2860–7. doi: 10.1001/jama.292.23.2860. [DOI] [PubMed] [Google Scholar]
  • 37.Kumar BN, et al. Ethnic differences in body mass index and associated factors of adolescents from minorities in Oslo, Norway: a cross-sectional study. Public Health Nutr. 2004;7(8):999– 1008. doi: 10.1079/phn2004644. [DOI] [PubMed] [Google Scholar]
  • 38.Rush E, et al. Body size, body composition, and fat distribution: a comparison of young New Zealand men of European, Pacific Island, and Asian Indian ethnicities. N Z Med J. 2004;117(1207):U1203. [PubMed] [Google Scholar]
  • 39.Snijder MB, et al. What aspects of body fat are particularly hazardous and how do we measure them? Int J Epidemiol. 2006;35(1):83–92. doi: 10.1093/ije/dyi253. [DOI] [PubMed] [Google Scholar]
  • 40.Gorber SC. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev. 2007;8(4):307–26. doi: 10.1111/j.1467-789X.2007.00347.x. [DOI] [PubMed] [Google Scholar]
  • 41.Whitlock G, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96. doi: 10.1016/S0140-6736(09)60318-4. [DOI] [PMC free article] [PubMed] [Google Scholar]

RESOURCES