Research reviewEcological risk model of childhood obesity in Chinese immigrant children
Introduction
Childhood obesity is a critical public health threat in the U.S. (Skinner & Skelton, 2014). Over the past three decades, the childhood obesity rate has doubled for preschool children aged 2–5 years and tripled for children aged 6–11 years in the U.S. (Institute of Medicine of the National Academies, 2005). Moreover, more severe forms of childhood obesity (i.e., class 2 and 3 obesity) have increased over the last 14 years (Skinner & Skelton, 2014). Childhood obesity has both immediate and long-term risks to children's physical health, such as Type 2 diabetes, high cholesterol, metabolic syndrome, and sleep apnea (National Institutes of Health, National Heart, Lung, and Blood Institute, 2010). Children who are obese also suffer socioemotional health problems (e.g., low self-esteem, social marginalization) leading to poor academic and social adjustment (Harrist et al, 2012, Strauss, Pollack, 2003).
Chinese Americans are the largest and fastest growing Asian American subgroup, increasing about one-third during the 2000s (Hoeffel, Rastogi, Kim, & Shahid, 2012). Children of immigrants in the U.S. appear to be at higher risk of being overweight than their non-immigrant counterparts (Baker et al, 2009, Balistreri, Van Hook, 2009). Despite the slender Asian stereotype, 23.5% of 4-year old Chinese American children were found to be at risk of being overweight or obese in a nationally representative sample (Jain et al., 2012) and nearly one-third of 6-to-11 year old Chinese American children were reported to be overweight or obese (Au et al, 2009, Chen, Kennedy, 2005).
In addition, Chinese individuals carry higher health risks of being overweight or obese compared to their counterparts of European descents (Razak et al., 2007). Chinese individuals with the same BMI as Whites have higher percentage body fat and are at a higher risk of developing chronic diseases, cardiovascular disease, and Type 2 diabetes mellitus, possibly because of genetic differences in body composition, metabolic responses, and epigenetic factors (e.g., Pan et al, 2004, Razak et al, 2007). Despite their rapid population growth, increasing obesity prevalence, and the severe health consequences of being overweight in this population, Chinese immigrant children have been neglected in the literature on obesity.
Although there are important biological predispositional causes of obesity that require continued attention, emerging research suggests that a transdisciplinary understanding of obesity through an ecological perspective is also needed (Harrist et al., 2012). Bronfenbrenner's (1979) ecological model of human development has guided developmental researchers for decades in understanding the contributions of the environment from the perspective of the developing person within a set of nested and intertwined structures, including the microsystem, mesosystem, exosystem, macrosystem, and chronosystem (see Fig. 1). This ecological model also highlights the complex reciprocal interactions between the active developing person and his/her immediate environment, referred as proximal processes, in which development takes place (Bronfenbrenner, 1994). Also, distal processes are included, such as families' ability to interact with their environment and utilize resources, which indirectly impact children's risk for obesity. Moreover, given that children's obesity is associated with nutrition and diet, physical activity, and personal and relational attributes, this review identifies and discusses key factors reflecting these attributes at various levels of the ecological model (Harrison et al, 2011, Neumark-Sztainer, 2005). With the rates of childhood obesity at their highest point in the history, it is imperative to understand the risk factors in Chinese immigrant children's ecological context to guide future prevention and intervention efforts that might be more culturally appropriate and effective in preventing obesity and promoting healthy behaviors.
In this review, Chinese immigrant children refer to children who are born to foreign-born first-generation immigrant parents of Chinese descent. These children include both foreign-born (first-generation and/or 1.5 generation) and U.S. born (second-generation) individuals (Garcia Coll & Marks, 2012). Due to the limited research on these topics among Chinese immigrant families, we reviewed relevant research from other immigrant groups or individuals of Asian descent, when appropriate. In some cases, findings from studies conducted on non-immigrant or non-Asian descent will also be presented in highlighting important processes that might be relevant for Chinese immigrant groups. This review was not intended to be exhaustive in its identification of risk factors or in the research reviewed. Instead, specific key characteristics in each system of the ecological model were identified and discussed. Moreover, the mediating or moderating linkages among these characteristics were proposed from an ecological perspective, in determining possible maladaptive processes, which may put Chinese immigrant children at risk of being overweight or obese. Overall, the full ecological model involves a view of the development of childhood obesity as influenced by specific risk characteristics in the child and families as well as the mediating and moderating processes among these factors at different system levels. By presenting a conceptual framework and relevant research, this review can provide a basic foundation for directing future interdisciplinary research in seeking solutions to childhood obesity within this understudied population.
Section snippets
Microsystem: family food and lifestyle patterns
The microsystem is a pattern of social roles, activities, and interpersonal relations experienced by a child in an immediate setting and environment. Also, the microsystem involves the complex reciprocal interactions between the developing child and his/her immediate environment, referred to as proximal processes (Bronfenbrenner, 1994). The family is the most important part of the microsystem for young Chinese immigrant children, who may be particularly vulnerable to unhealthy weight gain due
Mesosystem: utilization of resources
The mesosystem comprises the linkages and processes taking place between two or more immediate settings in which the child belongs (i.e., microsystems) (Bronfenbrenner, 1994). As discussed in the previous section, parents, children's institutional setting (e.g., school, daycare) and professional health services are important parts of the microsystem for Chinese immigrant children. The link between parents and children's institutional setting, and the link between parents and professional health
Exosystem: parents' occupation and environmental barriers
The exosystem comprises the linkages and processes taking place between two or more settings, at least one of which does not contain the child, but in which events occur that indirectly influence processes within the immediate setting of the child (Bronfenbrenner, 1994). In the exosystem, Chinese immigrant parents' occupation and the environmental barriers to engaging in physical activity or accessing healthy types of groceries and foods were identified as risk factors.
Macrosystem: cultural ethnotheories and societal attitudes
The macrosystem consists of the overarching pattern of the characteristics of the micro-, meso-, and exosystems of a given culture, with particular reference to the belief system, bodies of knowledge, customs, and life-styles embedded in each of these broader systems (Bronfenbrenner, 1994). Specific cultural beliefs and values from their parents' heritage culture, which may put Chinese immigrant children at risk of being overweight or obese, were identified at the macrosystem level. Moreover,
Chronosystem: family acculturation and children's school transition
The chronosystem encompasses change or consistency over time not only in the characteristics of the child but also of the environment in which the child lives (Bronfenbrenner, 1994). Parents' early life food insecurity and the families' acculturation-related experiences may put Chinese immigrant children at risk of being overweight or obese. In addition, the school transition was identified as a challenging change for Chinese immigrant families with young children.
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Mothers’ feeding profiles among overweight, normal weight and underweight Chinese preschoolers
2020, AppetiteCitation Excerpt :Variations in maternal feeding practices have been identified across different cultural and ethnic groups, and differences in feeding beliefs and practices may also be related to child weight differently. Zhou and Cheah (2015) noted inconsistent findings in maternal feeding practices and their associations between child unhealthy diet and BMI in Chinese populations. Specifically, the use of highly controlling feeding practices is common among Chinese and Chinese American parents (Huang, Calzada, Cheng, & Brotman, 2012; Jiang et al., 2007), and greater use of monitoring was also found among Chinese American mothers with preschoolers than non-Hispanic white mothers (Huang, Calzada, Cheng, & Brotman, 2012).
Acculturation and activity behaviors in Chinese American immigrants in New York City
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