Journal of Nutrition Education and Behavior
Research BriefUsing Focus Groups to Identify Factors Affecting Healthful Weight Maintenance in Latino Immigrants
Introduction
Overweight and obesity is a major public health concern in the United States (US).1, 2 Latinos are at high risk of being overweight and obese: an estimated 37.9% of Latinos are obese and 76.9% are obese/overweight.3 The causes of obesity are multifactorial; physical inactivity and unhealthful dietary patterns are recognized as significant contributors to obesity-related morbidity and mortality. Thus, obesity prevention guidelines include recommendations for these 2 modifiable behaviors.1, 2, 4, 5, 6
The immigrant population is the fastest growing segment of the US population. Currently, immigrants constitute 12.5% of the US population, and 53.1% of immigrants are from Latin America.7 Although the prevalence of obesity and overweight is lower in immigrants than among US-born adults, there has been a dramatic increase in obesity and overweight prevalence among immigrants.8 Notably the length of US residency has been found to be associated with increased rates of overweight and obesity.8, 9, 10 The increased prevalence of obesity among immigrants may be associated with acculturation to US norms.11
Most intervention research has focused on promoting weight loss among overweight and obese individuals, and only a limited number have focused on preventing overweight and obesity among high-risk populations such as Latino immigrants. Interventions that include treatment components addressing diet, exercise, and behavioral change have been effective in promoting and maintaining weight loss.12, 13 Unfortunate-ly, many individuals who successfully lose weight regain it within 5 years post-treatment.14 This regaining of lost weight suggests that alternate approaches to promote and maintain healthful weight should be explored. A Health at Every Size (HAES) approach (also referred to as a nondiet approach) may provide a useful approach to obesity prevention. This approach directs the focus away from weight loss to enhancing self-regulation through avoidance of dieting, increasing awareness of hunger and satiety (defined as eating when hungry and stopping eating when full), and respecting one's own and others' body size.15 Outcomes are weight neutral, and weight loss, which may or may not occur, is not the goal.16 Interventions using an HAES approach promote healthful practices, including increasing physical activity and eating a healthful diet.17 Although results are mixed, some interventions developed using this approach have been effective in preventing weight gain.15, 16
Recent immigrants to the US are ideal candidates for obesity prevention efforts, as obesity among immigrant groups increases with increasing time spent living in the US.8, 9, 10 There is a 4-fold greater risk of obesity among Latino immigrants who have lived in the US for 15 years or more.10, 18 It is important to understand changes in diet and physical activity associated with immigration, as less healthful diets and reduced physical activity may be associated with increased weight. Thus, the primary purpose of this study was to use focus groups to explore how migration to the US changed diet and physical activity among Latinos. A secondary purpose was to explore participants' percep-tions of HAES-related concepts.
Section snippets
Methods
Participants were recruited from a well-established, nonprofit, community-based organization located in Central Falls, Rhode Island that provides an array of services to assist the Latino and immigrant communities in the state. According to data from the 2000 census, Central Falls is 47.8% Hispanic/Latino, and 29% of the population lives below the poverty level.19 Study eligibility requirements included self-identifying as Latino, being between 18-45 years of age, having no known chronic
Participants
In total, 35 people (20 women, 15 men) participated in the focus groups, and all participants were originally from South America, Central America, Mexico, or the Caribbean. The majority (97%) reported an annual household annual of less than $20,000, and 60% had not graduated from high school. Additional details about the sample can be found in the Table.
Changes in Diet and Physical Activity since Coming to the US
Overwhelmingly, participants felt that their diets were more healthful in their home countries. Before coming to the US, participants said they
Discussion
Latinos are the largest and most rapidly growing population group in the US, and the process of acculturating to the US is associated with developing obesity.24 Thus, interventions are needed to prevent obesity, and as increased length of time in the US is associated with increased risk of obesity, intervention efforts are needed for more recent immigrants in an effort to promote weight maintenance. As with all interventions, cultural preferences and cultural values should be taken into account.
Implications for Research and Practice
To the authors' knowledge, an HAES intervention has not been tested in Latino immigrant populations. Although this present study has limited generalizeability, using an HAES approach may be appropriate to promote weight maintenance among Latino/Latina immigrants. It would be important that intervention messages recognize that changes in diet and physical activity derive from multilevel factors. Cultural influences on behavior also would need to be acknowledged. For example, the intervention
Acknowledgments
The study was supported by funding from the Rhode Island Agricultural Experiment Station grant: RH00131. The authors would like to acknowledge and thank all individuals who participated in the focus groups.
References (37)
- et al.
Position of the American Dietetic Association: weight management
J Am Diet Assoc
(2002) - et al.
Acculturation and overweight-related behaviors among Hispanic immigrants to the US: the National Longitudinal Study of Adolescent Health
Soc Sci Med
(2003) - et al.
A descriptive study of individuals successful at long-term maintenance of substantial weight loss
Am J Clin Nutr
(1997) Teaching the Health at Every Size paradigm benefits future fitness and health professionals
J Nutr Educ Behav
(2009)- et al.
The association between length of residence and obesity among Hispanic immigrants
Am J Prev Med
(2004) - et al.
Counseling Latina mothers of preschool children about weight issues: suggestions for a new framework
J Am Diet Assoc
(2004) - et al.
Body image, weight, and food choices of Latina women and their young children
J Nutr Educ Behav
(2003) The Surgeon General's Vision for a Healthy and Fit Nation
(2010)The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity
(2001)- et al.
Prevalence and trends in obesity among US adults, 1999-2008
JAMA
(2010)
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report 2010
The Practical Guide to Identification, Evaluation, and Treatment of Overweight and Obesity in Adults
Dramatic increases in obesity and overweight prevalence and body mass index among ethnic-immigrant and social class groups in the United States, 1976-2008
J Community Health
Ethnic-immigrant differentials in health behaviors, morbidity, and cause-specific mortality in the United States: an analysis of two national data bases
Hum Biol
Obesity among US immigrant subgroups by duration of residence
JAMA
Behavioral Weight Control
Long-term maintenance of weight loss: current status
Health Psychol
Cited by (26)
Maintenance of physical function in frail older adults
2014, Nursing Clinics of North AmericaCitation Excerpt :Multiple barriers to initiating and maintaining a regular routine of physical activity are reported in the literature specific to older adults.11,14,21 Cultural and geographic populations studied include African American,22–26 Australian,27 Canadian,28 Russian immigrant,29 Asian,30 Korean,31 German,32 Latino,25,33,34 Italian,35 Swedish,36 Norwegian,37 Chinese,25 Vietnamese,25 American Indian,25 Israeli,38 and multiethnic populations.39 Health-related populations studied have included persons with obesity,17,26 arthritis,40 Alzheimer disease (and caregivers),41 diabetes,24 Parkinson disease,42 cardiovascular disease,43,44 sleep,16 cancer,45,46 mobility disabilities,26 depression,47 and multiple sclerosis.48
Effects of Culturally Tailored Nutrition Education on Dietary Quality of Hispanic Mothers: A Randomized Control Trial
2019, Journal of Nutrition Education and BehaviorCitation Excerpt :The obesogenic food environment of the US, with large portion sizes, high sugar intake, and low physical activity levels, often leads to excessive weight gain in immigrants. Previously cited reasons for excess weight gain include lack of time to exercise or prepare food, more choices for fast food, and less healthy options for food such as fruits and vegetables.6 A review of Hispanic food patterns in the US concluded that changes in diet quality upon immigration are complex and range from shifts in the availability of food and beliefs to changes in the frequency of meals, scheduling, and snacking in the host country.7
Gathering around the table: Negotiating family mealtime patterns among Latino families
2023, Family RelationsPadres Activos (Active Fathers): An Experiential Learning Approach to Obesity Prevention and Health Engagement among Latino Fathers and Their Children
2023, Journal of Latinos and EducationRETHINKING OBESITY: Critical Perspectives in Crisis Times
2022, Rethinking Obesity: Critical Perspectives in Crisis Times