Date of Degree
Doctor of Philosophy (Ph.D.)
Community Health and Social Sciences
Terry T-K Huang
Karen R. Flórez
Sergio A. Costa
Epidemiology | International Public Health | Latin American Studies | Nutritional and Metabolic Diseases | Public Health
obesity, Latino immigrants, Colombia, Cross-sectional Study, New York, Immigrant Health
Introduction: The prevalence of obesity and overweight in adults and children continues to increase worldwide, accounting for the mortality and morbidity from several diseases. Obesity disproportionally impacts Latinos in the United States (U.S.), and despite their diversity in origins, ancestry, and culture, it is still unclear the burden of obesity by specific Latino groups. For example, little information is available about how obesity impacts Colombians in the U.S. (the largest South American population). New evidence also indicates that Latino immigrants may no longer be arriving with healthy weight status to the U.S. because Latin American countries are undergoing epidemiologic and nutrition transitions. More obesity research is required to understand the heterogeneity of Latinos in the U.S. and to examine the relationship between migration and obesity, including comparisons of Latino immigrant populations in the U.S. (e.g., Colombians in New York City (NYC)) with their source population in Latin America. Furthermore, Latino children embedded in migrant networks with relatives who live in the U.S. are at increased risk of excess weight. It is unclear if the same findings apply to intraregional migration networks in Latin America, such as Colombian children with migrant parents from South-to-South migration trajectories.
Methods: Secondary analysis of data from two public health surveys (i.e., NYC Community Health Survey (NYC CHS) years 2013-2017 and the National Survey of the Nutritional Situation (ENSIN) year 2015) using weighted multivariable logistic regression models. The first study (Chapter 2) estimates how obesity (Body Mass Index (BMI) ≥30 kg/m2) may differ between adult Colombians and the four largest Latino adult populations in NYC (i.e., Puerto Rican, Mexican, Ecuadorian, and Dominican) controlling for lifestyle behaviors (i.e., daily consumption of sugar-sweetened beverages (SSB) and PA in the past 30 days), health status (i.e., Type 2 Diabetes and Hypertension diagnosis) and socio-demographic factors (e.g., age, gender, education level), using data from the NYC CHS 2013-2017. The second study (Chapter 3) compares obesity prevalence between adult immigrant Colombians residing in NYC and adult nonimmigrant Colombians residing in main Colombia cities and their home country controlling for age, gender, education level, and daily SSB consumption, using data from the ENSIN 2015 and NYC CHS 2013-2017. The third study (Chapter 4) explores the role of migrant parents on excess weight (BMI z-score ≥1) among children in Colombia, controlling for demographics (e.g., age, gender), behavior indicators (e.g., compliance with recommended PA and daily intake of fried food, fruits, and vegetables), urbanicity, and household indicators (e.g., wealth index, family characteristics, reasons for emigration, food insecurity), using data from ENSIN 2015.
Results: In Chapter 2, we found that obesity prevalence among Colombians (23.8%; 95% CI 18.8, 29.5) was significantly lower than among Mexicans (36.8%; 95% CI 31.5, 42.4) and Puerto Ricans (36.3%; 95% CI 31.7, 41.3). After full adjustment, the prevalence ratios (PR) of obesity remained significantly lower for Colombians (PR=0.80; 95% CI 0.64-1.00) compared to Mexicans. No significant differences were found in the prevalence of obesity for comparisons between Colombians and Ecuadorians or Dominicans. In Chapter 3, we found that obesity prevalence was 49-62% greater for immigrant Colombians living in NYC when compared to nonimmigrant Colombians living in their home country (PR=1.49; 95% CI 1.08, 2.07) and in main Colombian cities (PR=1.62; 95% CI 1.01, 2.62). Sex strengthened these differences as Colombian immigrant men in NYC were 72% more likely to have obesity compared to nonimmigrant men living in their home country and in main cities (PR=1.72; 95% CI 1.03, 2.87). No significant differences were found in the adjusted models among women. In Chapter 4, we found that most migrant parents returned to Colombia from Venezuela (84%) and reported higher moderate and severe household food insecurity than non-migrant parents (59% versus 32%). Models excluding household food insecurity showed that PRs for excess weight were 48% lower for children with return migrant parents (PR=0.52; 95% CI 0.27, 0.99) compared to children with non-migrant parents. After adjustment for household food insecurity, the PR comparing both groups was no longer significantly different.
Discussion: Colombians in NYC experience a higher prevalence of obesity compared to non-Latino Whites. However, Colombians have a lower prevalence of obesity compared to other Latino groups in NYC, such as Mexicans and Puerto Ricans. Any protection among men in Colombia is no longer present after immigration to the U.S., while Colombian women have a similarly high prevalence of obesity both in Colombia and NYC. Colombian children with migrant parents from other South American countries experienced less excess weight than children with non-migrant parents; however, disparities in household food insecurity largely explained the difference. Future research focused on understudied Latino populations in the U.S. may further our understanding of the diversity in the community in terms of obesity, obesity-related risk factors, and migration networks, which will inform public health efforts to combat obesity and other health risks. Collectively, the findings of this dissertation support the need to: disaggregate Latinos into distinct cultural groups in future obesity research; prioritize public health action for adult women in Colombia and both Colombian men and women in the U.S.; prioritize migrant populations in Colombia for public health efforts addressing food insecurity; and support binational obesity initiatives to prevent and avert the long-term consequences of obesity in Latino communities in the U.S. and countries of origin.
Devia, Carlos A., "Obesity Risk and Comorbidities Among Colombians in New York City and in Colombia" (2023). CUNY Academic Works.