Does It Begin At School or Home? Institutional Origins of Overweight Among Young Children in Immigrant Families
Children of immigrants and their families face unique challenges as they adjust to life in the US. These challenges are not only related to the multiple and often difficult adjustments they must make with respect to schooling, language learning, and their social lives, but also concern possible threats to their health. Children of immigrants may be particularly vulnerable to health risks because more than half of the children of immigrants in the US are living in families with low incomes (i.e., incomes lower than twice the official poverty level) (Reardon-Anderson, Capps, & Fix, 2002). In addition, as children of immigrants and their families attempt to navigate their new environments, they may find it more difficult to avoid health hazards than others who may be more familiar with the US environment (primarily schools, neighborhoods, businesses, and cities) and US healthcare systems. In this chapter, we focus on one potential threat to health among children of immigrants: overweight among children. Following the recommendations of the Centers for Disease Control, we use the term “overweight” rather than “obesity” when referring to adiposity among children. The two terms are distinct in that “obesity” refers to an excess of body fat while “overweight” is a measure of weight relative to height, and it is not well-established how to measure excess body fat in children, particularly on the basis of height and weight. We specifically examine the degree to which children of immigrants vs. children of natives encounter hazards or unique challenges in their environments that could lead to overweight, and further seek to explain differences in overweight in terms of factors associated with the home environment versus those factors associated with neighborhoods and schools. In the past 25 years in the US, the prevalence of overweight and at-risk for overweight children quadrupled, increasing from roughly 4% to 16% (National Center for Health Statistics, 2004). Using the guidelines provided by the Center for Disease Control, we define the term “overweight” as having a body mass index (BMI) at or exceeding the 95th percentile within age-and gender-specific groupings (of a standard population of children taken from the 1970s and 1980s), and “at-risk for overweight” as between the 85th and 95th percentiles. Percentile BMI is the most widely used measure of adiposity in children because it is strongly related to health outcomes in children. Overweight among children has been linked to a number of health problems including hypertension, elevated blood pressure, and diabetes that track into adulthood (Deckelbaum & Williams, 2001a; Dietz, 1998; Strauss & Pollack, 2003), and is related to
difficulties in social adjustment, poor mental health, and lower academic achievement (Datar, 2004; Strauss & Pollack, 2003). Children of immigrants may face particularly high risks for developing overweight. A common finding emerging from research on immigrant health is that health outcomes of immigrants are better than natives when they first arrive in the US, but are likely to deteriorate with increased time and generations in the US (Hummer, Rogers, Nam, & LeClere, 1999; Landale, Oropesa, Llanes, & Gorman, 1999; Rumbaut & Weeks, 1989). Although selective migration may account in part for immigrants’ initial healthy outcomes (Palloni & Arias, 2004), the dominant hypothesis is that exposure to the American environment (e.g., fast food industry and advertising, availability of cheap, prepackaged food, reliance on cars) leads to the “Americanization” of health behaviors involving diet, exercise, and smoking, which in turn leads to overweight and obesity (Blumenthal, 2002; Carter, 2002; Fried & Nestle, 2002). Immigrant families may be particularly vulnerable to health risks involving diet and exercise for a number of reasons related to their unfamiliarity with American food, language barriers, and inability to purchase ingredients to make foods from their countries of origin.