Weight Status of Mexican Immigrant Women: A Comparison With Women in Mexico and With US-Born Mexican American Women

Objectives. We assessed the association between birthplace, residence, or years in the United States and actual weight (body mass index), perceived weight accuracy, or provider screens for overweight or obesity among Mexican immigrant women.Methods. We used linked data from Health and Nutrition Examination Survey waves 2001–2006 and 2006 National Mexican Health and Nutrition Survey to compare 513 immigrants with 9527 women in Mexico and 342 US-born Mexican American women.Results. Immigrants were more likely than women in Mexico to be obese and to perceive themselves as overweight or obese after adjustment for confounders. Recent immigrants had similar weight-related outcomes as women in Mexico. Immigrants were less likely to be obese than were US-born Mexican Americans. Within the overweight or obese population, reported provider screens were higher among immigrants than among women in Mexico, but lower than among US-born Mexican Americans. US residency of at least 5 years but less than 20 years and reporting insufficient provider screens elevated obesity risk.Conclusions. Mexican-origin women in the United States and Mexico are at risk for overweight and obesity. We found no evidence of a “healthy immigrant” effect.Two out of 5 adult Mexican American women are obese,1 placing them at increased risk for obesity-related health conditions and higher health care expenditures.2–6 Mexican immigrants, who are foreign-born and constitute about one third of all Mexican Americans, are generally considered healthier and less obese than are US-born women of Mexican origin.7–12 This so-called protective advantage in immigrants may no longer hold true, at least with respect to overweight or obesity, if one considers the current weight status of women living in Mexico. According to our recent binational population-based study, the prevalence of overweight and obesity among women aged 20 to 59 years was approximately 70% in Mexico, which was the same as the prevalence of overweight and obesity in Mexican Americans13; cross-national similarities in overweight and obesity persisted when we controlled for age, parity, and education. These sociodemographic covariates have also been shown to influence women’s predisposition to migrate.14,15In addition, we found that among women categorized as overweight or obese, women in Mexico were less likely to recognize themselves as such accurately and were less likely to have been told by a health care provider that they were overweight or obese. Whether overweight and obese Mexican immigrant women in the United States are more likely to perceive their weight accurately and to receive provider screens for overweight and obesity than are overweight and obese women in Mexico is not known. These comparisons have policy relevance because accuracy in weight perceptions and provider screening and advice are associated with an increased pursuit of weight control.16,17Evidence shows that the health advantage of immigrants diminishes with time in the United States and is not sustained in the next generation because of acculturation, a process of incorporating mainstream societal norms, values, and lifestyles.8–12 However, the association between acculturation and body size shows inconsistent findings. Although body size has been shown in some studies to increase as immigrants adapt to the US sociocultural environment,8,10–12 others have shown an inverse association between acculturation and obesity among Mexican Americans.18–20 In recent studies, more years spent living in the United States21,22 and age at immigration as a child or an adult,21 both proxies for acculturation, were not associated with an increased body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) or waist circumference among women migrants. Evidence on the relationship between acculturation and perceived body weight and provider screens is sparse. These outcomes might vary according to place of birth or residence and duration of US residence. Understanding these issues can help to identify which Mexican-origin populations stand a high risk of excess weight or poor weight control and facilitate the development of targeted interventions.We extended our binational study on weight-related outcomes and disaggregated the Mexican American population into Mexico-born (immigrants) and US-born women of Mexican origin to address the following 2 research questions. First, are there disparities in actual and perceived weight between immigrant women and women in Mexico, and between immigrant and US-born Mexican American women? Second, among the overweight and obese, are there differences between immigrants and the 2 reference groups in their accuracy of weight perceptions and whether they had been screened by a health provider? To examine the first aim, whether immigrant women have a protective advantage in weight-related outcomes, we compared outcomes of immigrants—both overall and recent arrivals living in the United States less than 5 years—with those of women in Mexico. For the second aim, to examine the association between weight-related outcomes and acculturation, we compared Mexican immigrants with US-born Mexican American women and further examined the effects of time spent in the United States by immigrant women.