Immigration Status, Highest Education Achievement, and Prevalence of Obesity among US Adults

Introduction: The prevalence of obesity continues to rise among adults in the United States. It has been suggested that immigrant populations acquire the risk of chronic diseases of their new environment in the same generation. The aim of this study was to determine the prevalence of obesity among immigrant adults in the United States and evaluate the effect of formal education. Methods: We used the 2018 Health Information National Trends Survey (HINTS 5 Cycle 2). Our analytic cohort included 3,051 respondents (weighted population size = 222,389,992) who indicated whether they were born in the United States or not and reported their heights and weights. We used logistic regression analyses to examine the association of immigration status and highest education achieved by survey respondents with the prevalence of obesity (body mass index ≥ 30kg/m2). We calculated odds ratios (OR) and 95% confidence interval (CI) and used survey weights in all analyses. Results: There were 436 (14.1%) immigrant respondents (weighted population size = 31,289,107) and 2,615 (85.9%) US born respondents (weighted population size = 191,100,885). There were no differences in mean age, sex, and income between immigrants and US born survey respondents, but immigrant respondents were more likely to be Hispanics (P < 0.001) and married (P < 0.001) but less likely to have a history of cigarette smoking (P=0.002). A total of 1,025 (34.8%) respondents (weighted population size = 77,311,123) were obese. The prevalence of obesity was lower among immigrants (28.2% vs 35.9%, OR = 0.62; 95% CI: 0.35-1.07) regardless of educational achievement. When compared with those with high school education or less (43.7%), those with some college education had lower but comparable prevalence of obesity (35.6%; OR = 0.70; 95% CI: 0.44-1.13) but college graduates were significantly less likely to be obese (24.4%; OR = 0.43; 95% CI: 0.26-0.71) regardless of immigration status. However, this protective association with high education achievement was only among US born respondents (Table 1). Conclusion: Higher formal education achievement was not associated with reduced prevalence of obesity among immigrant US adults. Table 1. - Association of educational status with obesity by immigration status among US adults US born respondents Immigrant respondents Education status % obese OR (95% CI) Education status % obese OR (95% CI) High school or less N = 639 46.1% Reference High school or less N = 132 33.5% Reference Some college N = 831 36.9% 0.63 (0.38-1.05) Some college N = 88 21.4% 0.73 (0.23-2.30) College graduate N = 1,135 24.3% 0.35 (0.21-0.60) College graduate N = 213 25.3% 0.88 (0.27-2.83) Multivariate model adjusted for age, sex, race, insurance, marital status, income, and smoking.