Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health.

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.2009.159491

Obesity Stigma: Important Considerations for Public Health

Racial minorities bear a disproportionate burden of morbidity and mortality. These inequities might be explained by racism, given the fact that racism has restricted the lives of racial minorities and immigrants throughout history. Recent studies have documented that individuals who report experiencing racism have greater rates of illnesses. While this body of research has been invaluable in advancing knowledge on health inequities, it still locates the experiences of racism at the individual level. Yet, the health of social groups is likely most strongly affected by structural, rather than individual, phenomena. The structural forms of racism and their relationship to health inequities remain under-studied. This article reviews several ways of conceptualizing structural racism, with a focus on social segregation, immigration policy, and intergenerational effects. Studies of disparities should more seriously consider the multiple dimensions of structural racism as fundamental causes of health disparities.

/pdf/structural-racism-and-health-inequities-old-issues-new-5du6ryhsif.pdf

STRUCTURAL RACISM AND HEALTH INEQUITIES: Old Issues, New Directions.

"This essay examines some of the pitfalls in contemporary immigration theory and reviews some of the most promising developments in research in this field. As a data-driven field [of] study, immigration has not had to contend with grand generalizations for highly abstract theorizing. On the contrary, the bias has run in the opposite direction, that is toward ground-level studies of particular migrant groups or analysis of official migration policies. As the distillate of past research in the field and a source of guidance for future work, theory represents one of the most valuable products of our collective intellectual endeavor. Ways to foster it and problems presented by certain common misunderstandings about the meaning and scope of scientific theorizing are discussed." The geographical focus is on the United States.

https://www.jstor.org/stable/pdf/2547415.pdf

Immigration theory for a new century: some problems and opportunities.

The authors used the 1992-1995 National Health Interview Survey to examine the effect of immigrant status (both nativity and duration of residence in the United States) on the health of Asian and Pacific Islander adults by constructing models in which national origin was also specified. In logistic regression models adjusted for age, marital status, living arrangement, family size, and several socioeconomic indicators, immigrants were found to be in better health than their US-born counterparts, but their health advantages consistently decreased with duration of residence. For example, for Asian and Pacific Islander immigrants whose duration of residence was less than 5 years, 5-9 years, and 10 years or more, the odds ratios for activity limitations were 0.45 (95% confidence interval (CI): 0.33, 0.62), 0.65 (95% CI: 0.46, 0.93), and 0.73 (95% CI: 0.60, 0.90), respectively. Similar findings emerged for respondent-reported health and bed days due to illness. These results support the validity and complementarity of the migration selectivity and acculturation hypotheses. However, the picture was not uniformly positive. The health of certain Asian and Pacific Islander groups, notably Pacific Islanders and Vietnamese, was found to be less favorable than average. Finally, after adjustment for health status, immigrants seemed to have less adequate access to formal medical care.

Immigration and the Health of Asian and Pacific Islander Adults in the United States

The US immigrant population is growing dramatically, making the health status of racial/ethnic minorities an increasingly important public health issue. Immigration to the United States is usually accompanied by environmental and lifestyle changes that can markedly increase chronic disease risk. In particular, adoption of US dietary patterns that tend to be high in fat and low in fruits and vegetables is of concern. The process by which immigrants adopt the dietary practices of the host country--called "dietary acculturation"--is multidimensional, dynamic, and complex; in addition, it varies considerably, depending on a variety of personal, cultural, and environmental attributes. Therefore, to intervene successfully on the negative aspects of dietary acculturation, it is important to understand the process and identify factors that predispose and enable it to occur. In this report, we give an overview of acculturation, define dietary acculturation and present a model for how it occurs, discuss measurement issues related to dietary acculturation, review the literature relating acculturation to eating patterns, and provide a case study illustrating how information on acculturation can be used to design dietary interventions in 2 markedly different immigrant groups. Finally, we give applications for nutrition researchers and dietetic practitioners. Studies investigating associations of acculturation with disease risk should identify and intervene on those steps in the acculturation process that are most strongly associated with unhealthful dietary changes. Practitioners working with immigrants should determine the degree to which dietary counseling should be focused on maintaining traditional eating habits, adopting the healthful aspects of eating in Western countries, or both.

Dietary acculturation: applications to nutrition research and dietetics.

Amid concerns over use of TB and AIDS to exclude immigrants, this book looks at how earlier generations grappled with such problems, from the Irish immigrants of New York wrongly blamed for the cholera epidemic in 1832 to San Francisco's Chinese labourers vilified for causing the bubonic plague in 1900, to Miami's Haitian refugees stigmatized as AIDS carriers in the 1980s. The book describes these and many other episodes of medicalized prejudice, and analyzes their impact on public health policy. Alan M. Kraut is the author of "Huddled Masses: The Immigrant in American Society, 1880-1920".

Silent Travelers: Germs, Genes, and the Immigrant Menace

This history of the 'new immigration' weighs the many factors that prompted the decision to leave the old world. Though the designation 'new immigrant' generally refers to southern and eastern Europeans only, this volume also includes the Chinese and Japanese who arrived in the period from 1880-1921. Kraut argues that immigration to America was but one of the many choices available to the immigrants, and that individual aptitude and desires were just as influential as cultural, social, and familial pressures to find a better life. The immigrants' impact on America and their new countrymen is also considered. Includes a very good, 32-page photographic essay

The huddled masses : the immigrant in American society, 1880-1921

The current wave of immigration to the United States—mostly Asians and Latin Americans—may well be the largest in the 20th century. Many newcomers practice habits of health and hygiene deficient by American standards. Some prefer the shaman to the physician and traditional herb remedies to modern medical therapies. Physicians find themselves practicing at an invisible border separating them from their foreign-born patients, where differences of language and culture can lead to misunderstanding and frustration, impeding a physician's ability to gain cooperation with prescribed therapy. Similar issues faced physicians at the turn of the century. Newly arrived Italians, East European Jews, and Chinese were often ambivalent toward physicians and their therapies. Quacks further undermined the physician's credibility among immigrants. Today, some physicians try collaborating with shamans and herbalists to accommodate patients' cultural preferences. Respect for the customs and taboos of immigrant patients pays dividends in physician effectiveness and efficiency. (JAMA. 1990;263:1807-1811)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=381245&pdfFileName=jama_263_13_032.pdf

Healers and strangers. Immigrant attitudes toward the physician in America--a relationship in historical perspective.

American Refugee Policy and European Jewry, 1933-1945.

La grippe was the foreign-sounding name for a disease that was neither fearful nor a stranger to most Americans at the turn of the last century. This name for the influenza virus that swept through cities and towns, sickening many thousands annually, was familiar. Most of the time victims of la grippe recovered. The United States Public Health Service did not see fit to make it a reportable disease. When many Americans pondered health menaces from abroad, it was not la grippe that sprang to mind, but the millions of immigrants who had been flowing through the nation's ports and across its borders, perhaps bringing with them more serious diseases such as tuberculosis, typhus, cholera, or trachoma. Moreover, Americans feared that newcomers weakened by illness might be unable to support themselves, becoming dependent upon state and local resources or the charity of their new neighbors. All that changed in 1918.

In 1918, the United States was in the midst of the largest wave of immigration in its history. Between 1880 and the 1920s, 23.5 million newcomers arrived in the United States, most of them from Southern and Eastern Europe, but also from China, Japan, Canada, and Mexico.1 (p. 52) The virulent strain of la grippe that was killing millions across the globe, known to many as the Spanish influenza, inspired fear in natives and newcomers alike. The influenza virus responsible for the pandemic of 1918 killed an estimated 20 million and perhaps as many as 100 million people worldwide. In the United States, approximately 550,000 died, an estimate derived from reporting that was incomplete and uneven at best.2–4 And, unlike other epidemics, this one took the lives of many young adults between 29 and 34 years of age, not the very young and very old who had been typical victims of other epidemics.5,6 In 1918, the United States was also a nation at war. Many of the young men who died were in the armed services. America's armed forces were hit hard: 32,165 died in U.S. military camps and another 18,136 in Europe.7,8

The flu did not respect borders and boundaries. Those felled by the disease in their home countries suffered and often died and so, too, did migrants who had wandered far from home.1,9–12 However, while the former wrestled with the disease in familiar places, surrounded by family and familiar institutions, migrants sought to regain their health and cope with their mortality among strangers. Some died of influenza among friends who stood powerless to cure the victim and could only show friendship and respect in how they mourned his passing. One such victim of “the cruel disease of influenza” was Frank Potesto, an Italian-born Denver police officer who succumbed in November 1918. His death was reported in Denver's Italian-language newspaper, Il Roma. Potesto was given a big funeral, “a true testament of the love that the colony [Italian community] wished to bestow on the poor deceased.”13 Others died tragically and alone. And still others died of the very fear that the sight of the suffering engendered. A resident of Hamden, Connecticut, 30-year-old Italian immigrant Maria Brava, acted in plays produced by the local Italian theater company. Brava poisoned herself “because of her worry that she would contract it [the flu].. .. Fearful of the suffering the distraught young woman took her own life.”14

How did native-born Americans view newcomers in the midst of this public health debacle? And how did various immigrant communities respond to the 1918 Spanish influenza epidemic? The presence of immigrants certainly complicated public health officials' battle against the epidemic. Government medical personnel needed to communicate advice and regulations to newly arrived, non-English-speaking immigrants. It was difficult, at times, to secure the compliance of the foreign-born with American standards of sanitation and hygiene, and public health regulations that seemed to them alien to their own beliefs about disease, prevention, and therapy. Foreign-born physicians, ethnic community leaders, and the foreign-language press were important mediators between public health officials and immigrants. They labored to diminish fears of the native-born that newcomers might be responsible for the epidemic. Institutions organized by the ethnic groups to which the newcomers belonged provided much-needed assistance to their own and to others during the crisis.

https://journals.sagepub.com/doi/pdf/10.1177/00333549101250S315

Alan M. Kraut

Papers

Silent Travelers: Germs, Genes, and the Immigrant Menace

The huddled masses : the immigrant in American society, 1880-1921

Healers and strangers. Immigrant attitudes toward the physician in America--a relationship in historical perspective.

American Refugee Policy and European Jewry, 1933-1945.

Immigration, ethnicity, and the pandemic.