There is evidence to suggest that immigrant populations from low or medium-income countries to high income countries show a significant change in obesogenic behaviors in the host society, and that these changes are associated with acculturation. However, the results of studies vary depending on how acculturation is measured. The objective of this study is to systematically review the evidence on the relationship between acculturation - as measured with a standardized acculturation scale - and overweight/obesity among adult migrants from low/middle countries to high income countries. A systematic review of relevant studies was undertaken using six EBSCOhost databases and following the Centre for Reviews and Dissemination’s Guidance for Undertaking Reviews in Health Care. The initial search identified 1135 potentially relevant publications, of which only nine studies met the selection criteria. All of the studies were from the US with migrant populations from eight different countries. Six studies employed bi-directional acculturation scales and three used uni-directional scales. Six studies indicated positive general associations between higher acculturation and body mass index (BMI), and three studies reported that higher acculturation was associated with lower BMI, as mainly among women. Despite the small number of studies, a number of potential explanatory hypotheses were developed for these emerging patterns. The ‘Healthy Migrant Effect’ may diminish with greater acculturation as the host culture potentially promotes more unhealthy weight gain than heritage cultures. This appears particularly so for men and a rapid form of nutrition transition represents a likely contributor. The inconsistent results observed for women may be due to the interplay of cultural influences on body image, food choices and physical activity. That is, the Western ideal of a slim female body and higher values placed on physical activity and fitness may counteract the obesogenic food environment for female migrants.

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Acculturation and obesity among migrant populations in high income countries - a systematic review

/pdf/the-healthy-migrant-effect-not-merely-a-fallacy-of-4g2rcqh8bq.pdf

The ‘healthy migrant effect’–not merely a fallacy of inaccurate denominator figures

The existence of a healthy immigrant effect – where immigrants are on average healthier than the native-born – is now a well accepted phenomenon. There are many competing explanations for this phenomenon including health screening by recipient countries, healthy behaviour prior to migration followed by the steady adoption of new country (less) healthy behaviours, and immigrant self-selection where healthier and wealthier people tend to be migrants. We explore the last two of these explanations for the healthy immigrant effect by examining the health outcomes, health behaviours, and socio-economic characteristics of immigrants from a range of source countries in the US, Canada, UK and Australia. We find evidence of strong positive selection effects for immigrants from all regions of origin in terms of education. However, we also find evidence that self-selection in terms of unobservable factors is an important determinant of the better health of recent immigrants.

The Healthy Immigrant Effect and Immigrant Selection: Evidence from Four Countries

Nach wie vor fehlt eine Datenbasis, die Migranten und ihre gesundheitliche Situation angemessen reprasentiert. Einer der Grunde fur diesen Mangel ist die unzulangliche Erfassung des Migrationsstatus in der amtlichen Statistik und in epidemiologischen Studien. Voraussetzung fur eine adaquate und standardisierte Operationalisierung ist eine genaue Definition der Begriffe „Migrant“ und „Migrationshintergrund“. In unserem Beitrag diskutieren wir Konzepte zur begrifflichen Bestimmung und Erfassung ethnischer Minderheiten und Migranten und entwickeln auf dieser Grundlage einen Mindestindikatorensatz fur die epidemiologische Forschung. Der vorgeschlagene Mindestindikatorensatz zur Erfassung des Migrationsstatus enthalt die Merkmale Geburtsland von Vater und Mutter, Einreisejahr, Muttersprache, Deutschkenntnisse sowie den Aufenthaltsstatus. Zentraler Indikator zur Identifikation von Migranten ist das Geburtsland der Eltern und nicht – wie bislang zumeist ublich – die Staatsangehorigkeit. Die Klassifikation mittels der juristischen Kategorie Staatsangehorigkeit wird damit abgelost durch die Klassifikation anhand des lebensbiographischen Ereignisses „Migration“. Mit der Migration gehen spezifische Lebensbedingungen und Handlungsanforderungen einher, die uber mehrere Generationen fur die Gesundheit von Bedeutung sein konnen. Ein Instrument zur Erfassung des Migrationsstatus muss dahingehend weiterentwickelt werden, dass es diese aus dem Migrationsereignis resultierenden Besonderheiten in der Lebenssituation widerspiegelt und moglichst alle Aspekte eines Migrationshintergrundes berucksichtigt.

Mindestindikatorensatz zur Erfassung des Migrationsstatus

Mindestindikatorensatz zur Erfassung des Migrationsstatus - Empfehlungen für die epidemiologische Praxis

Summaryobjective To test the hypothesis that as a minority with lower socio-economic status, Turkish residents in Germany might experience a higher mortality than Germans.



methods All-cause mortality rates by age group and sex of Turkish and German adults for the time period 1980–94 were calculated from death registry data and mid-year population estimates.



results The age-adjusted mortality rate (per 100000) of Turkish males aged 25–65 years resident in Germany was 299 in 1980 and 247 in 1990, consistently half that of German males. The mortality of Turkish females in Germany was 140 in 1990, half that of German females. Mortality of Turkish males/females in Ankara was 835 and 426 in 1990.



conclusion In view of the socio-economic status of Turkish residents in Germany the large mortality difference compared to Germans is unexpected. It cannot be fully explained by a selection at the time of hiring (healthy migrant effect) because it lasts over decades and extends into the second generation. A healthy worker effect is unlikely because Turkish residents have a lower employment rate than Germans. There is little evidence for movement of gravely ill persons back to Turkey. An ‘unhealthy re-migration effect’ in which socially successful migrants with a lower mortality risk stay in the host country while less successful ones return home even before becoming manifestly ill would partly explain our findings.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-3156.1998.00233.x

Low overall mortality of Turkish residents in Germany persists and extends into a second generation: merely a healthy migrant effect?

Cardiovascular mortality of Turkish nationals residing in West Germany.

About 7.2 million foreign nationals are living in Germany. Only few epidemiological studies have assessed their health status, unlike in other countries with large migrant populations. Hence, it is not known whether foreigners in Germany experience special health risks and whether there is a need for specific public health interventions. The size of the group (9% of the total population) and their increasing length of stay further emphasise the need for epidemiological research on migrants. In this article we describe the obstacles for such studies in Germany: difficulties in characterising the group of interest; problems of availability and accessibility of data sources; and aspects of data protection. Minor changes in mortality statistics and improved access to existing data sources within the limits of data protection would improve research opportunities.

Hajo Zeeb

Papers

Low overall mortality of Turkish residents in Germany persists and extends into a second generation: merely a healthy migrant effect?

The ‘healthy migrant effect’–not merely a fallacy of inaccurate denominator figures

Cardiovascular mortality of Turkish nationals residing in West Germany.

[Epidemiologic studies among foreign immigrants in Germany--rational and obstacles].

3. Life Course Epidemiology: A Conceptual Model for the Study of Migration and Health