Background
Acculturation & enculturation
Methods
Protocol
Information sources
Search strategy & study selection process
Databases searched | Academic Search Complete (EBSCOhost); Academic Search Premier (EBSCOhost); CINAHL with Full Text (EBSCOhost); Global Health (EBSCOhost); MEDLINE with Full Text (EBSCOhost); and PsycINFO (EBSCOhost). |
Key Words | MeSH keywords: (Obes* OR Overweight OR Weight gain OR Bodyweight OR Body mass index OR Waist-hip ratio) AND (Enculturat* OR Acculturat* OR assimilat* OR Integrat* OR Cultural change OR Biculturalism OR Cultural integration OR Culture diffusion OR Cultural adaptation OR Cultural shift Or Social integration) Additional keywords: (Obesity OR overweight person OR overweight OR weight gain OR body weight OR body mass index OR waist-hip ratio) AND (Acculturation OR culture change OR assimilation OR integration OR social integration OR biculturalism OR cultural integration OR culture diffusion OR cultural change OR cultural adaptation OR cultural shift). |
Inclusion criteria | i. The study was published in a peer-reviewed scientific journal. ii. The study used an acculturation scale (UDM or BDM) to measure acculturation. iii. The study did not rely on surrogate measures of acculturation (e.g. length of stay in host country, generations (1st vs. 2nd), or nativity/birthplace). iv. The population under study comprised migrants and/or refugees from low- or medium-income countries living in high-income countries. v. The populations under study comprised adults over 18 years of age. The paper was published between January 1990 and May 2011. |
Validity & quality assessment
Results
Study selection
Author (year) | Host country | Country of origin ( N)/ Gender | Study design | Acculturation scale | Measure of overweight /obesity | Results | Quality | Limitations |
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Ahluwalia et al., [45] | USA | Mexico (1301, female: 664 male: 637) | Cross-sectional | Bi-dimensional acculturation scale (BDM) | Measured BMI, waist circumference | Higher degree of acculturation correlated with higher BMI. Among participants with a BMI ≥ 25, lower scores on acculturation predicted less likelihood of considering self as overweight (60% vs. 73%) and less likely of having attempted to lose weight (OR 5 0.49; 95% CI: 0.31–0.79). | Moderate | Certain sample subgroups were too small for empirical examination. Despite using the BDM acculturation model, the analysis treated as a UDM. |
Barcenas et al., [46] | USA | Mexico (7503, female: 5471, male: 2032) | Cross-sectional | Bi-dimensional Acculturation Scale for Hispanics (BDM) | Self-reported BMI | Higher degree of acculturation and length of residency in the US were correlated with higher BMI: 46% of highly acculturated participants were obese compared with 43% with a low degree of acculturation (p < .0096). | High | Self-reported BMI cannot be verified and may bias results. |
Bertera et al., [47] | USA | El Salvador (1205, female: 581 male: 624) | Cross-sectional | Uni-dimensional acculturation scale (UDM) | Measured BMI | Higher degree of acculturation was associated with higher BMI. As acculturation increased so too did BMI, and together with other variables accounted for 45% of the variance in BMI (p < .01-.001). | Moderate | Self-reported BMI cannot be verified and may bias results. |
Fitzgerald et al., [48] | USA | Puerto Rico (200 female) | Cross-sectional | Uni-dimensional acculturation scale (UDM) | Measured BMI | Higher degree of acculturation was associated with higher BMI. Acculturation correlated positively with obesity; with less acculturated participants were 54% less likely to be obese. | Moderate | Data collection methods were not adequately reported. |
Franzen et al., [49] | USA | Thailand/Laos, Hmong (65, female: 48, male: 17) | Cross-sectional | Short Acculturation Scale for Hispanics (BDM) | Measured BMI | Higher degree of acculturation was associated with higher BMI. Changes in the environment and increased acculturation level had negative effects on body weight and overall health. | Moderate | Participant attrition was not adequately reported. |
Hazuda et al., [50] | USA | Mexico (2941, female: 1677, male: 1264) | Cross-sectional | Functional Integration with Mainstream Society scale (FIMS-scale), Value Placed on Preserving Mexican Cultural Origin scale (VPPMCO-scale) (BDM) | Measured BMI, sub scapular to triceps skin-fold thickness ratio, waist-to-hip circumference ratio. | In men, higher degree of acculturation was associated with higher BMI and less favourable body fat distribution. In women, higher degree of acculturation was associated with lower BMI and a more favourable body fat distribution (p = .01-.001). Prevalence of obesity was greater in Mexican-Americans than in non-Hispanic whites. | High | -- |
Khan et al., [51] | USA | Mexico (female: 1723, male 1418)-, Cuba (female: 451, male 377)-, and Puerto Rican- (female: 747, male: 64) (5180) | Cross-sectional | Uni-dimensional acculturation scale (UDM) | Measured BMI | Spanish language preference correlated positively with obesity, and acculturation measurement of generations correlated positively with obesity (p = .05-.001). | Moderate | The sample included second and third generation Cuban-Americans and Puerto Ricans as well as first generation migrants. For 2nd and 3rd generations, there was no full description of the process of acculturation for these subgroups of the sample. This may compromise comparability. |
Lee et al., [52] | USA | Korea(356, female: ?, men: ?) | Cross-sectional | Two-culture Matrix Model based on Gordon’s theoretical work (BDM) | Self-reported BMI | Assimilated men recorded higher BMIs (1.7kg/m2 more) than men with lower degrees of acculturation (p < .05). Acculturation correlated positively with frequency of light physical activity (men OR = 4.34, p < .005; women OR = 7.38, p < .005) and better health in men (OR = 2.74, p < 05). No relationship between BMI and acculturation was present for women. | Moderate | Sample included second generation Korean Americans, and was generally of a higher SES than 1990 census. |
Miller et al., [53] | USA | Soviet Union women (218) | Longitudinal (1 year duration) | American and Russian Behavioural Acculturation Scale (BDM) | Measured BMI & waist circumference | Maintaining origin cultural orientation correlated positively with higher waist circumference (β = −.15, p < .05) and BMI (r
2
= .25, p < .01. | High | -- |
Study characteristics & samples
Study quality
Acculturation scales
Study findings
Discussion
Strengths and limitations
Conclusions
Key messages
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Based on the reviewed studies, there appears to be an overall positive relationship between acculturation and obesity in populations migrating to high-income countries from low- to middle-income countries.
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Migrant gender appears to be a significant factor in the relationship between acculturation and obesity. Due to the limited valid research on this topic, future study should focus on this relationship.
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The role of nutrition transition in the relationship between acculturation and obesity also is likely to play an important role in the connection between acculturation and migrant weight gain and obesity.
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For the sake of empirical reliability and rigour the use of validated, comprehensive and uniform acculturation scales should feature prominently in future study.