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Obesity among Hispanics - a brief demographic account. Rodolfo Valdez, Ph.D., M. Sc. Division of Diabetes Translation Centers for Disease Control and Prevention Atlanta, GA. Introduction. Hispanics are at increased risk for obesity. - PowerPoint PPT Presentation
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Obesity among Hispanics- a brief demographic account
Rodolfo Valdez, Ph.D., M. Sc.Division of Diabetes TranslationCenters for Disease Control and
PreventionAtlanta, GA
Introduction
• Hispanics are at increased risk for obesity.
• The population of Hispanics in the United States increased from 22.4 million in 1990 to 35.3 million in 2000.
• There is a need for identifying modifiable risk factors associated with the excess prevalence of obesity among Hispanics.
Objectives
• To assess the prevalence of obesity in Puerto Rico and several states of the U.S. with large Hispanic populations.
• To examine the association between obesity and some demographic variables in these populations.
Methods I
• Comparison of frequencies obtained from CDC’s Behavioral Risk Factor Surveillance System (BRFSS) .
• Software: SAS, SUDAAN.• The BRFSS uses telephone health
surveys designed to continuously monitor the risk behaviors for chronic disease, injuries, and death in the U.S. population, state by state.
Methods II
• Populations selected were from Puerto Rico and six states (NY, NJ, IL, FL, TX, CA) that represent the high density and the diversity of origins of the Hispanic population in the United States.
• Sample size: five years of the BRFSS (1998-2002), n = 134,802. Results are the weighted average over five years.
• Age-standardization: U.S. Census 2000.
Definition of ObesityBody Mass Index [weight (kg)/height (m)2]
BMI Category
Lean <18.5 Underweight
18.5 – 24.9 Normal weight
Overweight 25.0 – 29.9 Overweight
Obesity 30.0 – 34.9 Obesity (Class 1)
35.0 – 39.9 Obesity (Class 2)
40+ Extreme Obesity
Hispanic population in 6 states and Puerto Rico as a percentage of the total U.S. Hispanic population and
of the total intra-state population (U.S. 2000 Census)
11
4
8
19
31
10
1412
17
32 32
NY, NJ IL FL TX CA PR
%
% total US Hispanic population
% total intra-state population
Age distribution of Hispanic and non-Hispanic white BRFSS participants from six states (NY, NJ, IL, FL,
TX, CA) and Puerto Rico (BRFSS 1998-2002).
16
8 8
47
1813
22
68
18 - 44 45 - 54 55 - 64 65+
Age (years)
%
HispanicNon-Hispanic white
Prevalence of obesity in adults by age and ethnicity in six states (NY, NJ, IL, FL, TX, CA) and Puerto Rico
(pooled data)
20.7
30.2
26.9
23.3
14.9
21.9 22.6
16.3
18 - 44 45 - 54 55 - 64 65+
Age (years)
%
HispanicNon-Hispanic white
Crude prevalence of obesity in adults by ethnicity in six states and Puerto Rico
(BRFSS 1998-2002).
18.9
24.1
19.1
27.9
23.5
20.8
16.718.7
16.6
19.317.2
NY, NJ IL FL TX CA PR
%
Hispanic Non-Hispanic white
Age-standardized prevalence of obesity in adults by ethnicity in six states and Puerto
Rico(BRFSS 1998-2002).
19.8
25.1
19.2
28.8
24.5
21.0
16.318.3
16.5
19.116.9
NY, NJ IL FL TX CA PR
%
Hispanic Non-Hispanic white
Distribution of educational attainment in U.S. Hispanic and non-Hispanic white from six states
(NY, NJ, FL, IL, TX, CA) BRFSS 1998-2002
37.1
28.0
21.6
13.3
7.2
28.8 29.3
34.7
<High School High School Some College College ormore
%
Hispanic Non-Hispanic white
Age-standardized prevalence of obesity in adults by ethnicity and educational attainment in six states
(NY, NJ, FL, IL, TX, CA) and Puerto Rico. Pooled data.(BRFSS 1998-2002).
27.5
22.120.5
17.1
22.9
19.718.1
14.0
<High School High School Some College College ormore
%
Hispanic Non-Hispanic white
Distribution of U.S. Hispanic and non-Hispanic white adult populations by income in six states (NY, NJ,
FL, IL, TX, CA)(Pooled data, BRFSS 1998-2002).
46.6
25.6
15.512.3
19.7
28.8
40.0
11.5
< 25 25 - 49 50+ Unknown
Annual household income ($) x 1,000
%
Hispanic Non-Hispanic white
Age-standardized prevalence of obesity in adults by ethnicity and income in six states (NY, NJ, IL, FL,
TX, CA) and Puerto Rico (Pooled data, BRFSS 1998-2002).
25.123.7
20.4 20.920.619.4
14.813.7
< 25 25 - 49 50+ Unknown
Annual household income ($) x 1,000
%
Hispanic Non-Hispanic white
Percentage distribution of the Duncan Socioeconomic Index in adults (25-64 years) by
ethnicity(The San Antonio Heart Study).
62
20 18
10
35
55
3835
27
Lowest Middle Highest
Duncan Socioeconomic Index
%
Foreign-bornMexican AmericanNon-HispanicwhiteU.S.-born MexicanAmerican
Wei M et al. Ann Epidemiol 1996; 6: 307-313
Prevalence of diabetes in Mexican American adults (25-64 years) by migration and acculturation status
(NHANES III, adjusted for age and education).
5.0
6.9
12.8 13.5
7.06.1
Men Women
%
Mexican-born
U.S.-born Spanish-speakingU.S.-born English-speaking
Sundquist J & Winkleby MA. Am J Public Health 1999; 89: 723-730
Percentage of adult women (25-64 years) with no leisure-time activity during the past month by ethnicity and years of education (NHANES III).
61
47
30
18
46
2825
12
< 9 9 - 11 12 > 12
Years of education
%
Mexican-AmericanNon-Hispanic white
Winkleby MA et al. JAMA 1998; 280: 356-362
Age- and sex-adjusted prevalence of obesity in U.S. adolescents (7th-12th grade) by generation of birth (National Longitudinal Study of Adolescent Health).
24.0
24.6
31.8
31.4
Non-HispanicWhite
Hispanic, firstgeneration
Hispanic, secondgeneration
Hispanic, thirdgeneration
% Obesity(> 85th BMI percentile, 1995 WHO standard)
Popkin BM & Udry JR.. Journal of Nutrition 1998; 128:701-706.
Summary
• The prevalence of obesity varies among the different Hispanic groups.
• Income and education are inversely associated with obesity rates in both Hispanics and non-Hispanic whites.
• Hispanics outnumber non-Hispanic whites at the high-risk end of the income and education distributions.
Conclusions
• Hispanics in the U.S. and Puerto Rico are undergoing a health transition.
• The transition involves over exposure to social factors that seem to favor the development of obesity.
• As the social condition of Hispanics improves, the high prevalence of obesity among them may recede.
• Prevention campaigns may accelerate the health transition