Trends of Obesity, Overweight, Underweight and Body Mass Index among Refugees in Buffalo, New York

1.Background: As the leading destination for refugees, the US has resettled more than 3.1 million refugees since 1975. New York State receives about 4,000 refugees a year with approximately 1,300 resettlements in Buffalo. The health status and disease burden of refugees can be diverse and dynamic. With previous studies largely focusing on malnutrition and infectious diseases, there is substantial gap in the literature assessing obesity and chronic non-communicable diseases (NCDs) among refugees. 2.Objectives: The overall goal of the study was to examine the prevalence and changes in obesity, overweight/obesity, underweight and body mass index (BMI) or BMI percentile status among child and adult refugees. The specific aims were: a) study the changes in the initial weight status of refugees upon arrival in the US; b) examine the longitudinal changes in a cohort of refugees from their initial to most recent health assessments; c) evaluate the between-group differences in weight status across subgroups by gender and region of origin. 3.Methods: A retrospective chart review was conducted for child (2-18 y) and adult (≥19 y) refugees who had initial health assessments in Buffalo, NY between 2004 and 2014. The changes in the initial weight status across time-periods were evaluated in cross-sectional studies separately for children (n=1208) and adults (n=1618). A total of 818 children and 1055 adults were followed for at least one year longitudinally from initial to their most recent health assessments. The main outcomes studied were obesity (BMI≥30/ BMI percentile≥95th), overweight/obesity (BMI≥25/ BMI percentile≥85th), underweight (BMI<18.5/ BMI percentile<5 th), BMI/ BMI percentile. Multiple regression analysis was conducted along with Chi-square, McNemar's tests and analysis of covariance to evaluate between-group differences. 4.Results: In children, overall initial prevalence of obesity was 7.4% and overweight/obesity was 16.4%. Initial obesity rates ranged from 3.1% in Asians to 16.7% in East Europeans (p<0.01); similarly, overweight/obesity status ranged from 8.4% in Asians to 33.3% in Europeans (p<0.01). Over 4.5 years in the Buffalo, obesity rates increased among girls (8.8% vs 12.1%, p=0.04) and boys (8.6% vs 13.3%, P<0.01 ); overweight/obesity rates also increased among girls (18.3% vs 27.6%, p<0.01) and boys (15.5% vs 25.7%, P<0.01 ). There were no differences in initial obesity, overweight/obesity and BMI/BMI percentile across time-periods in both children and adults. Overall initial obesity rate was lowest in Asians and highest in East European women (9.4% vs 46.4%, p<0.01) and men (3.3% vs 30.0%, p<0.01), respectively. Over 3.9 years in the US, obesity rates increased in women (20.0% vs 34.7%, p<0.01) and men (9.5% vs 17.3%, p<0.01); obesity/overweight rates also increased in women (55.1% vs 73.5%, p<0.01) and men (39.6% vs 58.6%, p<0.01). In subgroup analysis, the only longitudinal decreases in overweight/obesity rates were among Middle Eastern (81.4% vs 78.0%, p<0.01) and East European (75.0% vs 70.8%, p<0.01) women. There was interaction between region of origin and gender ( p=0.02). Every additional year in the US increased risk of obesity by 17% in women (RR,1.17(1.04,1.31)) and 33% in men(RR,1.33(1.15,1.53)) after adjusting for age and BMI at arrival. 5.Conclusions: There were no changes over time in the initial overweight/obesity rates. Among women, post-resettlement overweight/obesity rates exceeded US rates; while, rates among refugee men and children approached the corresponding US rates. Clinical and community-based assessments are needed along with culturally-appropriate strategies to prevent unhealthy weight gain among refugees.