Food Acculturation and Associated Health Risks Among Immigrants

Background: Studies document that overweight and obesity is more likely in individuals from lower socioeconomic status and ethnic minorities, including immigrants. Upon arrival in a new country, immigrants have lower body mass index (BMI), and are less likely to be overweight and obese than natives. However, longer residence is associated with higher BMI, often attributed to adoption of unhealthy diets and behaviors.

Food acculturation –the process by which immigrants adopt the food and dietary practices of their new country, has been associated with chronic disease risk and overall deteriorating health. In particular, unfamiliar food cultures and food purchasing environment, lack of knowledge on how to prepare and incorporate new foods in traditional diets, perceptions towards food in new country, all limit immigrants’ food choices and access. As such, immigrants are at higher risk of adopting diets that may have long-term negative health impacts.

While studies in the U.S. and in other developed countries have investigated the changing diabetes status of African immigrants, very few in the U.S. have focused on immigrants from eastern African. Yet, this group reports high rates of overweight and obesity, diabetes and pre-diabetes. Using unidimensional model, this study explored the multi-level facilitators and barriers associated with food and dietary acculturation patterns, including food choices, availability, accessibility and affordability among immigrants and refugees.

Methods: Data used in this qualitative study comes from in-depth interviews (N=10) conducted among East African immigrants living in St. Louis, MO. Participants recruitment and interviews were done in Fall 2020 and Spring 2021.

Results:

Demographics: participants included six men and four women, all adults over 18, with a mean age of 46 years. They lived in the U.S. for an average of 10.5 years with a wide range of 4-28 years. Key findings are:

• Factors influencing food choices and decisions – participants expressed a strong preference for ethnic foods, but fear of the unknown “The food has different taste, different ingredient, difficult to buy food I don’t understand. It doesn’t taste the same like back home”. Dietary restriction is another strong factor that influences the choice. All our participants mentioned they only eat “Halal” meat and that limits their choices.
• Access and availability – limited choices of Somali/African stores make food choices more difficult and expensive. Transportation is another issue especially for new arrivals compounded by unreliable public transport and unfamiliar weather patterns.
• Generational difference in food preferences: While adults prefer to eat ethnic foods, the kids adjusted to and prefer American food, bringing cultural diet-clash into the households.
• Community support was identified as key area in food acculturation for new immigrants. Having a community that can provide information on where to shop, ethnic stores, language and transportation help are really important, and more importantly, orientation to the shopping environment.

Conclusion: We find that the factors that contribute to food acculturation are both personal and structural. While there is strong preference for ethnic foods among adults, there are challenges to accessing those markets including – availability, variety, transportation and cost.