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Acculturation and Post-Immigration Changes in Obesity, Physical Activity, and Nutrition: Comparing Hispanics and Asians in the Waterloo Region, Ontario, Canada

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Acculturation and Post-Immigration Changes in Obesity, Physical Activity, and Nutrition: Comparing Hispanics and Asians in the Waterloo Region, Ontario, Canada Wilfrid Laurier University Scholars Commons @ Laurier Theses and Dissertations (Comprehensive) 2016 ACCULTURATION AND POST-IMMIGRATION CHANGES IN OBESITY, PHYSICAL ACTIVITY, AND NUTRITION: COMPARING HISPANICS AND ASIANS IN THE WATERLOO REGION, ONTARIO, CANADA. Michele Vitale Mr. Wilfrid Laurier University, [email protected] Sean Doherty Wilfrid Laurier University, [email protected] Follow this and additional works at: https://scholars.wlu.ca/etd Part of the Human Geography Commons Recommended Citation Vitale, Michele Mr. and Doherty, Sean, "ACCULTURATION AND POST-IMMIGRATION CHANGES IN OBESITY, PHYSICAL ACTIVITY, AND NUTRITION: COMPARING HISPANICS AND ASIANS IN THE WATERLOO REGION, ONTARIO, CANADA." (2016). Theses and Dissertations (Comprehensive). 1884. https://scholars.wlu.ca/etd/1884 This Dissertation is brought to you for free and open access by Scholars Commons @ Laurier. It has been accepted for inclusion in Theses and Dissertations (Comprehensive) by an authorized administrator of Scholars Commons @ Laurier. For more information, please contact [email protected]. ACCULTURATION AND POST-IMMIGRATION CHANGES IN OBESITY, PHYSICAL ACTIVITY, AND NUTRITION: COMPARING HISPANICS AND ASIANS IN THE WATERLOO REGION, ONTARIO, CANADA By Michele Vitale Master of Arts in Geography, University of Iowa, 2012 Master of Science in Rural Sociology, Auburn University, 2007 Bachelor of Arts in Sociology, Università La Sapienza, 2000 DISSERTATION Submitted to the Department of Geography and Environmental Studies, Faculty of Arts in partial fulfillment of the requirements for Doctorate of Philosophy in Geography Wilfrid Laurier University Michele Vitale 2016 i Author’s Declaration I hereby declare that I am the sole author of this thesis. This is a true copy of the thesis, including any required final revisions, as accepted by my examiners. I understand that my thesis may be made electronically available to the public. ii Preface Statement The manuscripts presented in this dissertation are the result of a collaborative effort. Michele Vitale, as the first author, developed the methodology, collected the primary data, and statistically analyzed the results; Dr. Sean Doherty, as the second author, supervised the whole process, suggested the implementation of specific methods, and edited all manuscript versions. Signatures: First Author (Michele Vitale) Second Author (Dr. Sean Doherty) iii Acknowledgements I would like to thank my supervisor Dr. Sean Doherty for his guidance and support throughout the undertaking of this thesis. Thank you very much for your comments and suggestions when reviewing the multiple drafts of this thesis. I would also like to thank my committee members Dr. Alison Mountz, Dr. Daniel Rainham, and Dr. Margaret Walton-Roberts, for their support and feedback, and to Dr. Bruce Newbold for his external review. This study would not have been possible without the contribution of all research participants, who kindly shared their time and precious experiences. Thank you also to the Central Ontario Chinese Cultural Centre, the First Mennonite Church, the Grace Lao Mennonite Church, the Kitchener-Waterloo Taiwanese Canadian Association, the Korean Joonim’s Church, the Spanish Church of God, and the Vietnamese Association KW, which generously offered their help in recruiting study respondents. Financial support for this research was provided by Wilfrid Laurier University and the Ontario Graduate Scholarship. I feel extremely grateful to Dr. Michael English, Dr. Brent Wolf, Deborah Russell, and Cherie Mongeon who helped me to secure the financial support that allowed me to concentrate on my research. Finally, the completion of this thesis would not have been possible without my parents, my brother, and my partner Echo. Thank you for your constant encouragement and support. iv Dedication A mia mamma, Immacolata, mio papa, Sossio, e mio fratello, Luigi. v Table of Contents Author’s Declaration ..................................................................................................................................... ii Preface Statement ....................................................................................................................................... iii Acknowledgements ...................................................................................................................................... iv Dedication ..................................................................................................................................................... v List of Figures ............................................................................................................................................. viii List of Tables ................................................................................................................................................ ix 1. Introduction ........................................................................................................................................ 10 2. Background ......................................................................................................................................... 12 2.1 Obesity as a Complex Condition ....................................................................................................... 12 2.2 Determinants of Obesity ................................................................................................................... 15 2.3 Relative Contributions of Physical Activity vs. Diet to Obesity ......................................................... 20 2.4 Prevalence of Obesity and Related Conditions in Minorities ........................................................... 24 2.5 Obesity Determinants and Ethnicity ................................................................................................. 27 2.6 Is There a Positive Association between Acculturation and Obesity? .............................................. 30 2.7 Obesity among Ethnic Groups in Canada .......................................................................................... 34 2.8 Research Questions and Objectives .................................................................................................. 37 3. Methodology....................................................................................................................................... 42 3.1 Data Collection .................................................................................................................................. 42 3.2 Measures ........................................................................................................................................... 43 3.3 Statistical Analysis ............................................................................................................................. 45 3.4 Qualitative Analysis ........................................................................................................................... 46 4. First Manuscript .................................................................................................................................. 48 5. Second Manuscript ............................................................................................................................. 70 6. Third Manuscript................................................................................................................................. 96 7. Conclusions ....................................................................................................................................... 131 6.1 Summary of Findings ....................................................................................................................... 131 6.2 Summary of Theoretical Implications ............................................................................................. 133 6.3 Summary of Implications for Future Preventive Efforts ................................................................. 134 References ................................................................................................................................................ 137 vi Appendices ................................................................................................................................................ 146 Appendix A. Questionnaire ................................................................................................................... 146 Appendix B. Health Professionals Interview Guide .............................................................................. 154 Appendix C. Participant Informed Consent Statement......................................................................... 155 vii List of Figures Figure 1 Prevalence of Overweight & Obesity by Ethnicity in Canada, 2001/2003 .................................... 35 Figure 2 Prevalence of Overweight & Obesity by Immigration Status in Canada, 2001/2003 ................... 36 viii List of Tables Table 1 Body Weight Classifications for Adults........................................................................................... 14 ix 1. Introduction The purpose of this doctoral dissertation is to build the theoretical and empirical foundations for undertaking a deeper analysis of the propensity of immigrants to become overweight and obese since time of immigration. The ‘Background’ chapter of the document underlines the most relevant uncertainties that still characterize the current knowledge of obesity,
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