Increasing rates of overweight, obesity, and related metabolic diseases documented among refugee communities across the United States necessitate greater attention to how processes of integration impact refugee health. These nutritional health trends (e.g., increasing rates of obesity) suggest potential disconnects between refugees\u27 past environments and their conditions after re-settlement, which may contribute to adverse changes in energy balance (diet and exercise). While Bhutanese refugees were among the largest refugee groups entering the US during the five years leading up to this research, very few studies have examined how they have responded to integration and the impact of this transition on their health. Grounded in human adaptability and political economic theories, and adopting a biocultural approach, this dissertation investigates how Bhutanese refugees in “Prospect City” (pseudonym) negotiate changing and unfamiliar structural and sociocultural conditions after resettlement and the consequences for energy balance and nutritional status. The results reveal high rates of overweight and obesity compared to US averages. Age and caste related differences in nutritional status were also found. High rates of overweight and obesity corresponded with an energy imbalance due to over consumption of energy dense traditional foods and limited understanding of the importance of regular exercise. Over consumption of energy dense traditional foods stemmed from several interrelated factors: the abundance of foods in the US, prior experiences with food deprivation, a history of political exile that reinforced desires to preserve cultural food preferences, and joint family efforts to accommodate work-related time constraints by increasing food production and availability. Decreases in exercise appeared to stem from more sedentary lifestyles in the US as a result of work environments and available transportation, coupled with a lack of health knowledge regarding health benefits of physical activity. This dissertation’s findings are being reported to Prospect City’s Bhutanese Community Organization to help develop strategies for improving nutritional health in the community
