ethnic differences in obesity, diet and physical activity

Ethnic differences in obesity, diet and physical activity

Vanessa Higgins & Angela Dale

Centre for Census & Survey Research

University of Manchester

Background• In England, almost two-thirds of adults and a third of children are either

overweight or obese

• Government estimates that without action this will rise to almost 9 in 10 adults and two-thirds of children by 2050

• Obesity linked to increased risks of diabetes, heart disease, cancer

• Government strategies – “Healthy Weight, Healthy Lives”, Jan 2008. Identifies 5 areas for tackling

excess weight including promotion of healthier food and physical exercise

– Diet (5 a day; food labelling; restrictions on advertising to children; school-meals)

– Physical activity guidelines– Some recognition of cultural/ethnic differences in these strategies but

need more

Aims of the project• Analyse ethnic differences in three outcomes:

– Obesity– Diet– Physical activity

• Use Health Survey for England from 1999 and 2004 (ethnic boosts)

• Explanatory variables: gender, age, generation, social class, educational level, religion, type of neighbourhood etc (diet and physical activity for obesity)

• Parental diet, physical activity, obesity and other characteristics

• Assess change between 1999 and 2004

% obese by ethnic group by sex

0

5

10

15

20

25

30

35

40

% Men

Women

Aged 16+, Base (unweighted) 11022Source: Health Survey for England 2004

Obesity and ethnicity

• Age: increase in obesity prevalence with age was marked among Black Caribbean, Black African and Indian women.

• Children: Black Caribbean and Pakistani girls at increased risk of obesity and Pakistani and Indian boys are more likely to be overweight. HSE 2004 shows BA boys at risk of obesity.

• Issues of socio-economic confounders – is this a real relationship

• Abdominal obesity in South Asians- Body Mass Index or Waist circumference?- different BMI cut-offs for Asians?

% eating 5 or more portions of fruit or vegetables by ethnic group by sex

0

5

10

15

20

25

30

35

40

45

% Men

Women

Aged 16+, Base (unweighted) 13515Source: Health Survey for England 2004

Diet and ethnicity• All minority ethnic groups have healthier diet than general population.

• Other literature confirms UK South Asian and Afro-Caribbean diets generally healthier than white population. Evidence of high quantities consumed in Caribbean diet

• Heterogeneity of South Asian and Afro-Caribbean: religion, region etc

• Cultural beliefs: mealtime structures, significance of food

• Migration: modification of traditional diet when move to UK, adoption of fast foods, time since immigration

• Age: fruit and veg consumption highest among older groups. Do older people retain traditional eating patterns that may not be followed by younger generations?

% meeting physical activity recommendations by ethnic group by sex

0

5

10

15

20

25

30

35

40

45

% Men

Women

Aged 16+, Base (unweighted) 13482Source: Health Survey for England 2004

Physical activity and ethnicity• Smaller scale studies support HSE findings of low levels of

physical activity among South Asians. Extends to children and young people

• Cultural barriers: language, dress code, modesty and lack of single-sex facilities, concept of physical activity to Bangladeshis. Also non-cultural issues, don’t over-emphasise cultural barriers

• Migration: do British born South Asians do more physical activity than first generation? Does length of time since immigration affect activity levels?

• Lack of literature on physical activity of other ethnic minority groups in UK!

Operationalisation (2004)

• Diet– Summary measure of fruit and vegetable consumption based on the 5-

a-day guidelines (aged 5+)

– Separate components of fruit and vegetable consumption (aged 5+)• Salad, pulses, vegetables, composite dishes, fruit juice, fresh fruit, dried fruit,

frozen or tinned fruit, other dishes made from fruit

– Summary measure of fat scores (aged 16+)

– Separate components of fatty foods consumed (aged 16+)• Milk, cheese, red meat, white meat, fish, fried food, sweet/savoury snacks,

pastries, butter/ghee, reduced fat spreads, oils

– Salt added in cooking and at table (aged 16+)

Operationalisation (2004)• Physical activity of adults (aged 16+)

– Summary measure based on current guidelines of 30+ mins of activity of moderate intensity 5+ days week

• Low activity: less than once a week• High activity: at least 5 days a week

– Separate components: sports/exercise; brisk walks; heavy housework/gardening/DIY; occupational activity

• Physical activity of children (aged 5-15)

– Summary measure based on current guidelines of 1 hour+ of moderate intensity per day

– Separate components: sports/exercise; walking; active play; housework/gardening

• Obesity– Body Mass Index (weight in kgs/height in metres²). WHO cut off points for obesity for

adults and children– Waist Circumference

Summary

• Use HSE to analyse ethnic differences in obesity, diet and physical activity

• Highlighted some of the complexities of measuring outcome variables and some explanations for observed differences

• We will use standard measures but also implement alternatives

• Explanatory work and regression models

Our contact details:

vanessa.higgins@manchester.ac.ukCentre for Census and Survey ResearchUniversity of Manchester0161 275 7766

angela.dale@manchester.ac.ukCentre for Census and Survey ResearchUniversity of Manchester0161 275 4876