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Ethnic differences in diet, physical activity and obesity
Vanessa Higgins & Angela Dale
Centre for Census & Survey Research
Overview
• Aims of project
• Literature
• Exploratory analysis
• Models
Aims of the project• Use Health Survey for England from 1999 and 2004 (ethnic boosts)
• Analyse ethnic differences in three outcomes:
– Obesity
– Diet
– Physical activity
• Explanatory variables such as gender, age, generation, educational level, type of neighbourhood, migration, (diet and physical activity for obesity)
• Household data - parental diet, physical activity, obesity and other characteristics
• Assess change between 1999 and 2004
Background• In England, around a quarter of all adults are obese (2006 HSE data)
• Government estimates that without action this will rise to one-third by 2012 (Zaninotto et al, 2009)
• 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 healthy food and physical activity
– Diet (5 a day; food labelling; restrictions on advertising to children; school-meals)
– Physical activity guidelines and strategies (5*30mins moderate) (Physical Activity Plan 2005 ; Game plan 2002)
Some recognition of cultural/ethnic differences in these strategies but need more
Literature
• Measure of obesity
• Healthier diet among ethnic minorities
• Lower levels of physical activity for some ethnic groups
• Why are we seeing these differences?– Cultural beliefs (e.g. significance placed on food, eating together
as family, cultural barriers to physical activity)– Body image– Concept of physical activity– Migration– Socio-economic confounders
Obesity by agegroup by ethnic group - males age 16+
0
10
20
30
40
50
60
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
Black Caribbean Black Af rican Indian Pakistani Bangladeshi Chinese Irish White
Obesity by age group by ethnic group - females age 16+
0
10
20
30
40
50
60
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
Black Caribbean Black Af rican Indian Pakistani Bangladeshi Chinese Irish White
% eating 5-a-day by agegroup by ethnic group - males aged 16+
0
10
20
30
40
50
60
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
Black Caribbean Black African Indian Pakistani Bangladeshi Chinese Irish White
%
% eating 5-a-day by age group and ethnic group - females age 16+
0
10
20
30
40
50
60
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
16
-3
4
35
-5
4
55
+
Black Caribbean Black Af rican Indian Pakistani Bangladeshi Chinese Irish White
% meeting physical activity guidelines by agegroup by ethnic group - males age 16+
0
10
20
30
40
50
60
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
BlackCaribbean
Black African Indian Pakistani Bangladeshi Chinese Irish White
% meeting physical activity guidelines by agegroup by ethnic group - females age 16+
0
10
20
30
40
50
60
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
16
-34
35
-54
55
+
BlackCaribbean
Black African Indian Pakistani Bangladeshi Chinese Irish White
Logistic regression: variables Separate models for males and females
Stage 1 : Age
Age2
Ethnic group
Stage 2 : Migrant status
Highest qualification
Economic status
Equivalised income tertiles
Urban indicator
IMD quintiles
This area has good local transport
This area has good leisure facilities for people like me (obesity and physical activity models
Ease of getting to supermarket (obesity and five-a-day models)
Meeting physical activity guidelines (obesity model)
Eating 5 day (in obesity model)
Five-a-day models: key resultsOdds of eating five-a-day (p<0.05)
• Males: – Higher for Black-Caribbean, South Asian and Chinese (ref: White)– Lower for those with lower qualifications (ref: degree)– Lower for those with lower incomes (ref: highest income)
• Females:– Increases with age and then declines with age– Higher for Pakistani and Bangladeshi (ref: White)– Higher for adult migrants (ref: British-born)– Lower for those with lower qualifications (ref: degree)– Lower for those with lower incomes (ref: highest income) – Lower for those living in more deprived areas (ref: least deprived areas)
Physical activity models: key results
Odds of meeting physical activity guidelines (p<0.05)
• Males: – Lower for Pakistani & Bangladeshi (ref: White)– Decrease with age– Lower for unemployed & retired/other economically inactive (ref:
employed) – Higher for those with lower qualifications (ref: degree)
• Females:– Lower for South Asian and Chinese (ref: White)– Lower for retired/other economically inactive (ref: employed)
Obesity (Adults) Male Female
Age 1.19 1.11
Age squared 0.998 0.999
Ethnic groups (White) Black Caribbean 0.91 2.03
Black African 0.70 3.18
Indian 0.47 0.93
Pakistani 0.54 1.47
Bangladeshi 0.12 0.68
Chinese 0.25 0.36
Irish 0.75 0.92
Highest qualification (Degree) Higher education below degree 1.21 1.38
A-level equiv 1.28 1.54
O-level/CSE/Foreign/other equiv 1.41 1.65
No qualifications 1.51 2.08
Equivilised income tertiles (Highest tertile)
Middle income 1.13 1.35
Lowest income 1.28 1.36
Good leisure facilities in area (agree) Disagree 0.75 0.98
Good local transport in area (agree)
Disagree1.07 0.75
Physical activity (No) Yes 0.72 0.65
Eating 5 day (No) Yes 1.17 1.16
Summary• Difference in levels of obesity varies between ethnic groups and gender:
– Black African and Black Caribbean women higher odds than white but no difference for men– South Asian men have lower odds than white but no difference for women– Chinese men and women both have lower odds than white men and women
• Physical activity and diet as predictors of obesity models:– Physical activity is a significant indicator of obesity when controlling for other variables– Five-a-day NOT significant indicator of obesity when controlling for other variables
• Relationship between obesity and physical activity not simple! – Black-African and Black-Caribbean women much more likely than white women to be obese
but NOT significantly less likely to be physically active – Chinese women and Pakistani and Bangladeshi men far less likely to be obese than white
counterparts but also significantly less likely to be physical active– Low levels of physical activity for Pakistani and Bangladeshi women and men cannot simply
be explained by cultural barriers for women
• Within each model only a few of the socio-economic characteristics are independent predictors of the outcome
• Next steps: separate ethnic models, different outcome measures, household data for parental influences on children, change between 1999 and 2004
Thank you!
