Research findings report of ETHNIC DIFFERENCES IN PHYSICAL ACTIVITY, DIET AND OBESITY project. A project in the ESRC Understanding Population Trends and Processes Programme, maintained by the ReStore repository and archived to NCRM Eprints 2022

Dale, Angela

Higgins, Vanessa

National Centre for Research Methods: NCRM EPrints Repository

RESEARCH FINDINGS   December 2010U P T A Pactivity, diet and obesity among girls, after controllingfor ethnicity and other factors.Indian, Pakistani, Bangladeshi and Chinese womenwere all less likely to meet the physical activityguidelines than White women after controlling forage, migration, educational qualifications, economicactivity, household income and area-level deprivation.Pakistani and Bangladeshi men were less likely thanWhite men to meet the physical activity guidelines.Men from most ethnic groups were more likely toconsume five or more portions of fruit and vegetableper day (5-a-day) than White men. Pakistani andBangladeshi women were more likely than Whitewomen to consume 5-a-day.Maternal physical activity had a strong associationwith child physical activity and maternal 5-a-dayconsumption with child 5-a-day consumption. Parentalobesity was a major predictor of childhood obesity,after controlling for ethnicity and other factors.Data and methods used in the studyWe used data from the HSE for 2004. The surveycontained an ethnic boost providing data on BlackCaribbean, Black African, Indian, Pakistani, Bangladeshi,Chinese, Irish and White groups. Key outcomes of theanalysis were obesity, physical activity and fruit andvegetable consumption for adults and children. For adultsand children, a series of logistic regression models weredeveloped for each of the three outcomes. The adultmodels controlled for age, ethnicity, migration,educational qualifications, economic activity, householdincome and area-level deprivation (physical activitylevels and levels of fruit and vegetable consumptionwere also included in the obesity models). For children,models included information about ethnicity, parentalsocio-economic characteristics, parental obesity, parentalOver the past decade, the UK Government has setrecommended guidelines and action plans to encouragethe population to eat a healthier diet and do morephysical activity, partly in order to combat rising obesitylevels. The Health Survey for England (HSE) collects datain relation to these guidelines, presenting an opportunityto examine differences between ethnic groups inmeeting them. This report is based on results from the2004 HSE.The prevalence of obesity varies between ethnic groupsin England with Black Caribbean, Black African andPakistani women showing higher prevalence of obesityas measured by Body Mass Index (BMI = weight(kg)/height (m²)) than those in the general populationand the prevalence was markedly lower for Chinesewomen (Sproston and Mindell, 2006). However, there isan increasing body of evidence that ethnic inequalities inhealth are mainly determined by social and economicinequalities (Nazroo, 2003).In this project we investigate the independent effects ofethnicity, socio-economic characteristics and migrationupon physical activity, diet and obesity for adults aged 16and over and, for children aged 2-15, the effects ofethnicity and parental characteristics on physical activity,diet and obesity.Key FindingsBlack African and Black Caribbean women were morelikely than White women to be obese after controllingfor a number of factors. However, none of the maleminority ethnic groups were more likely to be obesethan White males.Education was an important predictor of physicalactivity, diet and obesity after controlling for ethnicityand other factors. Mother’s highest level ofqualification was a strong predictor for physicalUNDERSTANDING POPULATION TRENDS AND PROCESSESETHNIC DIFFERENCES IN PHYSICAL ACTIVITY, DIET AND OBESITYVanessa Higgins and Angela DaleCentre for Census & Survey Research, University of ManchesterUPTAP Findings Higgins Nov 2010:UPTAP 2010  17/01/2011  12:18  Page 2and Chinese boys and Black African, Indian and Pakistanigirls were less likely to meet the recommended children’sphysical activity guidelines than their white counterpartsafter controlling for other factors.Ethnicity and fruit and vegetable consumptionThe logistic regression results for fruit and vegetableconsumption (not shown here) showed that BlackUPTAP RESEARCH FINDINGSphysical activity and parental consumption of fruit andvegetables.Adult obesity was measured by BMI which is an internationallyrecognised measurement of obesity and overweight. Theanalyses used a dichotomous variable of obese/not obesewith obese defined as a BMI of more than 30kg/m foradults. Children were classified as obese/not obese usingthe International Obesity Task Force (IOTF) age-specificthresholds (Cole et al., 2000). Physical activity for adultswas defined as meeting/not meeting the current UK physicalactivity guideline of 30 minutes of at least moderate intensityphysical activity (including walks of 30 minutes or more ata fairly brisk or fast pace, heavy housework, gardening,DIY, sports and exercise and occupational activity) five daysper week. Fruit and vegetable intake for adults and childrenwas defined as meeting the UK guideline of eating/noteating five or more portions of fruit or vegetables a day.ResultsThe exploratory analysis — with no controls (Figures 1-3)showed gender differences within ethnic groups for thethree outcomes of physical activity, fruit and vegetableconsumption and obesity, so separate logistic regressionmodels were run for men and women.Ethnicity and physical activityThe results of the regression analysis, including the controlslisted above, showed that Indian, Pakistani, Bangladeshiand Chinese women were less likely to meet the physicalactivity guidelines than the white female reference group(Figure 4). The White reference group has an odds ratiovalue of 1. For men, Pakistanis and Bangladeshis were lesslikely to be physically active than the White referencegroup. Among children (Figure 5), Black Caribbean, IndianFIGURE 1. PERCENTAGE BMI OBESE BY AGE GROUP, AGED 16+FIGURE 2. PERCENTAGE EATING 5-A-DAY BY AGE GROUP ANDETHNIC GROUP, AGED 16+FIGURE 3. PERCENTAGE MEETING PHYSICAL ACTIVITY GUIDELINES BYAGE GROUP AND ETHNIC GROUP, AGED 16+UPTAP Findings Higgins Nov 2010:UPTAP 2010  17/01/2011  12:18  Page 3Caribbean, Indian, Pakistani, Bangladeshi and Chinese adultmales were more likely than White adult males to eat fiveor more fruit or vegetables per day (5-a-day) aftercontrolling for other factors. In comparison, onlyBangladeshi and Pakistani females were more likely thanWhite females to eat 5-a-day. Black Caribbean, Pakistani,Bangladeshi and Irish boys were more likely than whiteboys to eat 5-a-day, however, the confidence intervalswere very wide. There were no significant ethnicdifferences in the likelihood to eat 5-a-day amongst girls.December 2010Ethnicity and obesityFor adult obesity (Figure 6) Indian, Pakistani, Bangladeshiand Chinese men had significantly lower odds of beingobese than White men, after controlling for other factors,whilst Black Africans, Black Caribbean and Irish men werenot significantly different to White men. The resultsshowed different patterns for women, with Black Caribbeanand Black African women more likely to be obese thanWhite women (odds ratios of 2 and 3 respectively), whileChinese women remained nearly three times less likely tobe obese than white women. The logistic regressionmodels for children showed that Black African boys andgirls had higher odds of obesity than the White referencegroup in models that include a full set of controls.Socio-economic determinantsOnly a few of the socio-economic characteristics included inthe logistic regression models were predictors of obesity,physical activity and fruit and vegetable consumption aftercontrolling for other factors.Highest educational level was a strong predictor for allthree outcomes (physical activity, fruit and vegetableconsumption and obesity). Men and women with noqualifications or low level qualifications had higher odds ofbeing obese than those with degree-level qualifications.For men, those with qualifications below degree-level hadhigher odds of meeting the physical activity guidelinesthan those with degrees or equivalent but this may reflecthigher levels of occupational activity among those lessqualified. Both men and women with degree-levelqualifications were more likely than those with lower-levelqualifications to eat 5-a-day. For children, girls withmothers who had no qualifications were less likely to meetthe activity guidelines and more likely to be obese thanthose whose mothers had a degree level qualification orhigher. Mother’s level of qualification was also anFIGURE 4. ODDS RATIOS: PHYSICAL ACTIVITY, AGED 16+FIGURE 5. ODDS RATIOS: PHYSICAL ACTIVITY, AGED 2-15FIGURE 6. ODDS RATIOS: OBESITY, MALES AND FEMALES AGED 16+UPTAP Findings Higgins Nov 2010:UPTAP 2010  17/01/2011  12:18  Page 4     important predictor of fruit and vegetable consumptionamong children (for both boys and girls).Employment was a significant predictor of increasedphysical activity for men and women while boys withunemployed mothers were less likely to meet therecommended activity guidelines than those withmothers in employment. Income was significant for theconsumption of 5-a-day; both males and females withhigher household incomes were more likely to eat 5-a-daythan those with lower household incomes. Low householdincome was also a predictor of obesity for women.MigrationMigration was a significant predictor of fruit and vegetableconsumption; females who migrated to Britain as anadult were more likely than those born in Britain to eat5-a-day but there was no such difference for males. Girlswith mothers who were born outside Britain were morelikely to consume 5-a-day than those with mothers born inBritain. Migration was not a significant predictor of obesityor physical activity when holding other factors constant.Diet and physical activity as predictors of obesityNot meeting the physical activity guidelines had asignificant effect on the likelihood of being obese (bycomparison with the reference categories) for both menand women. Fruit and vegetable consumption was not asignificant predictor of obesity. This can be explained bythe fact that fruit and vegetable consumption is only apartial measure of diet and does not reflect eating habitsas a whole. In addition, there is also evidence that self-reported data on food consumption may be inaccurate.Parental diet, physical activity and obesityMothers’ physical activity level had a positive influenceon both boys’ and girls’ physical activity levels aftercontrolling for other factors. However, fathers’ activity levelwas not significant. Not surprisingly, parental consumptionof 5-a-day was a strong predictor of child consumption;both maternal and paternal consumption were significantfor both boys and girls. Parental characteristics wereimportant in explaining children’s obesity — in particularmother’s obesity for girls and father’s obesity for boys.Policy implications and impactsBlack African and Black Caribbean women were morelikely to be obese than White women but there was nodifference between Black African or Black Caribbean menand White men. This remains unexplained and requiresmore work to establish the various roles of life-style andeating patterns, occupation or body-image preference.The very low levels of obesity for Chinese men and women— with no indication of an increase among youngergenerations — is not readily explained by levels of physicalactivity or 5-a-day, and again needs research in moredepth to identify whether diet (using a better measure)plays a major role or whether there are additional factors.The low levels of physical activity amongst Pakistani andBangladeshi men and women suggest that policiesaimed at increasing physical activity should target theseethnic groups. However, as levels were low amongwomen and men, they cannot be simply explained bycultural barriers for women.The results highlight the importance of recognisingdifferences in levels of physical activity, diet and obesitynot just between ethnic groups, but also between thosewith different levels of educational qualifications. Theresults suggest policies should target those with lowerlevels of education in order to combat obesity andencourage a healthy diet.Parental BMI was a major predictor of childhood obesity,after controlling for ethnicity and other factors. Theseresults suggest that interventions aimed at reducingchildhood obesity should focus on parentalcharacteristics, but they also need to be sensitive togender and ethnic differences. The results suggest thatmaternal education may be a route for tackling obesitybut it seems that girls are more receptive than boys.ReferencesCole, T.J., Bellizzi, M., Flegal, K. and Dietz, W. (2000)Establishing a standard definition for child overweightand obesity worldwide: International survey, BritishMedical Journal, 320: 1-6.Nazroo, J.Y. (2003) The structuring of ethnic inequalitiesin health: Economic position, racial discrimination andracism, American Journal of Public Health, 93(2): 277-284.Sproston, K. and Mindell, J. (eds.) (2006) Health Surveyfor England 2004. Volume 1: The Health of MinorityEthnic Groups, The Information Centre, London.Contact details of authorsVanessa Higgins and Angela DaleCentre for Census and Survey Research (CCSR)School of Social Sciences, Kantorovich BuildingHumanities Bridgeford Street, University of ManchesterManchester, M13 9PLEmail: vanessa.higgins@manchester.ac.ukEmail: angela.dale@manchester.ac.ukU P T A P    For a full list of UPTAP Research Findings, visit www.uptap.netUPTAP Findings Higgins Nov 2010:UPTAP 2010  17/01/2011  12:18  Page 1

Ethnic differences in physical activity, diet and obesity - research findings

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Ethnic differences in physical activity, diet and obesity - research findings

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