One in five children in Reception class (age 4-5) at school is either overweight or obese according to the most recent figures from Public Health England. By the time they go into year 6 (age 10-11), the figure rises to one in three. Over time our children are becoming increasingly overweight and it’s a tide that parents, teachers, health professionals and policy makers are struggling to stem. But are there children from particular ethnic and cultural backgrounds who are at greater risk of becoming obese? If so, would a better understanding of who those children are help in the battle against obesity? Afshin Zilanawala has been exploring the links between a child’s weight or BMI and their ethnicity and asking which factors might need further consideration when it comes to tackling the problem.

Healthy eating initiatives like the recent NHS Change for Life Campaign which seeks to make families healthier and happier will hopefully play a role in getting children to eat the right things and be more active. All well and good if the messages are getting through loud and clear. But what if they’re not? And what if the reasons for that are somehow related to a child’s ethnicity?

There have been very few detailed studies of the links between a child’s ethnicity and their weight, something highlighted in the National Obesity Observatory’s 2011 report Obesity and ethnicity. However, a growing body of evidence is showing that children from certain ethnic backgrounds are at greater risk of obesity than their white peers.

So what factors are at play and what can we learn that might help overcome any cultural and social barriers that might stop these important messages getting through?

Key information such as what language is spoken at home, family routines and diet have been missing from the analysis. That combined with a tendency (partly because of a lack of available data) to lump people from very different ethnic backgrounds together has left a real void when it comes to quality evidence that could be used to develop and implement initiatives and interventions that could work.

Scrutinising family and cultural routines

Our research has gone some way to fill that void. We wanted to scrutinise more closely the cultural and family routine factors that might be linked to obesity across and within ethnic groups. We were able to do this making use of the very rich data available in the Millennium Cohort Study, which follows the lives of nearly 20,000 children.

When the children were 5, their height and weight were measured and a parent (usually the mother) answered questions about the family’s circumstances, their cultural traditions and routines.

Things that were taken into consideration about the mother were: whether the mother was working, whether she was a single parent, income and qualifications and her BMI. For cultural traditions we looked at the language spoken at home, and whether the mother was first, second or third generation immigrant. And for family routine and nutrition, we focused on the child’s bedtime and how much fruit they ate each day.

All those things were then looked at to see whether they were linked in any way with a child’s propensity to be overweight or obese at age 5.

Obese and overweight

What we found was that those children from a Black African, Black Caribbean and Bangladeshi background were around twice as likely as their white peers to be obese. Black Caribbean children were the most likely to be obese and Black African children were the most likely to be overweight. Pakistani children, by contrast, were the least likely to be overweight or obese and, indeed, 40% less likely to be obese than their white counterparts.

Other findings included:

• Pakistani, Bangladeshi, Black Caribbean and Black African children lived in the poorest households
• Mums of Indian, Bangladeshi and Pakistani children were most likely to speak a language other than English at home
• Bangladeshi children were most likely to go to bed after 9pm and least likely to eat any fruit in a day
• Mums of Black African children were most likely to have a high BMI

What emerged when we drilled down further, however, was that none of the factors we took into consideration could completely explain or account for the ethnic disparities or differences in the likelihood of a child being overweight or obese. That doesn’t mean that we conclude that diet and routine aren’t important, but it does indicate that there may be other important influences at play or that more detailed examination of children’s diet is needed if we are to get a better understanding of these disparities.

It is also clear to us that grouping together children from different backgrounds in research examining these important questions simply does not manage to bring to light which groups of kids are most at risk.

The British Nutrition Foundation has said it is “essential to encourage healthier eating and lifestyle habits from an early age, particularly within ‘at risk’ ethnic groups” and that “acquiring a better understanding of their dietary habits, including aspects of their traditional diets, can help health professionals and educationalists to recognise the needs of these groups and to support them to make healthier food choices”. This is something our research certainly reinforces.

Our work also indicates that obesity-related services for those ethnic group children most at risk could be a step in the right direction. Given that the Government says it wants to see a sustained downward trend in the level of excess weight in children by 2020, initiatives and interventions that take these things into consideration could start tipping the scales more in favour of that ambition being achieved.

What might work?

A report for the Departments of Health and Education back in 2008 made some interesting suggestions about approaches that could work. These included:

• Encouraging exercise in culturally appropriate activity; eg traditional/contemporary dance for girls; parents who prioritise schooling may react positively to after school clubs
• Focus on making traditional meals healthier; eg olive oil for ghee or palm oil
• Get approval/help of key community leaders to champion exercise/ healthy diet
• Engage with elders to remove assumption that a fat child is a healthy child
• Encourage children to talk to mothers about issues where mother has little English

Common sense suggestions like these, which are based on observational research, are likely to be useful to local authorities across the UK now tasked with tackling obesity in their communities.

But it is rigorous, robust academic evidence made possible by longitudinal studies like the Millennium Cohort Study that will provide us with the nuanced picture that will help us really get under the skin of the problem of obesity. Focused, informed policies and interventions that emerge from this evidence stand the greatest chance of success.

Further information

This blog is partially based on Race/ethnic disparities in early childhood BMI, obesity and overweight in the United Kingdom and United States, research by Afshin Zilanawala, James Nazroo, Yvonne Kelly, Amanda Sacker, Pamela Davis-Kean and Sharon Simonton published in the International Journal of Obesity.

Photo credit: Viper76