CURRENT TOPICS & OPINIONS

Ethnicity and obesity in the UK

Mary Gatineau and Shireen Mathrani from the National Obesity
Observatory explore the relationship between ethnicity and obesity
in the UK
There is no straightforward relationship
between obesity and ethnicity. Obesity
prevalence varies substantially between
ethnic groups in the UK and
interpretation of data is difficult because
of uncertainty about appropriate obesity
thresholds and associated levels of
health risk. In addition, health behaviours
both across and within minority ethnic
groups are influenced by a complex
interplay of cultural, lifestyle and
socioeconomic factors.1

Obesity prevalence
The most current data on adult obesity
by ethnic group are from the Health
Survey for England (HSE) 2004. Findings
suggest that compared to the general
population, obesity prevalence is lower
among men from black African, Indian,
Pakistaniand most markedly,
Bangladeshi and Chinese
communities.Among women, obesity
prevalence appears to be higher for
those from Black African, Black
Caribbean and Pakistani groups than for
women in the general population and
lower forwomen from the Chinese
ethnic group.2
The National Child Measurement
Programme (NCMP) provides the most
robust data on child obesity in the UK
and includes a detailed breakdown by
ethnic sub-group. Recent analysis by the
National Obesity Observatory (NOO)i
shows that in Reception class, obesity
prevalence is especially high for boys
and girls from Black African and Black
other ethnic groups and boys from the
Bangladeshi ethnic group.ii The pattern
for girls in Year 6 is broadly similar to that
of girls in Reception, while for boys in
Year 6, obesity prevalence is significantly
higher for all ethnic groups compared to
White British, with boys of Bangladeshi

ethnicity having the highest prevalence.

The analysis also finds a trend of rising
obesity prevalence for both boys and
girls of Bangladeshi ethnicity, with no
significant changes in any other ethnic
groups.3 Figure 1 provides a summary of
this rising trend for Bangladeshi children
in Year 6 compared to all other ethnic
groups combined.

Obesity measures and thresholds

There are a number of issues associated
with the measurement of obesity and the
thresholds used for minority ethnic
groups in the UK.
Different ethnic groups are associated
with a range of different body shapes
and different physiological responses to
fat storage. Body mass index (BMI) is not
always an accurate predictor of body fat
or fat distribution in individuals.

Research has shown that for the same

level of BMI, people of African ethnicity
appear likely to carry less fat and people
of South Asian ethnicity more fat than the
general population. This may have led to
an overestimation of obesity among
African and an underestimation among
South Asian groups.4
South Asian and Chinese populations
have been found to be at risk of chronic
diseases and mortality at lower levels
than European populations. Revised BMI
thresholds and waist circumference
measures have been recommended for
these groups.
NCMP findings demonstrate a very
high prevalence of obesity among boys of
Bangladeshi ethnicity. These findings are
in contrast with the general perception
that children from Black ethnic groups
have the highest obesity prevalence. The
high odds of children from Black groups
being classified as obese may in fact be
due to physical characteristics related to
ethnicity and, in particular, height, which
can lead to skewed BMI.3,iii

Figure 1
Prevalence of obesity among children in Year 6 (with 95% confidence limits) by
ethnic group and year of measurement
All other ethnic groups
Bangladeshi

25.0%

24.5%

23.2%
17.9% 18.5%

2006/07

18.3%

2007/08

18.2%

2008/09

18.8%

2009/10

Source: National Child Measurement Programme (NCMP), the NHS

Information Centre for health and social care

Copyright Royal Society for Public Health 2011

SAGE Publications
ISSN 1757-9139 DOI: 10.1177/1757913911412478

July 2011 Vol 131 No 4 l Perspectives in Public Health 159

CURRENT TOPICS & OPINIONS

Factors determining obesity riskiv
Dietary patterns of minority ethnic groups
are influenced by many factors including
availability of food, level of income,
health, food beliefs, religion, cultural
patterns and customs.5 While many
people from these groups have healthier
eating patterns than the White
population, less healthy diets are known
to be of concern in some groups, in
particular those of South Asian origin.
Migration to the UK has a significant
impact on dietary habits. Migrants may
find it difficult to maintain their traditional
eating patterns after moving country as
familiar foods may be difficult to find and
more expensive than Western
equivalents.
Participation in sport is relatively low
among Black and minority ethnic
communities compared with White
groups.6 This is particularly true for South
Asian populations. A combination of
personal, socioeconomic, cultural and
environmental barriers may discourage
people from minority ethnic groups from
engaging in physical activity.
Perceptions of weight and body image
vary within cultures, families and
generations, although the Western
cultural preference for slenderness has
largely been adopted by British minority
ethnic communities.7 In terms of how
they are viewed by others, people from

minority ethnic groups may experience a

double- or even multi-layering of obesityrelated stigma compared to the White
population.8
Members of minority ethnic groups in
the UK often have lower socioeconomic
status, with higher levels of
unemployment, less social mobility and
lower incomes than the White
population.9 They are often spatially
concentrated in deprived urbanized
areas with high crime rates and lack of
green space.10 These factors in turn are
associated with greater risk of obesity.

obesity prevalence by ethnic sub-groups

to identify those most at risk.
The debate continues about the
validity of using current definitions of
obesity for non-white ethnic groups, for
both adults and children. The use of
revised thresholds could change the
estimated burden of obesity-related
disease among minority ethnic groups. In
the meantime, it is particularly important
for South Asian populations in the UK to
be aware of the health risks of increased
BMI and waist circumference and for the
trend of rising obesity prevalence among
Bangladeshi children to be tackled.

Conclusion
There are many gaps in knowledge
regarding the relationship between
ethnicity and obesity. It remains unclear
how much of the difference in the
prevalence of obesity and associated
health risks across ethnic groups is
caused by biological differences, health
behaviours, culture or socioeconomic
status.
Apart from the HSE 2004, there is little
nationally representative data on obesity
prevalence in adults from minority ethnic
groups in the UK and data are scarce or
non-existent for many smaller ethnic
groups. Most research on ethnicity is
also restricted by small sample sizes. The
recent NCMP findings highlight the
importance of being able to analyse

Notes
i

ii

iii

iv

The National Obesity Observatory (NOO) was

established in 2007 to support policymakers
and practitioners working to tackle obesity. It
provides an authoritative and independent
source of information on data, evaluation and
evidence about obesity, overweight and their
underlying causes.
This analysis defines children as obese if their
BMI is greater than or equal to the 95th percentile of the British 1990 growth reference
(UK90). This threshold is commonly used for
population monitoring in England.
The standard BMI assumes that a bodys
mass increases as the square of the height.
Generally, mass increases with the cube of the
linear dimensions, so a formula using the
square will skew to higher BMIs for tall people.
Every culture encompasses a spectrum of
people and not all the factors here influence
every person from those communities.

References
1

Gatineau M, Mathrani S. Obesity and

Ethnicity. Oxford: National Obesity Observatory,
2011
NHS Information Centre. Health Survey for
England 2004: Health of Minority Ethnic Groups.
London: NHS Information Centre, 2006
Dinsdale H, Ridler C, Rutter H, Mathrani S.
National Child Measurement Programme:
Changes in Childrens Body Mass Index between
2006/07 and 2008/09. Oxford: National Obesity
Observatory, 2010
Harding S, Teyhan A, Maynard MJ, Cruickshank
JK. Ethnic differences in overweight and obesity

in early adolescence in the MRC DASH study:

The role of adolescent and parental lifestyle.
International Journal of Epidemiology 2008; 37(1):
16272
Gilbert PA, Khokhar S. Changing dietary
habits of ethnic groups in Europe and implications for health. Nutrition Reviews 2008; 66:
20315
Long J, Hylton K, Spracklen K, Ratna A, Bailey S.
Systematic Review of the Literature on Black and
Minority Ethnic Communities in Sport and
Physical Recreation. Leeds: Carnegie Research
Institute, 2009

160 Perspectives in Public Health l July 2011 Vol 131 No 4

7 Grace C, Begum R, Subhani S, Kopelman P,

Greenhalgh T. Understanding barriers to healthy
lifestyles in a Bangladeshi community. Journal of
Diabetes Nursing 2009; 13(2): 589
8 CABE. Urban Green Nation: Building the
Evidence Base. London: CABE, 2010
9 MacLean L, Edwards N, Garrard M, Sims-Jones
N, Clinton K, Ashley L. Obesity, stigma and public
health planning. Health Promotion International
2009; 24(1): 8893
10 Higgins V, Dale A. Ethnic Differences in Diet,
Physical Activity and Obesity. Manchester:
CCSR, 2010