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Dutch versus English advantage in the epidemic of central and generalised obesity is not shared by ethnic minority groups: comparative secondary analysis of cross-sectional data

International Journal of Obesity volume 35, pages 1334–1346 (2011)Cite this article

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Abstract

Background:

Ethnic minority groups in Western European countries tend to have higher levels of overweight than the majority populations for reasons that are poorly understood. Investigating relative differences between countries could enable an investigation of the importance of national context in determining these inequalities.

Objective:

To explore: (1) whether Indian and African origin populations in England and the Netherlands are similarly disadvantaged compared with the White populations in terms of the prevalence of overweight and central obesity; (2) whether the previously known Dutch advantage of relatively low overweight prevalence is also observed in Dutch ethnic minority groups and (3) the contribution of health behaviour and socio-economic position to the differences observed.

Methods:

Secondary analyses of population-based studies of 16 406 participants from England and the Netherlands. Prevalence ratios were estimated using regression models.

Results:

Except for African men, ethnic minority groups in both countries had higher rates of overweight and central obesity than their White counterparts. However, the Dutch minority groups were relatively more disadvantaged than English minority groups as compared with the majority populations. The Dutch advantage of the low prevalence of obesity was only seen in White men and women and African men. In contrast, English-Indian (prevalence ratio=0.87, 95% confidence interval (CI): 0.81–0.93) and English-Caribbean (prevalence ratio=0.82, 95% CI: 0.76–0.89) women were less centrally obese than their Dutch equivalents. The Dutch-Indian men were very similar to the English-Indian men. The contribution of health behaviour and socio-economic position to the observed differences were small.

Conclusion:

Contrary to the patterns in White groups, the Dutch ethnic minority women were more obese than their English equivalents. More work is needed to identify factors that may contribute to these observed differences.

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Acknowledgements

This project was supported by a VENI fellowship (Grant number 916.76.130) awarded by the Board of the Council for Earth and Life Sciences (ALW) of the Netherlands Organisation for Scientific Research (NWO).

Author information

Authors and Affiliations

  1. Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    C Agyemang, A Kunst, M Nicolaou, I van Valkengoed & K Stronks

  2. Public Health Sciences Section, University of Edinburgh, Edinburgh, UK

    R Bhopal

  3. Department of Epidemiology and Public Health, UCL, London, UK

    P Zaninotto

  4. Department of Sociology, School of Social Sciences, University of Manchester, Manchester, UK

    J Nazroo

  5. Newcastle University, Institute of Health and Society, Medical School, Newcastle, UK

    N Unwin

  6. Institute for Medical Technology Assessment, Erasmus Medical Center, Rotterdam, The Netherlands

    K Redekop

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  1. C Agyemang
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  2. A Kunst
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Correspondence to C Agyemang.

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Appendices

Appendix 1

Note on ethnic categories

Appropriate terms for the scientific study of health by ethnicity are under discussion.13 Different terms are used to refer to populations of South-Asian origin and African origin living in different European countries.13, 14, 15 In the United Kingdom, the term South-Asian refers to populations originating from the Indian Sub-continent, effectively, India, Pakistan and Bangladesh. African-Caribbean refers to people, and their offspring, with African ancestral origin, but who migrated to the United Kingdom from the Caribbean islands. The migration of these populations to the United Kingdom in the mid-20th century was mainly because of the need to rebuild United Kingdom following World War II. The demands of an expanding economy and the development of the welfare state required labour on a scale that could not be provided locally. Consequently, British Commonwealth citizens were encouraged to come to Great Britain. In the Netherlands, the term African-Surinamese is used to refer to people with African ancestral origins and their offspring who migrated to the Netherlands from Suriname.14 African-Surinamese are mainly the descendants of West Africans who were taken to the Suriname during the slave trade era. The term Hindustani-Surinamese is used to refer to people with South-Asian ancestral origin, and their offspring who migrated to the Netherlands from Suriname. The Hindustani-Surinamese are the descendants of the indentured labourers from North India—Uttar Pradesh, Uttaranchal and West-Bihar. After the abolition of slavery in 1863, the emancipated Africans were unwilling to continue working on the plantations because of poor labour conditions. To guarantee a constant supply of labour, the planters imported indentured labourers from North India between 1873 and 1917. The migration of the African-Surinamese and Hindustani-Surinamese to the Netherlands was mainly due to the political situation in Suriname. There were two large migration waves. The first was around independence of Suriname in 1975 and the second wave was around the revolution coup of the Desi Bouterse in February 1980.15 White is the term most commonly accepted and used to describe people with European ancestral origins. For the purposes of this paper, based on populations in the Netherlands (Amsterdam) and England (National and Newcastle upon Tyne), we use the following terminology:

  • For England-based Indian → English-Indian

  • Dutch-based Hindustani Surinamese → Dutch-Indian

  • England-based African Caribbean → English-Caribbean

  • Dutch-based African Surinamese → Dutch-African

  • England-based people of English European origin → White-English

  • Dutch-based people of European origins → White-Dutch.

Appendix 2

Age-standardised prevalence of overweight/obesity by ethnic groups and sex. (BMI defined as ⩾25 kg in all groups)

figure 4

Appendix 3

Age-standardised prevalence of overweight by ethnic groups and sex. BMI defined as ⩾23 kg in the South-Asian groups.

figure 5

Appendix 4

Age-standardised prevalence of obesity by ethnic groups and sex.

figure 6

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Agyemang, C., Kunst, A., Bhopal, R. et al. Dutch versus English advantage in the epidemic of central and generalised obesity is not shared by ethnic minority groups: comparative secondary analysis of cross-sectional data. Int J Obes 35, 1334–1346 (2011). https://doi.org/10.1038/ijo.2010.281

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