See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/254825911 Diet and Overweight Perception Article · January 2009 CITATIONS READS 0 256 1 author: Mary Nicolaou Academisch Medisch Centrum Universiteit van Amsterdam 100 PUBLICATIONS 1,075 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: MooDFOOD View project EuroDHYAN: Innovative Prevention Strategies for type 2 Diabetes in South Asians Living in Europe View project All content following this page was uploaded by Mary Nicolaou on 18 August 2014. The user has requested enhancement of the downloaded file. Diet and Overweight Perception An explorative study among Turkish, Moroccan and Surinamese migrants living in the Netherlands PROEFSCHRIF NICOLAOU.indb 1 2-12-2008 14:20:15 ISBN: 978-90-8659-278-4 The studies presented in this thesis were conducted within the EMGO Institute (www.emgo. nl <http://www.emgo.nl/> ), and within the department of Social Medicine of the AMC. The EMGO Institute participates in the Netherlands School of Primary Care Research (CaRe) which was re-acknowledged in 2000 by the Royal Netherlands Academy of Arts and Sciences. The department of Social Medicine participates in the Netherlands School of Health Sciences (NIHES), which was re-acknowledged in 2008 by the Royal Netherlands Academy of Arts and Sciences. The Netherlands Organisation for Health Research and Development (ZonMw: grant 2100.0012 and grant 36000029) provided funding for the studies in chapter 2, 3, 5 and 6. The Netherlands Hear Foundation (grant NHF-2000B074) provided funding for the study in chapter 4. Financial support for the printing of this thesis was kindly provided by the Department of Social Medicine of the Academic Medical Centre, University of Amsterdam and the Institute of Health Sciences, VU University, Amsterdam. Layout: Chris Bor, Medsiche Illustratie Dienst, AMC Cover design: Tarek Atrissi Design Printed by: Buijten & Schipperheijn, Amsterdam Chapter 0.indd 2 3-12-2008 11:32:37 VRIJE UNIVERSITEIT Diet and Overweight Perception An explorative study among Turkish, Moroccan and Surinamese migrants living in the Netherlands ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad Doctor aan de Vrije Universiteit Amsterdam, op gezag van de rector magnificus prof.dr. L.M. Bouter, in het openbaar te verdedigen ten overstaan van de promotiecommissie van de faculteit der Aard- en Levenswetenschappen op donderdag 5 februari 2009 om 10.45 uur in de aula van de universiteit, De Boelelaan 1105 door Maria Nicolaou geboren te Limassol, Cyprus PROEFSCHRIF NICOLAOU.indb 3 2-12-2008 14:20:15 promotoren: prof.dr.ir. J.C. Seidell prof.dr. K. Stronks copromotoren: dr. C.M. Doak dr. R.M. van Dam PROEFSCHRIF NICOLAOU.indb 4 2-12-2008 14:20:15 Contents page Chapter 1 General Introduction 7 Chapter 2 Ethnicity, Acculturation and Education Level in Relation to Quality 25 of the Diet: a Study of Surinamese Residents of the Netherlands Chapter 3 Cultural and Social Influences on Food Consumption in Dutch 39 Residents of Turkish and Moroccan Origin: A Qualitative Study. Chapter 4 Body Size Preference and Body Weight Perception among Two 59 non-Western Migrant Origin Groups Chapter 5 Ethnic Differences in Perception of Overweight and Association 75 with Weight Loss: the SUNSET study Chapter 6 Cultural Transition. A Qualitative Study of Body Weight and Body 95 Image in Moroccan Migrants and their Non-migrant Compatriots Chapter 7 General Discussion 115 Summary 141 Samenvatting 147 Publications 153 Acknowledgements 157 About the Author 163 PROEFSCHRIF NICOLAOU.indb 5 2-12-2008 14:20:15 PROEFSCHRIF NICOLAOU.indb 6 2-12-2008 14:20:15 1 General Introduction PROEFSCHRIF NICOLAOU.indb 7 2-12-2008 14:20:15 PROEFSCHRIF NICOLAOU.indb 8 2-12-2008 14:20:15 Introduction Overweight and obesity are a major public health problem both internationally and in the Netherlands, leading to increased risk of cardiovascular diseases, type 2 diabetes, cancer, musculoskeletal disorders and respiratory diseases 1. In addition, obesity may impact on the quality of life of individuals through their experience of social bias and discrimination 2. These in turn may have consequences for educational and professional achievement 3,4 as well as potentially impacting on psychological wellbeing 5,6. 1 Chapter Globally, there is evidence that the prevalence of overweight and obesity is reaching epidemic proportions with an estimated 1 billion overweight and 300 million obese adults 7,8. In the Netherlands more than half of the general adult population is either overweight (51% of males, 42% of females) or obese (10% of males, 12% of females), with marked increases in the past 20 years 9. Internationally and in the Netherlands therefore, the treatment and prevention General Introduction of overweight and obesity have received increased attention 8,10. A high risk group for the development of overweight and obesity are non-Western migrants to Western societies. Among these groups the prevalence of excessive weight is often higher than among host populations 11,12. Non-western migrants form an increasing proportion of the populations of many Western countries 13, including the Netherlands where 11% of the population comprises non-western migrants and their children 14 (from this point on migrants and their children will be referred to collectively as migrants). Among this group a large proportion originates from Suriname, Turkey or Morocco, each of these represent approximately 2% of the total population of the Netherlands and, counted together, close to 60% of all non-western migrants 14. Many live in large cities, for example 35% of the inhabitants of Amsterdam are of non-western origin, migrants originating from Morocco and Suriname each form 9% and from Turkey 5% of all residents 15. Table 1: Percent individuals with overweight or obesity: residents of Amsterdam (aged 35 years and older) Men Women Turk Moroc Afr-Sur SA-Sur Turk Moroc Afr-Sur SA-Sur (n=326) (n=289) (n=193) (n=149) (n=238) (n=116) (n=402) (n=189) overweight 59 48 39 44 37 43 33 41 Obese 20 9 19 15 52 35 42 26 Overweight 25.0≤BMI≤29.9 obese BMI≥30.0 Moroc=Moroccan. Turk=Turkish. Afr-Sur=African origin Surinamese. SA-Sur=South Asian origin Surinamese Source: Dijkshoorn H et al, 2008 16, and SUNSET study, data not published. The prevalence of overweight and obesity in these population groups seems to be high. Data from studies in Amsterdam, table 1, shows that more than half of Surinamese, Turkish and Moroccan adults aged 35 years or older are either overweight or obese and that obesity, in particular, is a problem among women. 9 PROEFSCHRIF NICOLAOU.indb 9 2-12-2008 14:20:16 Figures originating from a nationally representative sample 17, shown in table 2 indicate that while ethnic differences in prevalence of overweight and obesity among men are less striking, migrant women are more often obese, compared to their ethnic Dutch peers. At a first glance it appears that overweight and obesity prevalence is higher among migrants living in Amsterdam, however it’s important to note the difference in age groups studied. Considering the increasing proportions of migrants in Western populations, public health efforts need to account for these groups 10 . Table 2: Percent individuals with overweight or obesity: Figures based on national data (18-70 years) Men Women Dutch Turk Moroc Afr-Sur SA-Sur Dutch Turk Moroc Afr-Sur SA-Sur overweight 39 42 38 28 40 29 31 35 29 33 Obese 10 15 10 9 7 12 21 18 24 11 Overweight 25.0≤BMI≤29.9 obese BMI≥30.0 Moroc=Moroccan. Turk=Turkish. Afr-Sur=African origin Surinamese. SA-Sur=South Asian origin Surinamese. Source: Dagevos J and Dagevos H, 2008 17 Potential underlying causes of overweight and obesity The aetiology of overweight and obesity is complex, but at the most basic level, overweight is a result of behaviour that results in excessive energy intake or insufficient energy expenditure 8. Influences on behaviour include genetic, biological as well as environmental factors 18. Among migrant groups higher overweight and obesity prevalence can be partly attributed to genetic susceptibility 19,20. However, there is general consensus that genetic influences interact with environmental factors, and that the latter probably have a dominant influence on overweight development 8,21,22. Environmental influences on energy balance have been conceptualised by the ANGELO framework, (Analysis Grid for Environments Linked to Obesity) and include physical, economic, political and socio-cultural factors 22. These four influences can act at the macro level, i.e. the broader context, including amongst others, food production and distribution, transportation infrastructure, media and at the micro level, the local context which includes schools, work places, shops and neighbourhoods. This thesis focuses on two important determinants of overweight in four non-western migrant groups living in the Netherlands: Surinamese Hindustani and Creoles, Turks and Moroccans. Firstly, diet as one half of the energy balance equation and, secondly, the perception of overweight as an important underlying motivator for engaging in weight control. Three of the environmental influences as defined by the ANGELO framework are the basis of our studies; we focus on physical, economic and socio-cultural changes as they relate to migration. In the following paragraphs we discuss some of the current insights into the diet and body weight perception of migrants, as well as some potential determinants of these. The main aims 10 PROEFSCHRIF NICOLAOU.indb 10 2-12-2008 14:20:16 Box 1: Turkish, Moroccan and Surinamese immigrant populations Migration from Turkey and Morocco to the Netherlands was encouraged in the 1970’s in order to fill labour shortages, especially in the lower occupation classes. The initial migrants were male but within a few years they were joined by their families.