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OVERWEIGHT AND OBESITY AMONGST
RESIDENTS OF LAMBETH
RESEARCH REPORT
OVERWEIGHT AND OBESITY AMONGST
RESIDENTS OF LAMBETH
RESEARCH REPORT
Report prepared for:
NHS Lambeth
1 Lower Marsh
London SE1 7NT
Report prepared by:
Hamid Rehman and Dr Marie-Claude Gervais
Ethnos Research and Consultancy
23 Kingsford Street
London, NW5 4JT
Tel: 020 7424 7292
www.ethnos.co.uk
March 2010
TABLE OF CONTENTS
1.0.
BACKGROUND AND AIMS OF THE RESEARCH
1.1.
1.2.
Background
Aims and objectives of the research
1
1
1
2.0.
METHODOLOGY
2
2.1.
2.2.
2.3.
2.3.1.
2.3.2.
2.3.3.
2.4.
2.5.
2.6.
Research design
Focus groups
Portfolio of additional approaches used within focus groups
Vignettes
Ideal body size
Eatwell plate
Sample of focus groups
Recruitment of research participants
Analysis of data
2
2
3
3
3
3
3
5
5
3.0.
KNOWLEDGE ABOUT WEIGHT, HEALTHY EATING AND PHYSICAL
ACTIVITY
6
3.1.
3.2.
3.3.
3.4.
3.5.
3.5.1
3.6.
Introduction
Understanding of overweight and obesity
Knowledge of health problems associated with weight
Perceptions of excessive weight in own community
Healthy eating: what people know and what they eat
Concerns with Eatwell plate
Physical activity: what people know and what they do
6
6
7
7
8
10
10
4.0.
BARRIERS TO HEALTHY BEHAVIOUR CHANGE
12
4.1.
4.2.
4.2.1
4.2.2
4.2.3
4.2.4
4.3.
4.4.
4.5.
4.6.
4.7.
Introduction
Perceptions of the body
Ideal body size
Overweight body size
Underweight body size
Anger at White comparison
Identification with healthy lifestyles
Too stressed to be healthy
Too poor to be healthy
Children won’t eat it
Respondents’ suggestions for promoting healthy lifestyles
12
12
12
13
13
16
16
18
18
19
19
5.0.
OVERWEIGHT AND OBESITY AMONGST CHILDREN
21
5.1.
5.2.
5.3.
5.4.
Introduction
Children and body image
Children and diet
Children and physical activity
21
21
22
24
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
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6.0.
SUMMARY AND RECOMMENDATIONS
25
6.1.
6.2.
Summary
Recommendations
25
25
APPENDICES
Appendix A: Topic guide
Appendix B: Body Image
Appendix C: FSA’s Eatwell plate
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
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1.0. BACKGROUND AND AIMS OF THE RESEARCH
1.1. Background
The obesity epidemic is a major public health concern in the UK. Almost one in four adults
is obese with this figure predicted to rise to nine in ten adults by 2050 if left unchecked.
Obesity places an enormous economic burden on the state with cost to the NHS
estimated to be over £4 billions every year. Obesity has a serious impact on the physical
health and welfare of individuals. Obese people are at greater risk of diabetes, heart
disease and certain forms of cancer. Obesity causes some 9,000 deaths every year in
England. The obesity epidemic is not confined to adults. More than a quarter (28.6%) of
children aged between two and ten years are either overweigh or obese. This figure has
been gradually increasing.
Lambeth faces major challenges in its attempt to improve the health of its population. It is
one of the most deprived and densely populated boroughs in the country and
consequently has significantly poorer health outcomes in comparison to other boroughs.
Of major concern is the very high level of childhood obesity. Estimates show that amongst
school children in reception (aged 4-5 years), 14.4% are overweight and 11.8% are
obese. These figures increase amongst year 6 children (aged 10-11 years) with 15.3%
being overweight and 23.2% are obese.
The two main factors involved in overweight and obesity – diet and physical activity – are
both determined by a range of cognitive, affective, social, cultural and economic factors. In
order to adopt healthy dietary practices and levels of physical activity, households need to
share an understanding of what is healthy and have positive attitudes towards adopting
healthier dietary practices and increasing their levels of physical activity; but they also
need to have the resources – in terms of time, money and emotional resilience, for
instance – to actually establish sustainable healthier lifestyles. It is therefore important to
develop social marketing strategies that are based on a good understanding of the range
of factors that impact, either positively or negatively, on health-related behaviours.
1.2. Aims and objectives of the research
The overall aim of the study is to identify the knowledge, behavioural choices and
attitudes associated with overweight and obesity amongst Black Caribbean, West African,
White British, Portuguese and Somalian mothers residing in Lambeth, with a view to
informing health practitioners in the borough about how best to promote healthy practices
in these communities. Specifically, NHS Lambeth commissioned this research to:





understand knowledge and awareness of overweight and obesity
identify attitudes towards overweight and obesity
understand knowledge and awareness of healthy eating and physical activity
provide insight into behavioural choices related to overweight and obesity
identify barriers to healthy behaviour change
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
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2.0. METHODOLOGY
2.1. Research design
The research was conducted in two phases. Phase I consisted of four interviews with
health and community specialists. The aim of these interviews was to get an overview of
the communities in Lambeth; their size, location, histories and cultural practices in relation
to weight and health. These interviews allowed the researchers to get a good
understanding of the communities and to identify the key issues that needed to be
explored in the second, and main, phase of the study: focus groups with Lambeth
residents.
2.2 Focus groups
Focus groups are an appropriate method for qualitative study. They allow access to a
range of opinions and experiences relatively quickly, but leave scope for participants to
expand, in their own words, on themes of importance to them. Because each participant
prompts other group members into discussing their own views, the dynamics of focus
groups stimulate reflection and can produce more perceptive insights from each
participant than they may have produced without the benefits of group interactions. In
addition, the focus groups benefit from including a range of techniques to give a rounded
and exhaustive picture of the issues around overweight and obesity.
The focus group discussions were based on a topic guide that explored various
dimensions of overweight and obesity (see Appendix A):





knowledge of, and views about, healthy diet and physical activity
knowledge of, and views about, overweight and obesity
food consumption and physical activity behaviours
barriers to healthy eating and physical activity
suggestions for promoting healthy eating and physical activity
The focus group participants were all mothers of young children who are current Lambeth
residents.
2.3
Portfolio of additional approaches used within focus groups
In addition to focus group discussions, a range of projective techniques were used to
probe in greater depth certain dimensions of perceptions, experiences and expectations in
relation to overweight and obesity. The following portfolio of methods was used within
each focus group:



vignette of “health family”
ideal body size for adults and children
eatwell plate: description of balanced diet
2.3.1. Vignette
A short vignette, read out by researchers, was used to represent a scenario of the ideal
healthy family. Vignettes are excellent ‘triggers’ to generate discussion: people project
their own perceptions and experiences onto the scenario allowing for a detailed
understanding of their perceptions, attitudes, beliefs and expectations. The aim of this
specific vignette was to capture the extent to which research participants related to, or
identified with, the “health family” described in the scenario, and to assess what prevented
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
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them for adopting these behaviours portrayed in the scenario. The vignette used in this
research was the following:
“I would like you to picture in your mind a [vary ethnicity] family, with a
father, a mother and three children - two boys and a girl – aged
between 5 and 10 years-old. They live in Lambeth. They each eat at
least five fruits and vegetables a day as part of their diet, and everyone
in the family does at least half an hour of exercise every day.”
Respondents were then asked to discuss what kind of family would lead such a lifestyle,
how similar or different the family was to themselves and whether they could lead such a
lifestyle.
2.3.2. Ideal body size
The focus groups included a technique to identify what respondents regarded as the ideal
body size. The aim of this technique was to determine whether there were cultural
differences in what women regard as desirable – either from a health or from an aesthetic
point of view - between the various communities taking part in the research. It was
assumed that some communities may regard larger women and children as being
healthier and more beautiful, which could be detrimental to their health and could make it
difficult for health practitioners to communicate health education messages effectively.
Images of adult women of different sizes were presented to respondents who were asked
to identify, on a scale which included women ranging from thin to oversize, which image
they thought was an “ideal” body size, which they thought was “overweight” and which
was “underweight”. They were then shown images of children and asked to identify which
image they thought was “overweight”. Research participants completed these two tasks
individually. The images used are presented in appendix B.
2.3.3. Eatwell plate
The focus group participants were also shown the Food Standards Authority’s Eatwell
plate (Appendix C) – which represents a healthy balance between various food groups and asked to state the degree to which their current diet resembled the proportions
identified in the plate. This allowed us to understand how healthy respondents’ current diet
is, which food group is over-consumed or under-consumed, and what they know and
understand about healthy eating.
2.4. Sample for focus groups
The sample of focus group participants needed to take account of a number of key
variables in relation to the objectives of the research. Following discussions with
commissioners, the following variables were used to recruit participants for the focus
groups:
Ethnicity: The main groups in the research were as identified by Lambeth NHS: Black
Caribbean, West African, White British, Somali and Portuguese.
Gender: The focus groups took place exclusively with mothers. For a range of reasons,
especially in the target communities, mothers are largely responsible for food shopping,
meal preparation, giving snacks, walking (or not) children to school, and otherwise
encouraging more or less sedentary or active lifestyles.
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Family and weight status: Given the high levels of overweight and obesity amongst
primary school aged children, Lambeth NHS were particularly interested in conducting
the focus groups with mothers of children of primary school age. The mothers were
recruited on the basis that they themselves were overweight or obese1. This could not
be determined by using such measures as BMI but had to be established by our
specialist recruiters, using strict guidelines and a tailored recruitment questionnaire.
Language spoken: The groups with Black Caribbean, West African, Portuguese and
White British communities were conducted in English. As many Somalis do not speak
English, one of the Somali groups was conducted in Somali.
Socio-economic status: As there is a clear relationship between health status and
deprivation, the sample focused on mothers from lower socio-economic groups. It was
hypothesised that these were more likely to have more acute issues, less knowledge,
fewer resources to make positive changes, etc. By understanding the issues in groups
where barriers are most severe, the research can generate insights that can be applied
to all groups.
Location: All mothers were residents of Lambeth at the time of the study.
Based on the above considerations, the sample for the focus groups was as follows:
Table 1:
Sampling frame for focus groups
Group 1
Ethnicity
Black Caribbean
Age of children
4-5 years
Number of respondents
10
Group 2
Black Caribbean
6-11 years
10
Group 3
Somali
4-5 years
10
Group 4
Somali
6-11 years
10
Group 5
White British
4-5 years
7
Group 6
White British
6-11 years
7
Group 7
West African
4-5 years
6
Group 8
West African
6-11 years
6
Group 9
Portuguese
4-5 years
7
Group 10
Portuguese
5-11 years
8
1
All mothers in the focus groups were overweight or obese with the exception of Portuguese
mothers. We were unable to find overweight or obese Portuguese respondents. Discussions with
community workers and Portuguese focus group respondents suggest that overweight and obesity
are not significant problems in this community.
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
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2.5. Recruitment of research participants
Research participants were recruited based on the principles specified in the Code of
Conduct for Qualitative Research issued by the Market Research Society. Potential
research participants were intercepted on the streets, in shopping centres and in other
public places to ask if they would be interested in taking part in the research. Professional
recruiters, themselves from minority ethnic backgrounds and with deep networks in
Lambeth, used a screening questionnaire to establish each person’s ethnicity, the ages of
their children, their status as Lambeth residents (amongst other questions) in order to
determine whether they met the sampling criteria as set out above. Incentives were
offered to research participants to encourage attendance.
2.6. Analysis of data
All the focus group discussions were transcribed verbatim. Our approach to the
analysis is to ensure that a “brainstorming” session is held where researchers that were
in the field can come together and identify the “top-line” findings and key themes for the
analysis. A “grounded theory” approach allows us to continually revisit, add to and refine
the main emergent themes from analysis. The emphasis was placed on significant
issues, drawing out both similarities and differences in experiences across the various
groups. Because of our expertise on ethnicity and on the specific issues revolving
around overweight and obesity, our analysis was informed by relevant discourses on
these issues.
Ideal body size data were analysed by simply counting the number of responses for
each image. Results are presented for the image most frequently identified (the mode)
by each ethnic group.
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3.0. KNOWLEDGE ABOUT WEIGHT, HEALTHY EATING AND
PHYSICAL ACTIVITY
3.1. Introduction
This chapter discusses what people understand by the terms “overweight” and “obesity”
and the health risks associated with being overweight. It goes on to discuss knowledge of
what is a healthy diet and compares respondents’ current diet with a healthy diet as
recommended by The Food Standards Authority’s Eatwell plate. We also discuss what
people know about the level of physical activity required for health benefits and the
amount of physical activity people actually get.
3.2. Understanding of overweight and obesity
The medical profession defines overweight and obesity in terms of Body Mass Index
scores (BMI). Most of the respondents did not use or understand this term. Most
respondents understand overweight in aesthetic terms. Clothe sizes are used as a proxy
to define overweight and to monitor one’s own weight as the following quotes
demonstrate:
“I think it’s from size 18, from size 18 upwards it’s overweight.”
(Black Caribbean)
“Overweight is when you can’t fit into proper clothes and you have to
wear those great big tent like things.” (White British)
Obesity is defined in health and functional terms and is very much equated with morbid
obesity. For most respondents, obese people are those who cannot function in their daily
lives because of their size.
“I think an obese person is one of them people who can’t get out of
bed or off their chair, you know when their leg is [sic] full of rolls of
fat.” (White British)
“They’re housebound and they can’t get out of bed and wash
themselves so they have to have somebody to clean them. That is
obese when you cannot do anything for yourself.” (Black African)
“They cannot pray as they are obese.” (Somali)
This view seems to stem from images of obesity displayed in the popular media. It is a
widely held definition of obesity and, as a consequence, even those who are obese fail to
see themselves as such. Indeed, some respondents were shocked to learn from their
doctor that they were clinically obese.
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
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“I thought I was overweight but when my doctor told me I am obese, I
thought: “Oh my God, I didn’t know that”. I was shocked. I was like:
“Oh my God, I am clinically obese”.” (Black Caribbean)
“Well my doctor said I was clinically obese. I can breathe, I can wash
myself but apparently for my height I have got too much weight so I
am obese. But I can move.” (White British)
The only community that seems to have an understanding of overweight and obesity
which approximates that of the biomedical community were the Portuguese. Although they
also did not use BMI as a measure, they did understand overweight and obesity in terms
of a measure of excessive weight, and their thresholds in considering someone
overweight or obese were lower than in the other communities.
“Five kilos over is overweight but 20 kilos over is obese.”
(Portuguese)
3.3. Knowledge of health problems associated with weight
Despite limited understanding of overweight and obesity, all respondents were aware of
many health risks associated with excessive weight. Most were able to state that
excessive weight is associated with such conditions as heart disease, diabetes, strokes,
hypertension, stress and poor mental health. However, as will be discussed later, what is
regarded as overweight varies considerably between the different communities.
3.4. Perceptions of excessive weight in own ethnic community
Recognition and acceptance of a community-wide problem allows for the development of
community-wide solutions. For this reason, we were interested in understanding the
degree to which respondents perceived there to be a weight problem within their
community.
The Portuguese respondents stated that overweight and obesity are not major issues in
their community. This view is supported by the experience of our recruiters who had great
difficulty recruiting overweight or obese respondents for the focus groups. Further support
is provided by a community worker working with the Portuguese who stated the following:
“Weight is not a big problem in the Portuguese community. There are
lots of other problems but being overweight is not a big one.”
(Portuguese community worker)
Somalis recognise that there is a weight issue in their community but that this is restricted
to women. More women were said to be overweight than men partly due to men preferring
larger Somali women.
“Fat women are considered attractive in Somalia and the community
have brought that attitude with them.” (Somali)
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Both White British and Black Caribbean women recognised that the number of overweight
people from their communities was high and on the increase. However, none were said to
be obese.
“I guess you do see a lot more people who are big than you used to.
It’s ‘cos of all these takeaways I guess.” (White British)
West African women had a strong belief that African women are bigger than many other
women. While they agreed that there were many large women in their community, they
strongly disputed any association between large body size and ill health.
“The African woman is bigger naturally. She’s big but she is healthy.”
(West African)
3.5. Healthy eating: what people know and what they eat
There is generally a high level of awareness, across all communities, that eating five fruit
and vegetables a day is good for health. Most people are also aware that consuming large
amounts of fat, sugar or salt is detrimental to one’s health. However, despite this basic
knowledge, what people actually eat is often far from healthy.
Respondents were shown the FSA’s Eatwell plate which shows the proportion of various
food groups that should be consumed in a day (appendix C). Respondents were then
asked to state how their own diet compares with the recommended amounts. Below we
provide the main findings for each community.
Portuguese






Eat more fruit and vegetables (often in soups and salads)
Eat less foods and drinks high in fat/sugar
Eat more fish than meat
Eat mainly rice and bread as starchy foods
Cook mainly with olive oil
Did not comment on milk and dairy foods (cheese not main part of diet)
“I think that’s about right, would you say? We have probably more
vegetables because everyday for lunch, every Portuguese family has a
big vegetable soup. We eat lots of tomatoes, cucumber, salad, all
sorts.” (Portuguese)
“The children probably have more junk than the adults. They like it,
because we were not raised with it. But it’s not that often. At home, it’s
really good food. Maybe better than the dish here.” (Portuguese)
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
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West African






Have a diet which comprises of up to 75% of starchy foods (many consider potato and
yam as vegetables)
Eat fruit and vegetables (often cooked in curries)
Eat fish and meat (often red meat)
Eat/drink some foods and drinks high in fat/sugar (mostly with kids)
Cook mainly with palm oil (frying a common)
Did not comment on milk and dairy foods (cheese not part of diet)
“African food is the most nutritious. I don’t care what the PCT has
come up with, but I am really proud of what we eat. The only thing we
need is more education about proportions. The portions are too big.
That’s probably the only thing.” (West African)
“Like 2/3, maybe 3/4 would be that group [starchy food]. Because of
cassava and maize and rice.” (West African)
“The thing is, we eat lots of “dodo”, fried plantains.” (West African)
Black Caribbean





Eat less fruit and vegetables
Eat much larger proportion of meat (red/white meat, fish)
Eat more carbohydrates (rice, yam, dumplings)
Eat/drink larger proportion of sugary foods and drinks
Consume similar proportions of milk and dairy foods
“I hardly eat any fruit and veg; you know I eat a lot of spicy foods. I
would say my portions would be starchy food and the meat would be
the same size as the fruit and veg.” (Black Caribbean)
“I have a lot more meat than what is on the plate.” (Black Caribbean)
Somali





Eat about a half the recommended fruit and vegetables (children eat fruit but very little
vegetables)
Eat more carbohydrates (mainly rice and pasta)
Eat more meat than recommended
Eat less dairy products
Drink larger proportions of sugary drink
“Our food is mainly rice, pasta and meats. Some families hardly eat
vegetables.” (Somali)
“Our dinner table has more carbohydrates, meat and sweetened fruit
drinks. The vegetables and dairy products, except milk, are not a lot.”
(Somali)
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White British







Eat about half the recommended fruit and vegetables (some consider potatoes to be a
vegetable)
Children eat very little fruit and vegetables.
Eat more carbohydrates (mainly bread, potatoes, pasta)
Eat more meat than recommended
Eat a lot more sugary foods
Drink/eat more milk and dairy products
Frequent use of convenience foods and takeaways
“I can’t be bothered to cook after I’ve been running around all day, it’s
easier to phone for a takeaway.” (White British)
“Pizzas are quite healthy because you still get your veg and you’ve got
your carbs as well. Sometimes I like Chinese because you get your
veg with that as well.” (White British)
3.5.1. Concerns with Eatwell plate
The Eatwell plate has been produced to make healthy eating easier to understand by
showing, in a simple pictorial way, the types and proportions of foods that need to be
consumed in a healthy and well balanced diet. However, many respondents found some
aspects of the Eatwell plate very confusing. It was not clear to respondents whether the
recommended proportions referred to amounts to be consumed with each meal or the
foods that should be consumed in a day, week or longer. People were also confused
about how the plate related to meals where various food items are mixed together in one
dish, such as curries and stews, which are consumed frequently by many of the
communities. The plate was also criticised for not providing any information on portion
sizes which tend to be very large amongst many. Moreover, many staple foods such as
potatoes and rice, or food items that frequently consumed in their community, such as
yam/cassava, either did not appear on the plate or were very poorly shown.2
3.6. Physical activity: what people know and what they do
Everyone in the sample was aware that physical activity is good for health. However,
knowledge about what constitutes physical was highly variable. For many, physical activity
is equated with intense exercise or sports such as going to the gym, swimming or playing
tennis. These types of activities were felt to be inappropriate to respondents’ lifestyles.
Some respondents did know that activities such as walking, gardening or housework are
beneficial for health. However, respondents were almost universally unaware:



that 30 minutes of daily physical activity are recommended to generate health benefits
that physical activity has to be of moderate to high intensity to provide health benefits
of how to assess the level of intensity, and therefore the health gains, of their physical
activity.
For most respondents, physical activity consisted of walking their children to school,
2
We are aware of the Eatwell plate produced for different ethnic groups. However, for consistency across
groups the generic plate was used.
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
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shopping or housework. No one took regular exercise or consistently practiced any sport.
None seemed to be getting sufficient length or intensity of activity to provide health
benefits.
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4.0. BARRIERS TO HEALTHY BEHAVIOUR CHANGE
4.1
Introduction
This chapter identifies the main barriers to healthy behaviour change reported by
research participants. We begin with identifying what people perceive to be an ideal
body size, an overweight body size and an underweight body size. Understanding how
people perceive the body is important in identifying cultural and social attitudes to weight
which can act as barriers to healthy lifestyles. The second part of the chapter discusses
the extent to which people can relate to a healthy lifestyle. If people cannot identify with
a healthy lifestyle they are unlikely to pursue it. Finally, we discuss what the impact of
leading stressful lives, of children’s dietary preferences and the perceived financial costs
associated with being healthy has on leading healthy lives.
4.2. Perceptions of the body
The study found that there are cultural differences in people’s perceptions of what is
regarded as a desirable body size. By engaging mothers into discussions around what
they think “looks good” and is “healthy”, we are able to generate information on cultural
and social attitudes to overweight and obesity which may act as barriers to the adoption
of healthy lifestyles.
The focus group participants were given photographs of women of different sizes (see
Appendix B). Each participant was asked to put an ‘I’ next to the person in the
photograph that they thought had an ideal weight, an ‘O’ next to the first person they
thought was overweight and a ‘U’ next to the first person that was thought to be
underweight. The sheets were collected and analysed for each ethnic group. The results
below identify the most frequent response (the mode) for each ethnic group.
4.2.1. Ideal body size
Portuguese
Somali
White
British
Black
Caribbean
West
African
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Portuguese women show a preference for an ideal body image the resembled the
slimmest image. Most Somali and White British women preferred a slightly larger body
image than Portuguese. Black Caribbean women have a preference for image third from
left. Most West African women showed a preference for significantly larger body size
than all other respondents.
4.2.2. Overweight body size
West African
(Heavier)
Portuguese
Somali
Black Caribbean
White British
Many West African women either indicated that the last women on the right of the scale
was overweight or said that they did not regard anyone as overweight. This suggests
that the results may have been different in that community had the scale included larger
women. It is clear from the findings that West African women have attitudes to ideal
body size that conflict with health professionals’, making it difficult to communicate
relevant health messages effectively to this population. There were slight differences
between what Somalis regarded as overweight and Black Caribbean and White British
women. Not surprisingly, Portuguese women chose the least oversize body (the fourth
woman from the left of the scale) as being overweight.
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
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4.2.3.Underweight body size
Somali
White
British
Black
Caribbean
West
African
Portuguese
(Lighter)
There was general consistency across the groups about which body size was considered
as underweight. Most groups regarded the two women on the left to be underweight. The
exception was the Portuguese who thought that none of the women were underweight.
For them, an underweight woman would have to have a body size that was slimmer than
the slimmest image presented.
The body image data demonstrates important differences in how the body is perceived by
people from different cultures. Group discussions on body image confirmed these
differences. Somali women suggested that there is a preference for larger women in their
community.
“Somalis are overweight because fat women are considered beautiful
and skinny women are thought to be unhealthy in Somalia. People are
not aware of this difference between Somalia and Britain.” (Somali)
For White British women, being slim was something they desired but felt that it was
unrealistic to try and achieve. Some felt that there was a lot of media pressure on women
to “look like models”.
“Sure, I’d like to be a size eight, who wouldn’t! But I got kids, I got bills
to pay, I got worries.” (White British)
“We’re all supposed to look like them models. But you can only look
like them if you starve.” (White British)
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
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Some White British women felt that they would never be happy with their weight.
“I don’t think anyone is happy with their weight. Even when someone
tells me I look alright I think oh I wish I could be a certain size.”
(White British)
“Look at Victoria Beckham, she’s a size, what, zero? She’s still
unhappy with her weight.” (White British)
Portuguese women had a preference for slim bodies and tried to achieve this for
themselves. They did not like to be overweight, mainly for aesthetic rather than health
reasons.
“The Portuguese women like to dress nice. Elegant. We don’t like to be
fat because then we don’t look good.” (Portuguese)
“Like that woman [pointing to fourth from left on chart], that is definitely
overweight for me. Maybe she’s healthy, I don’t know, but I don’t think
it looks good.” (Portuguese)
West African women believe that the African woman is naturally large and that large
women are preferred by Africans.
“In our tradition, if you are very slim it doesn’t really look good.”
(West African)
“Back home when you’re skinny you’re looked down upon. It’s linked to
you actually suffering from something and not being able to afford the
basic things of life. That’s the way it is from where I come from.”
(West African)
Black Caribbean women believe that Black Caribbean women have a different body
shape, that their weight is distributed differently to other women. In a similar way to West
African women respondents, they did not think it was right to equate larger sizes and
different body shapes, on the one hand, with poorer health, on the other.
“Every religion, every race, we are all shaped different. Caribbeans
have very big hip area. Africans have big hip area. English people
don’t tend to have that so their weight always seems to be slightly less
so they shouldn’t judge us on the same scale.” (Black Caribbean)
“I understand that if it’s around the central part of your body then it’s
more dangerous because if affects your heart. But I think if you’ve got
broader hips it’s a bit healthier, it doesn’t do much harm. It doesn’t
affect your heart.” (Black Caribbean)
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4.2.4. Anger at White comparison
Many West African and Black Caribbean women expressed anger at the medical
profession for comparing their body sizes with White women. For them, Black bodies were
naturally larger and different in shape, and they could not be compared with White bodies.
They did not deny that being overweight can lead to health problems. However, they
resented the fact that doctors regarded them as overweight by comparing them to a white
standard. They themselves did not think they were overweight. These views were not
shared by Somali women.
“I’m always telling the doctor that I’ve always been a big person since I
was a baby and that’s how my children are and I believe I’m healthier
than somebody who is normal size. But he still keeps telling me to lose
weight.” (West African)
“I’m sorry to say this, but doctors use some people they think have
perfect stature or figure or whatever and say they have good health
and then they tell us to lose weight. Why should it have to be this
way?” (West African)
“When I go to the doctors they’re always telling me: “Oh you have to
lose weight because of diabetes” and all this and that. I’ve done all the
tests and there’s nothing wrong with me. I’m happy with how I am but
they keep telling me to lose weight.” (West African)
“To me White people weigh less than Black and if you compare White
people to Black I think we’re going to be heavier. They shouldn’t put us
in the same categories.” (Black Caribbean)
“I think we have more bigger girls and culturally speaking usually our
men like us a little bit more plump. I mean I would consider myself to
be moderately obese because it’s concentrated in certain areas but I
think that most people from other cultures are very thin, so it’s not right
to make comparisons.” (Black Caribbean)
4.3. Identification with healthy lifestyles
To asses the extent to which people identify with a healthy lifestyle respondents were
presented with the following scenario describing a healthy family:
“I would like you to picture in your mind a [vary ethnicity] family, with
a father, a mother and three children - two boys and a girl – aged
between 5 and 10 years-old. They live in Lambeth. They each eat at
least five fruits and vegetables a day as part of their diet, and
everyone in the family does at least half an hour of exercise every
day.”
The scenario contained two key messages recommended for healthy lifestyles; eating five
fruits and vegetables and doing half an hour of exercise daily. Once the scenario was read
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out to respondents, they were asked to describe the type of family that lived such a
lifestyle and the extent to which they could envisage such a lifestyle for themselves. This
technique was devised to establish whether people could identify with such a healthy
lifestyle.
Portuguese respondents thought this was a realistic scenario and that the family could be
Portuguese. They could envisage themselves living such a lifestyle. They had no issues
with eating five fruit and vegetables a day but did think exercising daily would be difficult.
“That is a good way to live if you have the time.” (Portuguese)
“We already eat that amount of fruit and vegetables so that doesn’t
seem difficult. Doing exercise everyday would be difficult.”
(Portuguese)
Some White British and Black Caribbean women thought it was possible to lead such a
lifestyle. However, many felt getting children to eat five fruits and vegetable a day would
be the most challenging. While they did not think the family was representative of their
community; it was not entirely alien to it. They thought the family could be from their
community, with Black Caribbean saying the family had to have been living in the UK for a
very long time. However, none thought that they themselves could lead such a lifestyle.
“I can see the kids probably doing half an hour of exercise a day
because they go to school, but I’ve never known a kid to eat five fruits
and veg, I’m sorry.” (White British)
“The two adults and the three kids all eat five lots of fruit and veg. No.
That’s impossible!” (White British)
“For a Caribbean, I don’t see that going on here. We Caribbean people
love our meals. We tend to eat a lot of meat, meat with carbohydrates
like rice, yam, dumplings, bananas.” (Black Caribbean)
“If that’s a Black family, they have had to have lived here a very long
time. And they have got to be well off.” (Black Caribbean)
Despite the fact that the scenario explicitly states the ethnicity of the family, which was
systematically varied in the focus groups to match that of the participants, all Somalis and
West Africans felt the family could not be from their community. They did not think
Somalis and West Africans could lead such a lifestyle or that they could afford to lead
such lifestyles. For them, the family described had to be a White, middle-class family.
“You’re eating vegetables and you’re working out, the kids are working
out. These guys have got time. I have to go to work, the kids come
back, what time do we have to do this routine of exercise and all? You
look at this family and either the mum is White and the dad is African
because 99.9% of Africans don’t do this.” (West African)
“I look at this family and they can’t be Africans.” (West African)
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“This is not a Somali family. Somali family cooks rice and meat and
little salad. Somali family does not do a lot of physical activity.”
(Somali)
“This family is raised in homes that value healthy eating and exercise
and they just continue to do what they were taught in their childhood.
Somalis are not raised in that way and do not care about healthy
eating or exercising.” (Somali)
“They are not a poor White family either because poor White people do
not care about healthy eating.” (Somali)
4.4. Too stressed to be healthy
Most respondents reported leading stressful lives with little or no time for themselves.
Many reported not having the time to shop and cook on a regular basis. Convenience
foods are often purchased because they last a long time, are easy to cook and do not go
to waste because they do get eaten.
“I’ve got no time to look after myself. I’m always rushing. I feel like
twenty-four hours is not enough for me.” (Black Caribbean)
“Every evening after I’ve done everything I can’t walk. Sometimes I
have to crawl to the bathroom in the morning, I’m limping I’m so tired.
So how am I supposed to exercise?” (West African)
“When I’m stressed, I eat. I comfort eat. Whenever I’ve got a problem, I
eat. I know I don’t have willpower but I can’t afford to have willpower.
I’ve got enough problems.” (White British)
“I can’t be bothered when I’ve been running about all day after my
daughter. I can’t be bothered to cook for myself. It’s like I think I’ve got
to cook and then wash and do that all over again and it’s easier to
phone for a take-away.” (White British)
4.5. Too poor to be healthy
Most respondents were on a low income where finances were tight. They felt that leading
a healthy life was expensive and the privilege of the ‘well off.’ Fruits and vegetables were
felt to be expensive not only because of the cost of purchasing them, but because they
are perishable, may not be eaten and are not as filling as convenience foods. Exercise
and sporting facilities were felt to be too expensive to participate in for adults and children.
“Fruit and veg goes off very fast so you have to buy it every few days.
For people who get paid once a week or once every two weeks, they
are gonna have to shop every few days and it don’t happen.”
(White British)
“If you go and buy a ready-meal, it’s cheaper than buying the
ingredients and cooking it yourself.” (Black Caribbean)
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“I’ve got to buy food that gets eaten. If I buy loads of fruits and veg and
it don’t get eaten it’s going in the bin. I can’t afford to do that.”
(White British)
4.6. Children won’t eat it
With the exception of Portuguese respondents, parents reported that their children refuse
to eat fruits and vegetables. The priority for mothers is to ensure that their children eat and
do not go hungry. Although they know that fruits and vegetables are good for their
children, they do not have the time or energy to have a confrontation with their children
over meals. They also do not want food wasted if the children do not eat it. Children are
therefore given what they will eat without there being a fuss.
“I buy the food that I buy because I want to make sure that I know that
she’s (daughter) is eating properly. I’d rather she was eating properly
than trying to shove vegetables down her throat.” (West African)
“Kids like kiddy stuff like chicken nuggets, kiddy pizza and pasta bake
and stuff like that. My little girl you give her that stuff and you know
she’s gonna eat it.” (White British)
4.7. Respondents’ suggestions for promoting healthy lifestyles
All respondents accepted that a diet of fruits and vegetables, and regular exercise, are
good for health. However, for health related message to be effective they need to relate to
the reality of people’s lives. Health messages that do not relate to people’s reality are
ignored or even resented. For many, leading a healthy lifestyle is perceived to be the
privilege of those leading comfortable lives where people have time and money to spend
on themselves. Most respondents in the research had little of both.
Respondents were asked to give their views about the best approach to promoting healthy
lifestyles in their communities. Following are some of their suggestions:

Doing activities in groups
“Nobody wants to go out on their bike or walk on their own. You feel
like a dummy. But if you’ve got a couple of people around you then you
don’t feel as bad doing it because you’ve got people there, you can
laugh and ride your bike. You can have a laugh with your friends. But if
you’re on your own it’s boring and you think should I go or should I sit
and watch the tele? I would sit and watch the tele.” (White British)

Providing affordable facilities
“I was thinking they should provide free classes every now and again
for people to come in the community for exercises that would help
because not everybody can afford it.” (Portuguese)
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“They should have outside gyms like they’ve got in Peckham and in
Mitcham. There’s like an outside park gym where they’ve got like
exercise bikes and rowing machines and stuff like that.” (Black
Caribbean)

Having role models/health advocates from the community
“I think maybe if you get one parent who is really into healthy eating to
maybe say: “Right, you all come over and maybe sort of like do it
together”, that would be good. It would be good to have someone like
us telling us what to do.” (Black Caribbean)

Having joint parent and children classes
“They should do exercise clubs for parents and kids because me and
my daughter do boxercising but I would like a keep fit class where I
can take my daughter with me and she’s not stuck in no crèche.”
(Black Caribbean)
“They should do activities children and their parents where they
show them how to eat healthy, what is healthy food and what’s not.”
(White British)

Providing culturally relevant classes – mostly suggested by West Africans and
Somalis
“If you go to your GP and he asks you what do you eat and you say
garri, he doesn’t understand so he can’t advise us. The only thing
they say is take this or take that, but most of us we don’t even buy
that stuff. But if they can show what we buy and say ok, since you
like eating rice, why not eat brown rice instead? They only tell you
you can’t eat that, it’s too much. We need people to teach us about
our own food.” (West African)
“I don’t know much about vegetables. It would be good to learn about
how to prepare vegetables and cook healthy Somali food.” (Somali)
“Africans dance and I mean we dance. Sometimes I’ve been dancing
and I can’t even walk for three days because of the physical activity.
They should set up dancing classes.” (West Africans)
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5.0. OVERWEIGHT AND OBESITY AMONGST CHILDREN
5.1. Introduction
In this section we discuss how children’s body size is perceived by parents and what
barriers parents face in feeding children a healthy diet. Finally, we look at what parents
know about the amount of exercise their children get.
5.2. Children’s body size
To understand how parents perceived children’s weight, mothers were shown a series of
computer generated images of children of various sizes (Appendix B). They were then
asked to rate the first child they thought was overweight. The chart below shows which
image most of the respondents from each community rated as overweight.
Portuguese
Somali
West African
Black
Caribbean
White
British
With the exception of the Portuguese, the greatest number of respondents in all
communities chose the largest child on the scale as the first one which they considered to
be overweight. Somali, West African, Black Caribbean and White British parents generally
perceived ‘large’ children as being healthy, rather than overweight. For a child to be what
health professionals regard as “overweight” was therefore valued in most communities.
Mothers across most communities also seemed to share the view that even if children
were overweight, this would be outgrown as they get older. They did not appreciate that
childhood obesity is related to weight problems in later life. Only one mother in the entire
sample expressed concern about one child being too large. However, many mothers did
complain that their children were underweight because they did not eat enough.
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5.3. Children and diet
Children dictate what they eat. Many parents feel helpless when trying to feed their
children healthy foods. Most parents say it is difficult or impossible to get children to eat
fruit and vegetables regularly. As a result, many children do not get sufficient fruits and
vegetables. The only exception is the Portuguese community. Portuguese parents
generally reported that fruit and vegetables are an important part of the whole family’s
diet.
“Only one of my children, my oldest daughter, eats vegetables on a
daily basis. The rest will not even touch it.” (Somali)
“When I’m cooking in the house, I’ve done my okra, I’ve done my garri
and my daughter will say: “Mum I don’t want that, I want rice.”
(West African)
“My son won’t eat no vegetables. Even when I cook spaghetti
bolognese, I have to take all the veg out otherwise he will sit there for
two hours picking every single onion or other veg out of his plate and
he won’t eat it.” (White British)
“I’ve tried my daughter with lots of different vegetables but sorry she
just don’t like them.” (Black Caribbean)
Some mothers report trying hard – or having tried hard in the past - to get their children to
eat more fruit and vegetables, but they have largely given up in order to avoid meals
becoming daily battles.
Meals for children are given at regular times. In fact, for some respondents, being able to
provide a meal for their children three times a day (regardless of the content of those
meals), is what they regarded as having a good diet. In most communities, breakfast
consisted of bread or cereals (often sugary) and milk, but without fruit. In the West African
community however, many reported that breakfast often consisted of eating the left-overs
from the previous evening meals, such as curries, and that breakfast portions could be
very large. This was not only the case for children but also for adults.
“With us, the thing is we warm up our left-overs [for breakfast]. It’s so
good! It’s not very healthy maybe but it’s really good!” (West African)
There were important differences between communities in terms of “snacking” practices.
Again, Portuguese people normally got their children to eat fruit and, occasionally biscuits
or crisps, for snacks. They tended to drink water or fruit juices. In other communities,
snacks were much more likely to consist of chocolate bars, biscuits, crisps, and fizzy soft
drinks. In the West African community, a number of respondents reported that it was
common to eat what would count as a full meal in terms of calorie intake (such as takeaway fried chicken, a hamburger or a sandwich) but to regard this as a mere snack to be
followed by a “proper” meal later. Generally, this seemed to be rooted in the view that a
“meal” is what is eaten at home, at regular time and in the company of others, while
everything else is treated as a mere “snack”.
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“R1: I always carry water with me for my daughter. I give her an apple
or a banana or some carrot sticks or, you know, something like that.
R2: Me too. But to be honest, I also give my children some biscuits as
well.
R1: Yes, biscuits and little bits of chocolate. But that’s rare. Quite rare.
I: How often would you say?
R2: Two or three times a week. Not more than that. But you don’t want
children to feel that they can never have these things because then it
is frustrating for them I think.” (Portuguese)
“If we get hungry, we can pop in to the local take-away place and get
some fried chicken. That’s not just me I think. That’s quite common
with us, isn’t it? (General agreement). And then we go home and have
a proper meal! We do.” (West Africans)
There also seemed to be some differences in the consumption of “fast food”. White
British, Black Caribbean and West African mothers all reported that they and their children
ate “fast food” or “junk food” with regular frequency. They knew that this was not healthy,
but it was easy and that often mattered more to them. It avoided having to shop, cook, do
the dishes, and it made the children happy. Mothers felt that they were giving their
children a “treat”, which made both parents and children feel good, especially in the
context of relative economic deprivation in which treats are few and far between. In many
cases, fast food consumption was largely or exclusively driven by children. Indeed, some
mothers said that they never went to any fast food outlet on their own, but that they took
their children because they loved it.
“My son, he just loves the little toys they give with Happy Meals. It’s
nice to see that he enjoys himself when we go there.[…] I wouldn’t go
on my own but I take my son sometimes.” (Black Caribbean)
“I don’t know anyone who doesn’t go to these places [fast food outlets].
It works out cheaper than having to do the same thing at home and
you’ve got none of the bother. Why not? I mean, I know why not
because it’s not the best for you, but…” (White British)
Somali and Portuguese mothers did not report as high a consumption of fast food. This is
partly because, as more recent migrants, they claim that they were never brought up with
that and therefore have yet to acquire the habit of turning to fast food. In the case of the
Somali community, dietary proscriptions and prescriptions as Muslims – in this case the
preference for halal meat – largely accounted for the lower consumption of fast food.
“We did not grow up with that. Even in Portugal, not a lot of people go
to MacDonald’s or Pizza Hut and things. It’s not like here.”
(Portuguese)
“We don’t go the MacDonald’s and that. We only eat halal food.”
(Somali)
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5.4. Children and physical activity
Parents have no knowledge of the recommended amount of physical activity for children.
All parents assume their children are getting enough physical activity. Most parents
assume this occurs in school. Parents do not know how much actual physical activity their
children are getting. Some parents assume ‘hyper’ children get plenty of exercise.
“My son’s got a lot of energy, he runs around like a nutter. He plays
mental at school, he comes home he’s so hyper.” (White British)
“The kids will get it (physical activity) in playtime at school, when they
walk to school, when they walk back, PE, after-school clubs, whatever.
The kids they get plenty of exercise.” (Black Caribbean)
There were some differences in the amount of physical activity which mothers felt was
necessary for boys and for girls. Mothers across most communities tended to feel that
physical activity was more important for boys than for girls. They were more likely to
register boys in various sporting and physical activity after-school clubs than girls, who
tended to engage in more sedentary leisure activities.
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6.0.
SUMMARY AND RECOMMENDATIONS
6.1.
Summary of findings

There is high awareness, across all communities, of the link between poor diet and
health.

Most people are aware of the recommended five fruits and vegetables a day.

Most people are aware that physical activity is good for health, but knowledge of what
constitutes physical activity is variable.

Most people consume more carbohydrates and meat, and less fruits and vegetables,
than the recommended amounts.

Meal portions are often very large.

Very few people are getting enough physical activity to benefit their health.

Very few understand overweight and obesity in terms of BMI. Most define overweight
in aesthetic terms and obesity in health and functional terms. Obesity is equated with
morbid levels of obesity.

All respondents know that excessive weight can lead to poor health. However, what is
regarded as overweight varies considerably across communities.

West Africans believe they have large body sizes. Black Caribbeans believe they have
different body shapes to White British. Some West Africans and Black Caribbeans
resent health professionals comparing their weight to a “White” standard.

Somalis suggest a preference for large women. Portuguese prefer slim bodies. White
British believe slim bodies are desirable but unrealistic.

Most respondents do not identify with people who live a healthy lifestyle that consists
of consuming five fruits and vegetables and doing 30 minutes of physical activity daily.

Stressful lives, expense and children disliking fruits and vegetables are major
additional barriers to achieving healthy lifestyles.
6.2. Recommendations

Challenge widespread misunderstandings around obesity, in particular association of
overweight and obesity with morbid levels of obesity.

Disentangle diet from body image: focus health promotion and health education
messages on increasing health, not (primarily) reducing weight.

Ensure that health advice is not seen to be exclusive to a small section of the
population: White and middle-class.

Acknowledge lifestyle and cultural barriers and tailor health advice accordingly. Make
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health messages relevant to people’s lives.

Challenge the view that ‘large’ children are healthy children. Emphasise the
association of childhood obesity with adult obesity.

Support parents in promoting healthy eating amongst children.

Organise health related activities in groups.

Use role models from within communities to promote healthy lifestyles.
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APPENDIX A: TOPIC GUIDE
EXPLORING KNOWLEDGE ABOUT, AND ATTITUDES
TOWARDS,OVERWEIGHT AND OBESITY AMONGST
ETHNIC MINORITY POPULATIONS IN LAMBETH FOCUS GROUP DISCUSSION GUIDE
AIMS: We are conducting a study in Lambeth on behalf of NHS Lambeth. The aims of the
study are to understand better the views of local people from diverse ethnic backgrounds to
their own and their family’s weight. This is so that local health professionals can become better
at supporting people across Lambeth to be able to be a healthy weight.
By consulting with you, we are hoping to:



develop a better understanding of health knowledge, attitude and behaviours in your
community,
develop a better understanding of what might make it difficult for people to reach and
maintaining a healthy weight; and
gather evidence of what health professionals and other services in Lambeth are doing, or
could be doing - to help prevent people being overweight and lose weight if they need to
PART I: INTRODUCTION
 ETHNOS – independent research company
 Confidentiality
 Warm up: Name, number of children, length of time in Lambeth
PART II: KNOWLEDGE AND ATTITUDES TOWARDS BEING OVERWEIGHT
VIGNETTE: “THE HEALTHY FAMILY”
“I would like you to picture in your mind a [vary ethnicity] family, with a father, a
mother and three children - two boys and a girl – aged between 5 and 10 yearsold. They live in Lambeth. They each eat at least five fruits and vegetables a day
as part of their diet, and everyone in the family does at least half an hour of
exercise every day.”

What do you think about this family? What can you tell us about them based on this
scenario? What kind of lives do you imagine they live?
(rich/poor, educated/uneducated, traditional/westernised, etc)

How similar or different are they to you?

Would you like to be more like them? Why? Why not?

How important is it to you personally to have a healthy lifestyle? How does it rank among
your priorities?

Is there anything that makes it difficult for you to be like them?
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS


Do you think there is a link between a person’s weight and how healthy they are?
Does it depend how overweight they are?
BODY SIZES - INSTRUCTIONS
Distribute “Body sizes” (women).
Please have a look at these pictures of women.

I would like you to put the letter “I” (for ideal) in the box below the person
that you think has the ideal body size – not too thin and not too fat.

Now, could you put the letter “U” (for underweight) in the box below the first
person that you think is underweight – too thin. If there is no one that you
think is underweight, leave it blank.

Now, could you put the letter “O” (for overweight) in the box below the first
person that you think is overweight – too fat. If there is no one that you think
is overweight, leave it blank.
Distribute “Body sizes” (children).
Please have a look at these pictures of children.

Could you put the letter “O” (for overweight) in the box below the first child
that you think is overweight – too fat. If you don’t think any child pictured
here is overweight, leave it blank.
Collect both completed body size questionnaires.







What do you consider to be overweight?
What does the term obese mean to you? What do you consider to be obese?
What do you think are the consequences of being overweight or obese: (explore without
prompting first, then probe for):
 people’s health? (heart problems, diabetes, stroke, high blood pressure, etc?)
 people’s family and social life?
 people’s self-confidence?
 people’s economic life?
 other aspects of people’s lives?
How serious do you think are these consequences? Do any of these worry you personally?
Do you think that overweight and obesity are/are not a common issues in the [own ethnic]
community?
Why do you think overweight and obesity are issues in your community?
What can people do to control their weight? (explore without prompting first, then probe
for):
 eating a healthy diet: fat, sugar, carbohydrates, fruits and vegetables, etc?
 taking regular exercise: how much, what level of activity, how often, etc?
 smoking
 not drinking
 avoiding stress
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS

other


What makes a healthy diet? (explore fruit/vegetables, ways of cooking, salt content etc)
What makes an unhealthy diet? (Food content, fizzy drinks, ways of cooking)

What kinds of illnesses do you think are caused by a poor diet? (explore heart disease,
diabetes, high blood pressure etc)



Would you say that your/your children’s diet is healthy?
What is healthy about it?
What is not healthy about it?

Do you think there are any benefits of doing physical activity? What are they? (explore
knowledge of both physical and mental health)

What kind of physical activity would you need to do to be healthy? (explore knowledge
of walking, housework, gardening etc)

How much physical activity do you think you have to do to be healthy? (explore
knowledge of 30 minutes day)
PART III: ACTUAL PRACTICES

Diet:
 Who does the food shopping in your house? Where do you shop?
 Who prepares meals?
 Do you/your children normally eat “traditional” foods or more “western” food?
 What does a typical dinner look like in your house?
 What would a typical “snack” look like in your family?
 Do you tend to eat between meals?
 How many meals do your children eat each day? (at home v outside)
 Do they have snack between meals? What do they eat?
“EATWELL” FOOD PLATE:
HOW DOES YOUR DIET COMPARE WITH RECOMMENDED BALANCED DIET
Distribute “Eatwell” plate to each participant.
I would like to ask you how your diet compares with what is presented in this plate.
Do you have about the same proportions of each “food group” (fruit and vegetables,
bread/rice/potatoes/ pasta, meat/fish/eggs/beans, milk and dairy foods, and foods and
drinks that are high in fat and/or sugar) as is recommended in this picture?
Any food group that is lower in your diet, compared to the plate?
Any food group that is higher in your diet, compared to the plate?
Do you eat five fruits and vegetables every day?
Collect “Eatwell” plates back from participants.
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
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Have you ever tried to change your/your children’s diet to lose weight?
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Why did you do that?
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What did you do? Eat less, avoid certain foods (meat, fat/oily food, fried
food, sugar/sweets, starchy food), avoid alcohol, eat more fruits/ vegs, more
starchy foods, etc.
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Did it work? Why? Why not?
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Physical activity:
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How much exercise would you say you do every week, if any?
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What kind of exercise do you do, if any? (walking to school, doing home chores,
sports, etc)
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How many times a week do you do that? For how long each time?
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What about your children?
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Is there anything else that you do/have been doing recently in order to lose weight/be more
healthy?
PART IV: BARRIERS TO ACHIEVING AND MAINTAINING HEALTHY WEIGHT
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Have you ever been advised by anyone to lose weight? By whom?
Is there anything that actually prevents you or your children from achieving a healthy
weight? Explore:
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cultural habit and social norms: hospitality, large portions, etc
positive role models
money and impact of food bought and social habits
influence of advertising and media
time and conflicting priorities
interest/motivation in topic or health
self-concept of current physical activity, size and eating habits
current health status
do they have friends and relatives to do things with and support each other
preference for more sedentary leisure activities
concerns over personal safety, racial harassment
availability targeted services and provisions
awareness of opportunities, services and provisions
personal responsibility
other
PART V: SUGGESTIONS FOR HEALTH EDUCATION AND PROMOTION
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What would it take to get you/your children to lose weight?
Is there anything that could be done to encourage you or your children to lose weight, eat
appropriate quantities or healthy food, take up regular physical activity, etc? What? By
whom? Where? When? With whom?
How would you get people in your community to lose weight?
How would you get children in your community to lose weight?
SUMMARY AND THANKS
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
APPENDIX B: BODY IMAGE
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS
APPENDIX C: FSA’S EATWELL PLATE
Overweight and obesity amongst residents of Lambeth – Research Report – ETHNOS