Influences on body weight of female Moroccan migrants in the Netherlands: A qualitative study

Exploring self-care and cervical cancer prevention attitudes and practices among Moroccan and Pakistani immigrant women in Catalonia, Spain: a comparative qualitative study

BACKGROUND

Self-care and preventive health strategies may trigger health inequities when individuals' cultural values and health beliefs are not fully understood and considered. In the case of cervical cancer (CC) screening programs immigrant women have shown lower attendance compared with native women, which increases the risk of late diagnosis and, consequently, a lower probability of survival. HPV self-sampling for CC screening has been recently added to the World Health Organization's (WHO) list of self-care interventions as a promising tool to reduce this disparity and improve screening coverage. In Catalonia, Spain, the introduction of HPV self-sampling as a part of the new population-based CC screening program, is a significant step. However, there is a lack of research addressing self-care and prevention among immigrant populations in this region. This study aims to fill this gap exploring self-care and prevention attitudes and practices among Moroccan and Pakistani women.

METHODS

We conducted focus groups and individual interviews with 36 Moroccan and 37 Pakistani women in Barcelona, Spain. The topic guide of the focus groups included case vignettes to stimulate the discussion and a semi-structured questionnaire was used for the interviews.

RESULTS

Our findings show that most Moroccan and Pakistani women do not prioritize self-care and prevention. They seek care for symptom treatment rather than disease prevention. In this sense, they reported not having the habit of doing regular check-ups and their self-care and prevention attitudes and practices seemed to be conditioned by cultural values. The implementation of an effective call and recall system could enhance the engagement of these populations with CC screening services.

CONCLUSION

This study provides evidence on how universal concepts of self-care and prevention may not aligned with more collectivist societies, emphasizing the limited applicability and motivation of global self-care interventions guidelines for individuals with different cultural backgrounds and values. Therefore, the successful implementation of CC screening programs or any other self-care intervention requires the adoption of culturally appropriate strategies.

Cardiometabolic risk profile among children with migrant parents and role of parental education: the IDEFICS/I.Family cohort

BACKGROUND AND AIMS

Evidence shows that migrant children have a higher risk of developing obesity than those with native parents. We aimed to investigate the association between parental migration background and cardiometabolic health in children and adolescents in Europe.

METHODS AND RESULTS

We included 8745 children aged 2-17 from the second follow-up of the European IDEFICS/I.Family cohort. Linear regression models were used to investigate the association between parental migration background (one or two migrant parent(s) vs native parents) and body mass index (BMI), metabolic syndrome (MetS) score and its individual components. Outcome variables were parametrized as age and sex-specific z-scores. We adjusted for age, sex, country, and parental education, and additionally for parental income, lifestyle including dietary factors, and maternal BMI. On average, children with two migrant parents had higher z-scores of BMI (+0.24 standard deviation (SD)) and MetS score (+0.30 SD) compared to those with native parents, whereas no significant differences were seen for children with one migrant parent. Associations were attenuated when controlling for maternal BMI and sports club activity. Parental education modified the associations with BMI and MetS z-scores such that they were more pronounced in children with low parental education.

CONCLUSION

Children with two migrant parents were at higher risk for adverse cardiometabolic health compared to children with native parents, especially in families with low parental education. These associations were explained by lower physical activity and maternal body weight and encourages early intervention strategies by schools and communities.

Perspectives of older women in the Netherlands: identifying motivators and barriers for healthy lifestyles and determinants of healthy aging

BACKGROUND

Women have a higher life expectancy than men but experience more years with physical disabilities in daily life at older ages, especially women with a migration background. This pinpoints older women as an important target group for strategies that stimulate healthy lifestyle, which benefits healthy aging. Our study investigates motivators and barriers for healthy lifestyles and perspectives on determinants of healthy aging of older women. This provides essential information for developing targeted strategies.

METHODS

Data was collected by semi-structured digital interviews from February till June 2021. Women aged 55 years and older living in the Netherlands (n = 34) with a native Dutch (n = 24), Turkish (n = 6) or Moroccan (n = 4) migration background were included. Two main subjects were investigated: (1) motivators and barriers on their current lifestyles regarding smoking, alcohol consumption, physical activity, diet and sleep and (2) perspectives on determinants of healthy aging. Interviews were analyzed using Krueger's framework.

RESULTS

Personal health was the most common motivator for a healthy lifestyle. In addition, peer pressure and being outdoors were specific motivators for physical activity. Bad weather conditions and personal dislike to be active were specific barriers. The social environment, personal preferences and personal belief to compensate with other healthy lifestyle behaviors were barriers for low alcohol consumption. Personal preferences (liking unhealthy food and not making time) were the main barriers for a healthy diet. Sleep was not perceived as a form of lifestyle behavior, but rather as a personal trait. Since there were no smokers, specific barriers were not mentioned. For Turkish-Dutch and Moroccan-Dutch women, additional barriers and motivators were culture and religion. These were strong motivators to abstain from alcohol consumption and smoking, but a barrier for a healthy diet. With regard to perspectives on determinants of healthy aging, positive views on aging and being physically active were perceived as most important. Women often wanted to increase their physical activity or healthy diet to stimulate healthy aging. Among Turkish-Dutch and Moroccan-Dutch women, healthy aging was also perceived as something in the hands of God.

CONCLUSIONS

Although motivators and barriers for a healthy lifestyle and perspectives on healthy aging vary for distinct lifestyles, personal health is a common motivator across all lifestyles. Having a migration background added culture and religion as distinct barriers and motivations. Strategies to improve lifestyle among older women should therefore have a tailored, culture sensitive approach (if applicable) for distinct lifestyle factors.

Does the neighbourhood food environment contribute to ethnic differences in diet quality? Results from the HELIUS study in Amsterdam, the Netherlands

OBJECTIVE

The aim of the current study was to establish whether the neighbourhood food environment, characterised by the healthiness of food outlets, the diversity of food outlets and fast-food outlet density within a 500 m or 1000 m street network buffer around the home address, contributed to ethnic differences in diet quality.

DESIGN

Cross-sectional cohort study.

SETTING

Amsterdam, the Netherlands.

PARTICIPANTS

Data on adult participants of Dutch, South-Asian Surinamese, African Surinamese, Turkish and Moroccan descent (n total 4728) in the HELIUS study were analysed.

RESULTS

The neighbourhood food environment of ethnic minority groups living in Amsterdam is less supportive of a healthy diet and of less diversity than that of participants of Dutch origin. For example, participants of Turkish, Moroccan and South-Asian Surinamese descent reside in a neighbourhood with a significantly higher fast-food outlet density (≤1000 m) than participants of Dutch descent. However, we found no evidence that neighbourhood food environment characteristics directly contributed to ethnic differences in diet quality.

CONCLUSION

Although ethnic minority groups lived in less healthy food environments than participants of ethnic Dutch origin, this did not contribute to ethnic differences in diet quality. Future research should investigate other direct or indirect consequences of residing in less supportive food environments and gain a better understanding of how different ethnic groups make use of their neighbourhood food environment.

Nutritional Health Education in Pregnant Women in a Rural Health Centre: Results in Spanish and Foreign Women

The dietary behaviour of pregnant women, as well as the socio-cultural conditions in which pregnancy takes place, influence obstetric outcomes. To analyse the influence of socioeconomic factors and dietary habits on obstetric outcomes in Spanish and foreign pregnant women living in a rural environment, a population-based, prospective-observational study in a cohort of Spanish and foreign pregnant women in the town of Yepes, in the province of Toledo, Spain was conducted. Foreign pregnant women are ecodependent on their partners, have secondary education and low socioeconomic level. Spanish pregnant women have secondary education, a medium socio-economic level, live with their partners and are economically independent. Moreover, 85% of Spanish pregnant women gave birth at term and reached a gestational age of 40 ± 1.83 weeks. However, only 55% of foreign pregnant women reached a gestational age of 39.72 ± 2.28 weeks. Through health education, pregnant women in this geographical area of Castilla la Mancha, Spain, adopted bicultural dietary patterns, thus reaching the prescribed diet of 2000 Kcal. Through this diet, both Spanish and foreign pregnant women maintained albumin and plasma protein levels within the established range, with no significant differences in obstetric outcomes among pregnant women in the study.

Physical activity participation among Arab immigrants and refugees in Western societies: A scoping review

Insufficient physical activity (PA) is the fourth prime risk factor for numerous non-communicable diseases. Arab immigrants and refugees (AIR) are at elevated risk for low or no participation in PA due to socio-cultural and ecological factors. This scoping review examined PA prevalence, knowledge, attitudes as well as barriers vs. facilitators to PA engagement across life domains among AIR in Western countries. A systematic search strategy was implemented across five automated databases (PubMed, Embase, Medline, Sociology Database and Transportation Research Board) to locate pertinent English language papers. Seventy-five articles were included in this study, and stakeholder consultation was conducted to validate the findings. The US and Europe are substantially ahead of Canada, Australia, and New Zealand in AIR-PA research. Despite showing positive attitudes and sound knowledge of PA recommendations, AIR exhibited a low PA engagement prevalence, revealing a knowledge-compliance gap. The prevalence of sufficient PA was lowest in the US (11-22%), whereas Europe showed the highest figures (26-45%). Personal barriers to PA participation involved mainstream language illiteracy and limited exercise skills, whereas improved PA literacy was a significant facilitator. Family responsibility and cultural restrictions were common psychosocial/cultural barriers, whereas social support and culturally-sensitive resources were powerful facilitators. Poorly maintained pedestrian/cyclist infrastructure was a leading environmental barrier amongst AIR in North America, but not Europe. Longitudinal and community-engaged AIR-PA research is needed, and intersectoral collaboration is required to inform tailored interventions and inclusive policies, fostering AIR and other vulnerable populations' exercise participation and improving their health and well-being.

A systematic review of qualitative studies exploring the factors influencing the physical activity levels of Arab migrants

Background

Evidence suggests that Arab migrant populations engage in low levels of physical activity. To our knowledge, there are no reviews that explore the perspectives of Arab migrant populations on the factors influencing physical activity. The aim of this systematic review was to thematically synthesise qualitative literature on the factors influencing physical activity among Arab migrant populations.

Methods

Five electronic databases (CINAHL, SPORTDiscus, PsychoInfo, MEDLINE, Embase) were searched in July 2018 and searched again in April 2020. A manual search in Google Scholar was also performed using keywords and the reference lists of included studies were also screened to identify further articles. The eligibility criteria for inclusion were studies that sampled adult (≥18 years) Arab migrant populations, used qualitative methodology, explored the factors influencing physical activity as a primary aim, and were published in English. The 10-item Critical Appraisal Skills Programme (CASP) checklist was used to assess methodological quality of individual studies. The results of the studies were thematically synthesised using the qualitative software Quirkos v1.6.

Results

A total of 15 studies were included, with the largest proportion of studies conducted in Australia, followed by the United States, Netherlands, Sweden, and then Canada. Five studies exclusively sampled Arab migrant populations in their study. A total of 7 major themes influencing physical activity among Arab migrants emerged from the synthesis: culture and religion, competing commitments and time, social factors, health-related influences, accessibility issues, outdoor environment, and the migratory experience.

Conclusions

The findings of this review highlighted the various factors influencing the physical activity levels of Arab migrant adults. While many of the factors influencing physical activity are shared with those experienced by other populations (e.g., time constraints), for Arab migrant populations there are other more unique factors closely associated with culture and religion that appear to influence their levels of physical activity. The findings of this review could be used to inform the design of physical activity interventions targeting Arab migrant populations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-020-01056-w.

Body composition parameters can better predict body size dissatisfaction than body mass index in children and adolescents

PURPOSE

Recent studies suggest that body mass index is not a reliable enough measurement for body composition in individuals, particularly in older and younger people. However, most research on body image has used the body mass index (BMI) as a physiological predictor of body satisfaction, particularly in children. The aim of this study was to investigate whether body composition is a better predictor of body size dissatisfaction in children than BMI.

METHODS

This is a cross-sectional study. Healthy children and adolescents aged 5-19 years, sex male and female, were recruited using a convenience sample in Brazil. BMI was measured according to the international standardization method and body composition was measured by bioelectrical impedance analysis (BIA) with a portable device model (BIA InBodyS10 multi-frequency, USA). Body size dissatisfaction was assessed using the Kakeshita's Figure Rating Scale for Brazilian Children. Data were analyzed with logistic regression analysis.

RESULTS

A total of 547 participants were evaluated, including 54% females and 67% Caucasian, with a mean age of 11.4 ± 3.8 years. The mean BMI was 20.5 ± 4.6 kg/m², and the mean percentages of fat and lean mass were 23.01 ± 10.59% and 72.84 ± 10.03%, respectively. In the multivariable model, only body composition was significantly associated with body size dissatisfaction (odds ratio: 1.849 (1.085-3.149, p = 0.024) and 1.828 (1.043-3.202, p = 0.035), respectively).

CONCLUSIONS

Body composition measures can better predict body size dissatisfaction in children and adolescents than BMI. This result may be relevant for the design of future studies on physiological indicators and body satisfaction.

LEVEL OF EVIDENCE

Level V, cross-sectional study.

The explanatory role of maternal feeding practices: do they explain ethnic differences in body weight of preadolescents?

INTRODUCTION

This study aimed to explore the role of ethnicity and maternal perceived weight status in the association between maternal child feeding practices and childhood Body Mass Index (BMI) at the age of 11-12 years in a multi-ethnic population.

METHODS

We collected data on child feeding practices by the validated Child Feeding Questionnaire (CFQ) among 2398 mothers of adolescents (M_age = 11.2, SD_age = 0.6). Multivariate linear analyses were used to determine the cross-sectional association between child feeding practices ('Restriction', 'Pressure to eat', and 'Monitoring'), maternal perception of child's weight status, SDS-BMI, and ethnicity.

RESULTS

'Restriction' (β = 0.16; 95% CI [0.11; 0.20]) and 'Pressure to eat' (β = -0.32 [-0.36;-0.28]) were significantly associated with child SDS-BMI. Both associations were strongly influenced by the mother's perception of child's weight status. Besides, non-native Dutch mothers performed significantly higher levels of 'Restriction' (M±SD = 12.17 ± 4.41) and 'Pressure to eat' (10.75 ± 4.03) compared to native Dutch mothers (11.25 ± 4.15 and 9.99 ± 3.83, respectively). Native Dutch mothers performed higher levels of 'Monitoring' (17.15 ± 2.54) compared to non-native Dutch mothers (16.73 ± 3.01). Furthermore, children of non-native Dutch mothers had a 0.15 (0.27; 0.46) higher SDS-BMI. Finally, results showed that the association between 'Pressure to eat' and SDS-BMI was stronger in native Dutch mothers (β = -0.20; 95% CI [-0.24; -0.15]) compared to non-native Dutch mothers (β = -0.11; 95% CI [-0.18; -0.04]).

DISCUSSION AND CONCLUSION

Ethnic differences in childhood BMI seemed to be partially attributable to the maternal perception of her child's weight status. Besides, maternal perception of child's weight appeared to play an important role in the association between maternal child feeding practices and childhood SDS-BMI. Hence, our findings contribute to the growing evidence concerning the bi-directional association between child feeding practices and childhood BMI.

Anthropometric status and body image perception among Moroccan university students

BACKGROUND

University students aged between 18 and 25 undergo several physical changes as a result of transition from adolescence to adulthood. Students do not always accept those changes and sometimes develop dissatisfaction towards their figures. In such cases, it is still not clear how actual body weight status can be affected by socio-cultural factors such as body image perception. The objective of this study was to determine the link between anthropometric status and body image perception among university students.

METHODS

Two hundred and forty six (246) university students from the Faculty of Sciences and Technologies within the Beni Mellal-Khenifra region in Morocco, aged 20-24 years were interviewed using face-to-face questionnaires. Anthropometric measurements and Body Mass Index were collected. Body image perception was assessed by Figure Rating Scale, and body size dissatisfaction was calculated as Feel minus Ideal Discrepancy (FID). Data were described using means and proportions. The Student t-test and the chi-square test have been used to assess the statistical significance of group differences.

RESULTS

Underweight students represented 16.7% of the investigated sample, while 11.4% suffered from overweight and obesity, higher in females students (14.4%) than in males (7.9%). Regarding body image perception, 43.9% of participants considered themselves underweight; whereas only 4.2% considered themselves overweight with no significant differences related to gender. Of note, the total prevalence of body image dissatisfaction was around 69.8%. Finally, among overweight/obese students, 88.9% of females and 71.4% of males expressed the wish to become thinner while 28.6% of the overweight/obese males wanted to get heavier.

CONCLUSION

The results of this study indicate a high rate of body image dissatisfaction and a tendency of participants to underestimate their body weight. This behavior may be a reflection of a real influence of social and psychological factors occurring during this critical period and may make university students vulnerable to many risk-taking behaviors. Thus, there is a need for suitable interventional programs and innovative strategies to ensure the understanding of the health consequences of overweight and obesity and to prevent associated comorbidities.

Dietary and Physical Activity Behaviours in African Migrant Women Living in High Income Countries: A Systematic Review and Framework Synthesis

Dietary and physical activity behaviours during preconception and in pregnancy are important determinants of maternal and child health. This review synthesised the available evidence on dietary and physical activity behaviours in pregnant women and women of childbearing age women who have migrated from African countries to live in high income countries. Searches were conducted on Medline, Embase, PsycInfo, Pubmed, CINAHL, Scopus, Proquest, Web of Science, and the Cochrane library. Searches were restricted to studies conducted in high income countries and published in English. Data extraction and quality assessment were carried out in duplicate. Findings were synthesised using a framework approach, which included both a priori and emergent themes. Fourteen studies were identified; ten quantitative and four qualitative. Four studies included pregnant women. Data on nutrient intakes included macro- and micro-nutrients; and were suggestive of inadequacies in iron, folate, and calcium; and excessive sodium intakes. Dietary patterns were bicultural, including both Westernised and African dietary practices. Findings on physical activity behaviours were conflicting. Dietary and physical activity behaviours were influenced by post-migration environments, culture, religion, and food or physical activity-related beliefs and perceptions. Further studies are required to understand the influence of sociodemographic and other migration-related factors on behaviour changes after migration.

Obesity in International Migrant Populations

PURPOSE OF REVIEW

This review examines the risk of obesity in migrant groups-specifically migrants from countries with lower prevalence of obesity to countries with higher prevalence of obesity. We examine obesity prevalence within migrant groups compared with native populations and the evidence on factors that might shape obesity risk in these migrant groups.

RECENT FINDINGS

Migrants may arrive in new countries with a health advantage including generally a healthier body weight. Genetic and epi-genetic factors, as well as body size preference, socio-economic factors, and stress exposure, may play a role in increasing unhealthy weight gain in migrant populations. This unhealthy weight gain leads to similar or greater obesity risk in migrant populations compared with native populations 10-15 years after migration. Meeting the challenge of prevention and treatment of obesity in diverse populations will require greater attention to minority groups in research in the future.

Systematic mapping review of the factors influencing physical activity and sedentary behaviour in ethnic minority groups in Europe: a DEDIPAC study

Background

Physical activity and sedentary behaviour are associated with health and wellbeing. Studies indicate that ethnic minority groups are both less active and more sedentary than the majority population and that factors influencing these behaviours may differ. Mapping the factors influencing physical activity and sedentary behaviour among ethnic minority groups living in Europe can help to identify determinants of physical activity and sedentary behaviour, research gaps and guide future research.

Methods

A systematic mapping review was conducted to map the factors associated with physical activity and sedentary behaviour among ethnic minority groups living in Europe (protocol PROSPERO ID = CRD42014014575). Six databases were searched for quantitative and qualitative research published between 1999 and 2014. In synthesizing the findings, all factors were sorted and structured into clusters following a data driven approach and concept mapping.

Results

Sixty-three articles were identified out of 7794 returned by the systematic search. These included 41 quantitative and 22 qualitative studies. Of these 58 focused on physical activity, 5 on both physical activity and sedentary behaviour and none focused on sedentary behaviour. The factors associated with physical activity and sedentary behaviour were grouped into eight clusters. Social & cultural environment (n = 55) and Psychosocial (39) were the clusters containing most factors, followed by Physical environment & accessibility (33), Migration context (15), Institutional environment (14), Social & material resources (12), Health and health communication (12), Political environment (3). An important finding was that cultural and religious issues, in particular those related to gender issues, were recurring factors across the clusters.

Conclusion

Physical activity and sedentary behaviour among ethnic minority groups living in Europe are influenced by a wide variety of factors, especially informed by qualitative studies. More comparative studies are needed as well as inclusion of a wider spectrum of the diverse ethnic minority groups resettled in different European countries. Few studies have investigated factors influencing sedentary behaviour. It is important in the future to address specific factors influencing physical activity and sedentary behaviour among different ethnic minority groups in order to plan and implement effective interventions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0554-3) contains supplementary material, which is available to authorized users.

"Skinny is prettier and normal: I want to be normal"-Perceived body image of non-Western ethnic minority children in the Netherlands

While the prevalence of overweight and obesity is higher among children of some non-Western ethnic minorities than among their Caucasian counterparts, their body image is understudied. The current study examined the body image of Dutch children of non-Western ethnic minorities (i.e., Surinamese, Antillean, Moroccan, and Turkish). Sociocultural influences from school, media and home environments and their perceptions of overweight prevention programs were taken into account. Fifty-two non-Western ethnic minority children (aged 8-12 years) participated in semi-structured interviews and focus groups. Results showed that the children generally underestimated their current body size, which was often overweight, and preferred thin and 'normal' body sizes. Results further revealed important insights into culturally determined themes, relating to perceived preferences in media, peers, parents, and teachers, nutritional habits, and children's beliefs about school-based health interventions. We conclude that targeting culturally sensitive awareness about actual body size and healthy body images seems paramount in future interventions.

Body image perception of African immigrants in Europe

Nutritional disorders are now spreading worldwide both in developed and developing countries. Body image ideals and dissatisfaction have been linked to a number of poor health outcomes, including nutritional disorders. While previous studies have offered insight into weight status and body image perception of immigrants in North America, very few studies have analysed these aspects in migrants from Africa to Europe. Our review examines the effects of the migration process on beauty ideals and body dissatisfaction in African immigrants in Europe compared to residents in their own countries. The PubMed, PsycINFO and Google Scholar databases were searched for studies published from January 2000 till November 2015. Of the 730 titles identified, 26 met the inclusion criteria and were included in the present review. Among African residents, the body preferences depend on the country of residence and their socio-cultural status. Ethnic groups living in great isolation or with low incomes still have an ancestral idea of beauty, preferring a shapely body. However ethnic groups living in urban areas are moving toward Westernization of beauty ideals, preferring underweight or normal weight bodies. This review highlights that both residents and migrants are at high risk of nutritional disorders due to the adoption of Western beauty ideals. The results suggest that body dissatisfaction and BMI are increasing from Southern Africa to Europe according to a geographical gradient (described for females by Spearman's coefficient and linear regression, respectively). We emphasize the need for monitoring of the weight and psychological status of immigrants and the development of specific preventive strategies in European countries.

Similarities and differences in underlying beliefs of socio-cognitive factors related to diet and physical activity in lower-educated Dutch, Turkish, and Moroccan adults in the Netherlands: a focus group study

BACKGROUND

Unhealthy eating patterns and a lack of physical activity (PA) are highly prevalent in most Western countries, especially among lower-educated people, including people of non-Western origin. The aim of this study was to investigate and compare the beliefs and barriers that underlie socio-cognitive and planning constructs related to healthy eating and PA among lower-educated Dutch, Turkish, and Moroccan adults.

METHODS

Focus group interviews were conducted with 90 Dutch, Turkish, and Moroccan lower-educated adults between March and August 2012. Five semi-structured group interviews were conducted with Dutch participants, five with Turkish participants, and four with Moroccan participants. Men and women were interviewed separately. The question route was based on the Theory of Planned Behavior and self-regulation theories. The theoretical method used for the qualitative data analysis was content analysis. The interviews were recorded, transcribed, and analyzed by applying the framework approach.

RESULTS

Some participants seemed to lack knowledge of healthy eating and PA, especially regarding the health consequences of an unhealthy lifestyle. Important attitude beliefs concerning healthy eating and PA were taste and health benefits. Participants suggested that social support can encourage the actual performance of healthy behavior. For instance, exercising with other people was perceived as being supportive. Perceived barriers to PA and cooking healthily were a lack of time and tiredness. These previously mentioned beliefs arose in all the ethnic groups. Differences were also found in beliefs between the ethnic groups, which were mainly related to religious and cultural issues. Turkish and Moroccan participants discussed, for example, that the Koran contains the recommendation to eat in moderation and to take care of one's body. Furthermore, they reported that refusing food when offered is difficult, as it can be perceived as an insult. Finally, men and women usually cannot exercise in the same location, which was perceived as a barrier. These factors did not emerge in the Dutch groups.

CONCLUSIONS

The same cognitive beliefs were discussed in all three ethnic groups. The importance of cultural and religious factors appeared to be the most significant difference between the Turkish/Moroccan groups and the Dutch groups. Accordingly, interventions for all three ethnic groups should focus on socio-cognitive beliefs, whereas interventions for Turkish and Moroccan populations can additionally take religious and cultural rules into account.

Systematic mapping review of the factors influencing dietary behaviour in ethnic minority groups living in Europe: a DEDIPAC study

Background

Europe has a growing population of ethnic minority groups whose dietary behaviours are potentially of public health concern. To promote healthier diets, the factors driving dietary behaviours need to be understood. This review mapped the broad range of factors influencing dietary behaviour among ethnic minority groups living in Europe, in order to identify research gaps in the literature to guide future research.

Methods

A systematic mapping review was conducted (protocol registered with PROSPERO 2014: CRD42014013549). Nine databases were searched for quantitative and qualitative primary research published between 1999 and 2014. Ethnic minority groups were defined as immigrants/populations of immigrant background from low and middle income countries, population groups from former Eastern Bloc countries and minority indigenous populations. In synthesizing the findings, all factors were sorted and structured into emerging clusters according to how they were seen to relate to each other.

Results

Thirty-seven of 2965 studies met the inclusion criteria (n = 18 quantitative; n = 19 qualitative). Most studies were conducted in Northern Europe and were limited to specific European countries, and focused on a selected number of ethnic minority groups, predominantly among populations of South Asian origin. The 63 factors influencing dietary behaviour that emerged were sorted into seven clusters: social and cultural environment (16 factors), food beliefs and perceptions (11 factors), psychosocial (9 factors), social and material resources (5 factors), accessibility of food (10 factors), migration context (7 factors), and the body (5 factors).

Conclusion

This review identified a broad range of factors and clusters influencing dietary behaviour among ethnic minority groups. Gaps in the literature identified a need for researchers to explore the underlying mechanisms that shape dietary behaviours, which can be gleaned from more holistic, systems-based studies exploring relationships between factors and clusters. The dominance of studies exploring ‘differences’ between ethnic minority groups and the majority population in terms of the socio-cultural environment and food beliefs suggests a need for research exploring ‘similarities’. The evidence from this review will feed into developing a framework for the study of factors influencing dietary behaviours in ethnic minority groups in Europe.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0412-8) contains supplementary material, which is available to authorized users.

Weight status, fatness and body image perception of North African immigrant women in Italy

OBJECTIVE

To investigate the nutritional status of North African (NA) immigrant women in Italy, analysing their body size, adiposity and body image perception in comparison to Italian natives and NA residents.

DESIGN

The study utilized a cross-sectional design. Anthropometric traits were directly measured and a few indices were computed as proxy measures of nutritional status and adiposity. Body image perception was assessed using silhouette drawings. ANCOVA, adjusted for age, was used to compare anthropometric traits among different groups of women and the χ 2 test to analyse differences in the prevalence of nutritional status.

SETTING

Italy and North Africa (Tunisia, Morocco).

SUBJECTS

A sample of 433 women aged 18-60 years old: NA immigrants (n 105); Italians (n 100); Tunisians (n 104); Moroccans (n 124).

RESULTS

Overweight/obesity prevalence was very high in immigrants (79·8 %). Immigrants had the highest BMI value, the greatest hip circumference and mid upper-arm circumference. Their triceps skinfold thickness was significantly higher than that of Italians, but lower than that of NA residents.

CONCLUSIONS

NA immigrant women in Italy showed a higher incidence of overweight compared with Italians and NA residents. All groups showed a preference for a thinner body in comparison to their actual bodies and the immigrants are the most dissatisfied. Immigrants remain a high-risk group for obesity. Assessment of their body composition and health risk profile should be improved by using specific anthropometric measures that are easy to collect even in the case of large migration flows.

Comparison of energy balance-related behaviours and measures of body composition between Turkish adolescents in Turkey and Turkish immigrant adolescents in the Netherlands

OBJECTIVE

To explore the influences of migration to a Western country on obesity and related risk factors by comparing measures of body composition and energy balance-related behaviours between Turkish adolescents in Turkey (TR-TR) and adolescents from Turkish immigrant ethnicity in the Netherlands (TR-NL).

DESIGN

Cross-sectional survey or baseline intervention data from six Dutch school-based studies and one Turkish study.

SETTING

Primary and secondary schools.

SUBJECTS

A total of 915 (49 % girls; mean age 13·1 (sd 0·8) years) TR-TR adolescents and 433 (51 % girls; mean age 11·7 (sd 1·3) years) TR-NL adolescents were included. Outcome measures were self-reported sugar-containing beverage consumption, fruit and vegetable intake, screen time, physical activity, measured body height and weight, BMI, waist and hip circumferences, and skinfold thicknesses.

RESULTS

Our data showed that more TR-NL adolescents were overweight (31 % v. 26 %) and obese (9 % v. 6 %) and had significantly higher mean BMI (21·1 v. 20·0 kg/m2), waist circumference (72·2 v. 71·3 cm) and suprailiac skinfold thickness (19·8 v. 13·1 mm) than TR-TR adolescents. TR-NL adolescents reported significantly higher sugar-containing beverage consumption (1173 v. 115 ml/d), less fruit and vegetable intake (295 v. 647 g/d), less screen time (253 v. 467 min/d) and higher physical activity levels (61 v. 27 min/d) than TR-TR adolescents.

CONCLUSIONS

Immigrant adolescents in the Netherlands were more often overweight and had a less favourable dietary pattern than their peers in Turkey, while their physical activity and screen time patterns were more favourable. These results suggest that adolescents from Turkish immigrant ethnicity in the Netherlands have adopted lifestyles towards the host culture.

Overweight and obesity in young Turkish, Moroccan and Surinamese migrants of the second generation in the Netherlands

OBJECTIVE

To examine differences in overweight and obesity of second-generation Turkish, Moroccan and Surinamese migrants v. first-generation migrants and the ethnic Dutch. We also studied the influence of sociodemographic factors on this association.

DESIGN

Data were collected in 2008 in a cross-sectional postal and online health survey.

SETTING

Four major Dutch cities.

SUBJECTS

In the survey 42 686 residents aged 16 years and over participated. Data from Dutch (n 3615) and second/first-generation Surinamese (n 230/139), Turkish (n 203/241) and Moroccan (n 172/187) participants aged 16-34 years were analysed using logistic regression with overweight (BMI ≥ 25·0 kg/m²) and obesity (BMI ≥ 30·0 kg/m²) as dependent variables. BMI was calculated from self-reported body height and weight. Sociodemographic variables included sex, age, marital status, educational level, employment status and financial situation.

RESULTS

After controlling for age, overweight (including obesity) was more prevalent in most second-generation migrant subgroups compared with the Dutch population, except for Moroccan men. Obesity rates among second-generation migrant men were similar to those among the Dutch. Second-generation migrant women were more often obese than Dutch women. Ethnic differences were partly explained by the lower educational level of second-generation migrants. Differences in overweight between second- and first-generation migrants were only found among Moroccan and Surinamese men.

CONCLUSIONS

We did not find a converging trend for the overweight and obesity prevalence from second-generation migrants towards the Dutch host population. Therefore, preventive interventions should also focus on second-generation migrants to stop the obesity epidemic.

The association between physical environment and cycling to school among Turkish and Moroccan adolescents in Amsterdam

OBJECTIVES

This study examined the effect of physical environment on cycling to and from school among boys and girls of Turkish and Moroccan origin living in Amsterdam.

METHODS

The LASER study (n = 697) was an interview study that included information on cycling to and from school and the perceived physical environment. Objective information on physical environment was gathered from Statistics Netherlands and the Department for Research and Statistics at the Municipality of Amsterdam. Structural equation modelling with latent variables was applied, taking into account age, gender, self-assessed health, education, country of origin, and distance to school.

RESULTS

For every unit increase in the latent variable scale for bicycle-friendly infrastructure, we observed a 21% increase in the odds for cycling to and from school. The association was only borderline statistically significant and disappeared after controlling for distance to school. The enjoyable environment was not associated with cycling to and from school after controlling for all background factors.

CONCLUSIONS

Bicycle-friendly infrastructure and an enjoyable environment were not important factors for cycling to and from school among those with no cultural cycling background.

Community energy balance: a framework for contextualizing cultural influences on high risk of obesity in ethnic minority populations

INTRODUCTION

Increases in the availability, affordability, and promotion of high-calorie foods and beverages and decreased obligations for routine physical activity have fostered trends of increased obesity worldwide. In high-income, plural societies, above average obesity prevalence is often observed in ethnic minority communities, suggesting that obesity-promoting influences are more prevalent or potent in these communities.

METHODS

An interdisciplinary group of scholars engaged in multiple rounds of focused discussion and literature review to develop a Community Energy Balance Framework (CEB). The objective was to explore the nature of the excess obesity risk in African descent and other ethnic minority populations and identify related implications for planning and evaluating interventions to prevent obesity.

RESULTS

A key principle that emerged is that researchers and programmers working with ethnic minority communities should contextualize the food- and physical activity-related sociocultural perspectives of these communities, taking into account relevant historical, political, and structural contexts. This perspective underscores the fallacy of approaches that place the entire burden of change on the individual, particularly in circumstances of social disadvantage and rapid cultural shifts.

CONCLUSION

The CEB framework is proposed for use and further development to aid in understanding potential health-adverse effects of cultural-contextual stresses and accommodations to these stresses.