Informed

The big South Asian health challenge

South Asians living in the UK are at increased risk of Type 2 diabetes and insulin resistance. High insulin levels are a possible risk factor for some types of cancer and a major risk factor for cardiovascular disease. In a multicultural society, such as modern Britain, it is important for health professionals to be informed on the health problems affecting different communities.

We asked experienced dietitian, broadcaster and best-selling author, Azmina Govindji, to explain why South Asians today face such a big health challenge and to share her top tips for a balanced diet for people from this community. Azmina has recently helped set up a new website, The Ismaili Nutrition Centre [1], which helps families factor health and nutrition into the preparation of their daily meals.

Why are insulin resistance and Type 2 diabetes higher among South Asians?

I think this is a multifactorial issue. Firstly, genetically, South Asian people appear to be more at risk of these conditions. Secondly, we know that when they put on weight, particularly men, they tend to put it on around the abdomen, which is linked with insulin resistance and a greater incidence of conditions such as Type 2 diabetes and cardiovascular disease. Thirdly, all of this is combined with a lower rate of physical activity, as the South Asian community doesn’t tend to be so active. Obviously, this depends on generation. It is very hard for us to generalize, but if you look at first generation immigrants they will be unlikely to attend the gym and cultural restrictions may not allow them to wear a swimming costume.

Another factor is eating habits. The Ismaili Nutrition Centre [1] recipes were collected from real communities, including Pakistani, Bangladeshi and Ismaili families, by King’s College London. We also had published data from Gujarati and Punjabi families. This is the first time that nutrition composition data were collected from individual households and published into a data book for professionals. When we compiled the recipes for the website, we thought hard about including many of them because they were so ‘red’ in terms of traffic lights. Many recipes were high in ghee and saturated fat with a very high salt level, which is a risk factor for stomach cancer and high blood pressure.

Those data were published in 2000 but I haven’t seen evidence to suggest that things have changed very much since then. And the younger generation immigrants will probably be having a mix of hectic lifestyles, ready meals and takeaways, as well as having some of the traditional foods their grandparents are cooking.

Are they taking the worst of both worlds in terms of calories and fat?

Possibly. We don’t have the data to prove this so we need to be careful. We don’t exactly know why there is a raised incidence of some conditions among South Asians, but we do know there are some key areas where more research is needed.

So do you think diet plays a big part?

It is difficult to generalise. All we can say is that the data collected by King’s College London showed an imbalance of saturated fats and salt intake.

I have noticed, anecdotally, that generally South Asians have a high intake of carbohydrates. For example, a typical meal might consist of potato and vegetable curry, some chapattis and rice. So you get three large servings of carbohydrate in a meal.

And it would probably be potatoes without the skin, white rice and white chapatti flour, so possibly a diet rich in less healthy refined carbohydrates.

Do you have any tips to make healthier versions of traditional recipes?

On the Ismaili Nutrition Centre website we give a list of healthy cooking tips such as substituting ghee with rapeseed or olive oil, using spray oils rather then pouring oil from the bottle and using a spoon to measure fats and salt instead of just ‘eyeing’ it. Another key piece of advice is helping people achieve the right balance of foods on the plate. An unbalanced plate might be filled half with beef curry and half with rice and chapattis. I suggest a balanced plate where only a quarter would be filled with beef curry and a quarter with rice or chapattis, while half the plate would be made up of salad and curried vegetables.

How can health professionals help South Asian families manage their weight?

I think we need to build a rapport. It is very important to understand their culture and dietary habits. You can only build a rapport if you have a true understanding of how dietary habits are affected by culture and even religion in some cases. For example, it may be considered impolite or ungrateful to leave food; some may believe that dishes aren’t tasty if they don’t have an oily layer on top; it is common practice to give sugary tea to children; and often young children who are weaned are given solids like rusk in their milk bottle, which can affect nutrient intake. When health professionals give dietary advice to South Asian communities they will be more effective communicators if they take these cultural beliefs and traditions into account.

Do you think reversing the trends in Type 2 diabetes will be challenging?

Of course it is a big health challenge. For example, South Asian people are up to six times more likely to have Type 2 diabetes, but we don’t fully know why. What we can do is try to make sure that healthy lifestyle habits are in place before diagnosis and that cultural issues form part of dietary management after diagnosis. This is exactly the message I use in my role as lead dietitian for the Change4Life BME interventions.

References

1. www.theismaili.org/nutrition