A socio-cultural study investigating the influences on food and lifestyle choices, and the cultural transition, of British Bangladeshis living in Tower Hamlets East London

The prevalence of obesity and Type 2 diabetes is increasing world-wide being most evident in non-industrialised populations, and in deprived communities and minority ethnic groups, residing in the "affluent west". In the UK, the South Asian population, and in particular the Bangladeshi community, are up to six times more likely than the general population to have Type 2 diabetes. In Tower Hamlets East London, the prevalence is higher than both the London and England average; with over half of the cases being Bangladeshi. There is strong evidence that it is the interaction between an altered lifestyle, associated with economic development and urbanisation, which has triggered this massive increase in the prevalence of Type 2 diabetes. Genetic causes, and poor foetal and infant nutrition, are also seen as contributory factors. Central to this thesis was the preposition that obesity and Type 2 diabetes are largely preventable and amenable to a wide range of public health prevention strategies. Too often a reductionist medical approach has been taken with the focus on individual behavioural change and few links to the culture of food and eating, or to the broader social, political, or economic context in which people live. This trans-cultural study utilised qualitative approaches over three phases: paired interviews, in-depth semi-structured interviews and multiple pass dietary recall; drawing upon current social science and public health nutrition paradigms to investigate the contextual factors influencing food choices and physical activity, as perceived by the community itself and key informants, as well as the trend in eating patterns between two generations of British Bangladeshis. Multiple drivers were revealed to be influencing food and activity choices with the community being significantly affected by urbanisation, being immersed in an obesogenic environment, the degree of acculturation into the British society and changes to the patriarchal structure of their community. The policy framework at the time of this research reflected an epistemological dilemma of a social issue continuing to be addressed with a largely clinical solution and the perception of a Government which despite outward appearances to the contrary, remained committed to the personalisation of the health agenda. The most recent change to the Coalition Government has seen this paradigm continuing, jarring sharply with the lived realities of the community and the overwhelming evidence that the obesity and diabetes epidemics cannot be dealt with by promoting behavioural change and individualised treatment alone. The long lasting theory in Public Health that the social dimensions of health need to be addressed in conjunction with biological determinants has been confirmed with a complex web of interactions weaving together to influence the choices being made, highlighting the interconnectedness of diet and culture, and the relationship to a culture in transition. The vast array of factors have substantial implications for further development of food and public health policy for this community relating to the prevention diet related non-communicable diseases, as well as for professional practice