ADIPOSITY IN BRITISH PAKISTANI AND WHITE BRITISH SCHOOL
CHILDREN AGED 7-11 YEARS LIVING IN MIDDLESBROUGH, UK:
ASSOCIATIONS WITH ETHNICITY, GENERATION, AND BIRTH WEIGHT

Abstract

People of South Asian ethnicities in the UK are at a high risk of obesity and related illnesses. This thesis tests predictions derived from the developmental origins literature regarding adiposity in British Pakistanis in middle childhood. Based on previous research, it was
predicted that British Pakistani children would be more adipose and have lower birth weights compared to white British children. It was also predicted that second generation British Pakistani children would be more adipose and have lower birth weights than the third
generation. White British children (n=211) and British Pakistani children (n=137), including second generation (n=82) and third generation (n=51), aged 7-11 years were measured for body mass index (BMI), waist circumference, triceps and subscapular skinfold thicknesses, blood pressure, and resting heart rate. Birth weight data were collected from one hospital in Middlesbrough (n=184). In addition, a pilot study was conducted on lifestyle, which explored potential differences in British Pakistani children’s lifestyle that may affect adiposity. Dietary
data (n=30) were gathered by multiple-pass recall interviews. Physical activity data were collected by accelerometry (n=27) and also by multiple-pass recall interviews (n=30). A questionnaire was developed for the lifestyle pilot to gain an understanding of parents’
(n=24) knowledge and practices of healthy lifestyles. Focus group interviews were conducted in one school with children (n=18), which explored children’s knowledge and practices of
healthy lifestyles. The same focus groups also explored the issue of child participation in the study to understand different motivations between ethnicities and sexes.

Compared to white British children, British Pakistani children were significantly fatter by standard deviation scores for triceps (p=0.003) and subscapular skinfolds (p<0.000), but not by BMI (p=0.599) or waist circumference (p=0.253). British Pakistani children had significantly lower birth weights (p<0.001), and were more frequently classified as low birth weight (p=0.01) and small-for-gestational age (p<0.001). These results may support the foetal origins hypothesis, which is that early life influences can adversely affect later health, by
linking foetal development with adiposity in childhood. There was a higher proportion of overfat by subscapular skinfold thickness (p<0.001) in second generation British Pakistani boys compared to the third generation. The two generation groups did not differ significantly
in any measure of birth weight. The lifestyle pilot sub-study suggests that differences in lifestyle patterns may exist between the British Pakistani and white British families who participated, and it could provide a basis for a full study on this topic. Methods implemented in public health research should reconsider using the body mass index alone as a predictor of body fatness, especially in populations including British Pakistanis. Qualitative
methodologies should be used to inform study design as a way of illuminating complex and interrelated issues such as obesity and ethnicity.