Big is beautiful? A survey of body image perception and its relation to health in British Bangladeshis with diabetes

Abstract

It is widely believed that some ethnic minorities consider large body size to be attractive and indicative of health and fertility. We surveyed 96 Bangladeshis with diabetes, randomly sampled from GP diabetes registers in London. Participants were interviewed in their mother tongue by a Bangladeshi anthropologist, and asked to select which of nine standard body forms (from 1 = very thin to 9 = very fat) matched each of 57 statements including “[the figure with the] best health”, “most beautiful”, “most fertile”, and so on. We discerned an important linguistic distinction between “most health” and “best health”. Over 80% of participants linked “most health” with the fattest figure and “least health” with the thinnest. In contrast, “best health”, “most beautiful”, “most fertile” and “least likely to get diabetes” were linked with a medium-sized figure, and “worst health” with extremes of body size. Participants accurately estimated their own body size, and women (but not men) felt they were significantly larger than they would like to be. Participants believed they had got thinner by (on average) 0.6 figure sizes since the onset of diabetes and would continue to do so. This perception was significantly greater in those with fewer years of formal education. Our findings suggest that Bangladeshis with diabetes see obesity as unattractive, unhealthy, associated with low fertility, and linked to diabetes and heart disease. However, they believe that they have lost weight since developing diabetes and that their weight loss will continue. These findings have implications for the design of health education programmes, which should move beyond the erroneous stereotype that “Asians like to be fat”.

Keywords:

• Body image
• ethnic minorities
• diabetes
• obesity

Acknowledgements

This study was funded by the Wellcome Trust. We are grateful to the GP practices and study participants for their time and co-operation. We also thank two anonymous referees for helpful comments on an earlier draft of this paper.