Diversity in health outcomes

There are important differences in health outcomes and risk levels between ethnic groups, which is why BMI thresholds need to take ethnicity into account. Several studies have shown that people from specific ethnic backgrounds experience higher risks of hypertension and cardiovascular disease at lower BMI levels than White populations because of increased levels of abdominal visceral fat.

Unlike subcutaneous fat, which sits beneath the skin and serves as an energy reserve, visceral fat surrounds the organs and increases the risk of insulin resistance and inflammation. It is linked to a higher risk of metabolic diseases such as type 2 diabetes and hypertension.

This contributes to what has been described as a ‘thin outside, fat inside’ (TOFI) or ‘skinny fat’ phenotype, which is commonly seen in South Asian populations – even in people with a normal BMI. The reasons for this fat distribution pattern are unclear, but it may reflect shared genomic factors.

Targeting dietary weight management and physical activity advice to people from ethnic minority groups is therefore an important priority, given that adverse health risks occur at lower BMI thresholds.

However, weight management approaches need to be tailored for patients from diverse ethnic backgrounds because cultural, dietary and socioeconomic factors all vary and significantly influence health behaviours.

Pharmacy teams should develop the skills needed to support patients from diverse cultural backgrounds and demonstrate cultural sensitivity, which helps build trust and improve the effectiveness of weight management support.

Cultural competence and sensitivity

The term ‘culture’ can be interpreted in various ways, but broadly refers to shared patterns of thinking, feeling, believing, reacting and problem-solving. Cultural competence means that healthcare professionals can understand, communicate and interact effectively with people from different ethnic minority backgrounds.

A person’s food choices are influenced by many factors, including household dynamics, community influences and socio-cultural norms. As a result, culturally appropriate weight management advice is more likely to benefit people from different ethnic backgrounds than standardised, traditional approaches.

In terms of weight management advice, cultural competence enables pharmacy teams to:

• Provide tailored care that aligns with a person’s values, beliefs and personal needs
• Reduce the potential for health inequalities
• Improve health outcomes.

The most important aspects of weight management advice are personalisation and respect: in other words, treating someone as an individual while acknowledging ethnic-specific risks and cultural contexts.

Food is an important part of identity and traditional foods are often highly valued. Research involving South Asian patients has shown that both family and community pressures to conform to social norms can strongly influence the consumption of traditional foods.

Translating dietary advice to align with traditional cultural foods can be challenging and any recommendations should be framed within the context of those foods rather than advocating a Westernised diet.

In addition, offering weight management advice to patients from diverse cultures requires recognition of several potential barriers that must be addressed. In essence, pharmacists should always adopt a culturally competent, person-centred approach.