Food beliefs and practices among British Bangladeshis with diabetes: Implications for health education

In order successfully to promote 'healthier' food choices, health professionals must first understand how people classify and select the foods they eat. We explored the food beliefs and classification system of British Bangladeshis by means of qualitative interviews with 40 first-generation adult immigrants with diabetes. Methods included audiotaped, unstructured narrative interview in which participants were invited to 'tell the story' of how diabetes affects them, pile sorting of food items, and participant observation of meals. We found considerable heterogeneity of individual food choices against a background of structural and economic factors (i.e. food choices were partly determined by affordability and availability), as well as cultural influences. Important themes included strong religious restrictions on particular food items (chiefly the Islamic prohibition of pork), and widely held ethnic customs based on the availability of foods in rural Bangladesh. Modification of the diet on immigration did not generally incorporate many 'Western' foods but included increased quantities of 'special menu' Bangladeshi foods such as meat and traditional sweets. Foods were not classified or selected according to Western notions of food values (protein, carbohydrate, etc.). Rather, within religious and ethnic patterns, further food choices were determined by two interrelated and intersecting binary classification systems: 'strong'/'weak' and 'digestible'/'indigestible', which appear to replace the 'hot'/'cold' classification prevalent elsewhere in South Asia. Different methods of cooking (especially baking and grilling) were perceived to alter the nature of the food. A desire for dietary balance, and a strong perceived link with health, was apparent. These findings have important implications for the design of health education messages. Dietary advice should reflect religious restrictions, ethnic customs and the different cultural meaning of particular foods, while also acknowledging the ability of the individual to exercise choice within those broad limits.