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Association of socioeconomic position with insulin resistance among children from Denmark, Estonia, and Portugal: cross sectional study

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7510.183 (Published 21 July 2005) Cite this as: BMJ 2005;331:183

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Community values, social advancement and health behaviour.

Dear Editor,

The authors provide a fascinating account of the different health
effects of social advancement in different countries. I do not find that
surprising, having seen the effect of socioeconomic advancement on the
diet and lifestyle of some Indian communities in India. In fact, I have
often wondered whether the deleterious effect of social advancement could
explain the high incidence of coronary artery disease among Asian
expatriates in the UK.

Refined sugar and high quality oil were expensive and difficult to
get hold of in the rural community from which my parents came. Only the
rich and the socially advanced could afford to regularly have high-quality
sweets and fatty foods. Others could only enjoy such foods during feasts;
making the ability to eat such unhealthy food a sign of a person's status.
Another status symbol was the ability to avoid strenuous physical
exertion; the ability to get away from the fat-busting labours of the
common lot.

It is therefore not surprising that the people of my parents'
generation used to consider that looking 'well-fed' and squidgy was
desirable. This was a culture that encouraged obesity among those who
could afford it. A culture that primed its expatriates to use their
newfound wealth to indulge excessively in oily and sweet food; to indulge
in inactivity and a life of leisure.

So maybe the rise of insulin resistance and obesity in some
communities is not Westernisation after all. Maybe people are just paying
the price for playing out the fantasies of their forefathers!

Competing interests:
None declared

Competing interests: No competing interests

25 July 2005
Arvindan Veiraiah
SpR Clinical Pharmacology
Llandough Hospital, CF64 2XX
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