Skip to main content Accessibility help

Global cities and cultural diversity: challenges and opportunities for young people's nutrition

  • Seeromanie Harding (a1) (a2), Christelle Elia (a1), Peiyuan Huang (a1), Chelsea Atherton (a2), Kyla Covey (a2), Gemma O'Donnell (a1), Elizabeth Cole (a1), Manal Almughamisi (a1), Ursula M. Read (a1), Alexandru Dregan (a2), Trevor George (a1), Ingrid Wolfe (a2), J. Kennedy Cruickshank (a1), Maria Maynard (a3), Louise M. Goff (a1) and Majella O'Keeffe (a1)...


Childhood obesity is a common concern across global cities and threatens sustainable urban development. Initiatives to improve nutrition and encourage physical exercise are promising but are yet to exert significant influence on prevention. Childhood obesity in London is associated with distinct ethnic and socio-economic patterns. Ethnic inequalities in health-related behaviour endure, underpinned by inequalities in employment, housing, access to welfare services, and discrimination. Addressing these growing concerns requires a clearer understanding of the socio-cultural, environmental and economic contexts of urban living that promote obesity. We explore opportunities for prevention using asset based-approaches to nutritional health and well-being, with a particular focus on adolescents from diverse ethnic backgrounds living in London. We focus on the important role that community engagement and multi-sectoral partnership play in improving the nutritional outcomes of London's children. London's children and adolescents grow up in the rich cultural mix of a global city where local streets are characterised by diversity in ethnicities, languages, religions, foods, and customs, creating complex and fluid identities. Growing up with such everyday diversity we argue can enhance the quality of life for London's children and strengthen their social capital. The Determinants of young Adult Social well-being and Health longitudinal study of about 6500 of London's young people demonstrated the positive impact of cultural diversity. Born to parents from over a hundred countries and exposed to multi-lingual households and religious practices, they demonstrated strong psychological resilience and sense of pride from cultural straddling, despite material disadvantage and discrimination. Supporting the potential contribution of such socio-cultural assets is in keeping with the values of social justice and equitable and sustainable development. Our work signals the importance of community engagement and multisectoral partnerships, involving, for example, schools and faith-based organisations, to improve the nutrition of London's children.


Corresponding author

*Corresponding author: Seeromanie Harding, email


Hide All
1.Bronfenbrenner, U (1979) The Ecology of Human Development. Experiments by Nature and Design. Cambridge, MA: Harvard University Press.
2.Al-Khudairy, L, Loveman, E, Colquitt, JL et al. (2017) Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database Syst Rev 6, CD012691.
3.Office National Statistics (2011) Ethnicity and National Identity in England and Wales: 2011. London: Office National Statistics.
4.Fukuyama, F (1995) Social capital and the global economy. Foreign Affairs 74, 89103.
5.Putnam, RD (2000) Bowling Alone: The Collapse and Revival of American Community. New York: Simon and Schuster.
6.Waterston, T, Alperstein, G & Stewart Brown, S (2004) Social capital: a key factor in child health inequalities. Arch Dis Child 89, 456459.
7.Laurence, J (2009) The effect of ethnic diversity and community disadvantage on social cohesion: a multi-level analysis of social capital and interethnic relations in UK communities. Eur Sociol Rev 27, 7089.
8.Stolle, D, Soroka, S & Johnston, R (2008) When does diversity erode trust? Neighborhood diversity, interpersonal trust and the mediating effect of social interactions. Polit Stud (Oxf) 56, 5775.
9.Rawlins, E, Baker, G, Maynard, M et al. (2013) Perceptions of healthy eating and physical activity in an ethnically diverse sample of young children and their parents: the DEAL prevention of obesity study. J Hum Nutr Diet 26, 132144.
10.Leeser, R (2016) English Indices of Deprivation 2015. Intelligence Briefing 2016–01. London: Greater London Authority.
11.Public Health England (2017) Public Health Profiles. London: Public Health England.
12.Cabinet Office (2017) Race Disparity Audit. London, UK: Cabinet Office.
13.Riste, L, Khan, F & Cruickshank, K (2001) High prevalence of type 2 diabetes in all ethnic groups, including Europeans, in a British inner city: relative poverty, history, inactivity, or 21st century Europe? Diabetes Care 24, 13771383.
14.Tillin, T, Hughes, AD, Mayet, J et al. (2013) The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent Revisited) – a prospective population-based study. J Am Coll Cardiol 61, 17771786.
15.Whincup, PH, Nightingale, CM, Owen, CG et al. (2010) Early emergence of ethnic differences in type 2 diabetes precursors in the UK: the Child Heart and Health Study in England (CHASE Study). PLoS Med 7, e1000263.
16.Harding, S, Whitrow, M, Lenguerrand, E et al. (2010) Emergence of ethnic differences in blood pressure in adolescence: the determinants of adolescent social well-being and health study. Hypertension 55, 10631069.
17.Sheehan, P, Sweeny, K, Rasmussen, B et al. (2017) Building the foundations for sustainable development: a case for global investment in the capabilities of adolescents. Lancet 390, 17921806.
18.Public Health England (2017) National Child and Maternal Health Intelligence Network. London: Public Health England.
19.Lake, A & Townshend, T (2006) Obesogenic environments: exploring the built and food environments. J R Soc Promot Health 126, 262267.
20.Harding, S, Whitrow, M, Maynard, MJ et al. (2007) Cohort profile: the DASH (determinants of adolescent social well-being and health) study, an ethnically diverse cohort. Int J Epidemiol 36, 512517.
21.Kuh, D & Shlomo, BY (2004) A Life Course Approach to Chronic Disease Epidemiology. Oxford, UK: Oxford University Press.
22.Bradby, H (2003) Describing ethnicity in health research. Ethn Health 8, 513.
23.Maynard, MJ, Harding, S & Minnis, H (2007) Psychological well-being in Black Caribbean, Black African, and White adolescents in the UK Medical Research Council DASH study. Soc Psychiatry Psychiatr Epidemiol 42, 759769.
24.Bhui, K, Silva, MJ, Harding, S et al. (2017) Bullying, social support, and psychological distress: findings from RELACHS cohorts of East London's White British and Bangladeshi adolescents. J Adolesc Health 61, 317328.
25.Klimidis, S, Minas, IH, Ata, AW et al. (1992) Construct validation in adolescents of the brief current form of the Parental Bonding Instrument. Compr Psychiatry 33, 378383.
26.Sweeting, H & West, P. Family life and health in adolescence: a role for culture in the health inequalities debate? Soc Sci Med 1995; 40: 163175.
27.Bhui, K, Stansfeld, S, Head, J et al. (2005) Cultural identity, acculturation, and mental health among adolescents in east London's multiethnic community. J Epidemiol Community Health 59, 296302.
28.Harding, S, Read, UM, Molaodi, OR et al. (2015) The determinants of young adult social well-being and health (DASH) study: diversity, psychosocial determinants and health. Soc Psychiatry Psychiatr Epidemiol 50, 11731188.
29.Stansfeld, SA, Haines, MM, Head, JA et al. (2004) Ethnicity, social deprivation and psychological distress in adolescents: school-based epidemiological study in east London. Br J Psychiatry 185, 233238.
30.Assari, S (2013) Race and ethnicity, religion involvement, church-based social support and subjective health in United States: a case of moderated mediation. Int J Prev Med 4, 208217.
31.Berry, JW, Phinney, JS, Sam, DL et al. (2006) Immigrant youth: acculturation, identity and adaptation. Appl Psychol-Int Rev 55, 303332.
32.Schwartz, SJ, Unger, JB, Zamboanga, BL et al. (2010) Rethinking the concept of acculturation: implications for theory and research. Am Psychol 65, 237251.
33.Lim, SS, Vos, T, Flaxman, AD et al. (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 22242260.
34.Lock, K, Pomerleau, J, Causer, L et al. (2005) The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet. Bull World Health Organ 83, 100108.
35.Aune, D, Giovannucci, E, Boffetta, P et al. (2017) Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol 46, 10291056.
36.Maynard, M, Gunnell, D, Emmett, P et al. (2003) Fruit, vegetables, and antioxidants in childhood and risk of adult cancer: the Boyd Orr cohort. J Epidemiol Community Health 57, 218225.
37.Wang, X, Ouyang, Y, Liu, J et al. (2014) Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. Br Med J 349, g4490.
38.Albertson, AM, Franko, DL, Thompson, D et al. (2007) Longitudinal patterns of breakfast eating in black and white adolescent girls. Obesity 15, 22822292.
39.Donin, AS, Nightingale, CM, Owen, CG et al. (2014) Regular breakfast consumption and type 2 diabetes risk markers in 9- to 10-year-old children in the child heart and health study in England (CHASE): a cross-sectional analysis. PLoS Med 11, e1001703.
40.Rampersaud, GC, Pereira, MA, Girard, BL et al. (2005) Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc 105, 743760, quiz 761–762.
41.Keski-Rahkonen, A, Kaprio, J, Rissanen, A et al. (2003) Breakfast skipping and health-compromising behaviors in adolescents and adults. Eur J Clin Nutr 57, 842853.
42.Pearson, N, Biddle, SJ & Gorely, T (2009) Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review. Public Health Nutr 12, 267283.
43.Pearson, N, Biddle, SJ & Gorely, T (2009) Family correlates of breakfast consumption among children and adolescents. A systematic review. Appetite 52, 17.
44.O'Dea, JA & Caputi, P (2001) Association between socioeconomic status, weight, age and gender, and the body image and weight control practices of 6- to 19-year-old children and adolescents. Health Educ Res 16, 521532.
45.Parker, G, Tupling, H & Brown, LB (1979) A parental bonding instrument. Br J Med Psychol 52, 110.
46.Neumark-Sztainer, D, Story, M, French, S et al. (1996) Patterns of health-compromising behaviors among Minnesota adolescents: sociodemographic variations. Am J Public Health 86, 15991606.
47.Giskes, K, Turrell, G, Patterson, C et al. (2002) Socio-economic differences in fruit and vegetable consumption among Australian adolescents and adults. Public Health Nutr 5, 663669.
48.Leech, RM, McNaughton, SA & Timperio, A (2014) The clustering of diet, physical activity and sedentary behavior in children and adolescents: a review. Int J Behav Nutr Phys Act 11, 4.
49.Hardy, LL, Grunseit, A, Khambalia, A et al. (2012) Co-occurrence of obesogenic risk factors among adolescents. J Adolesc Health 51, 265271.
50.Bagwell, S (2011) The role of independent fast-food outlets in obesogenic environments: a case study of East London in the UK. Environ Planning 43, 22172236.
51.Townshend, T & Lake, A (2017) Obesogenic environments: current evidence of the built and food environments. Perspect Public Health 137, 3844.
52.Cruickshank, JK, Silva, MJ, Molaodi, OR et al. (2016) Ethnic differences in and childhood influences on early adult pulse wave velocity: the determinants of adolescent, now young adult, social wellbeing, and health longitudinal study. Hypertension 67, 11331141.
53.Harding, S, Silva, MJ, Molaodi, OR et al. (2016) Longitudinal study of cardiometabolic risk from early adolescence to early adulthood in an ethnically diverse cohort. BMJ Open 6, e013221.
54.Molaodi, OR, Leyland, AH, Ellaway, A et al. Neighbourhood food and physical activity environments in England, UK: does ethnic density matter? Int J Behav Nutr Phys Act 2012; 9: 75.
55.Gore, FM, Bloem, PJ, Patton, GC et al. (2011) Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet 377, 20932102.
56.Patton, GC, Coffey, C, Romaniuk, H et al. (2014) The prognosis of common mental disorders in adolescents: a 14-year prospective cohort study. Lancet 383, 14041411.
57.Elia, CE, Karamanos, A, João Silva, AM et al. (2017) Discordance between perceived body size and actual body size and psychological wellbeing in adolescence: Evidence from the DASH longitudinal study. Nutrition Society Summer Conference 2017: Improving nutrition in metropolitan areas. London, UK.
58.Duong, HT & Roberts, RE (2014) Perceived weight in youths and risk of overweight or obesity six years later. J Psychosom Res 76, 2327.
59.Park, E (2011) Overestimation and underestimation: adolescents’ weight perception in comparison to BMI-based weight status and how it varies across socio-demographic factors. J Sch Health 81, 5764.
60.McCabe, MP, Mavoa, H, Ricciardelli, LA et al. (2011) Socio-cultural agents and their impact on body image and body change strategies among adolescents in Fiji, Tonga, Tongans in New Zealand and Australia. Obes Rev 12, 6167.
61.Schell, SF, Luke, DA, Schooley, MW et al. (2013) Public health program capacity for sustainability: a new framework. Implement Sci 8, 15.
62.Maynard, M, Baker, G & Harding, S (2017) Exploring childhood obesity prevention among diverse ethnic groups in schools and places of worship: Recruitment, acceptability and feasibility of data collection and intervention components. Prev Med Rep 6, 130136.
63.Maynard, MJ (2017) Faith-based institutions as venues for obesity prevention. Curr Obes Rep 6, 148154.
64.Andrews, T & Entwistle, E (2010) Does cross-sectoral partnership deliver? An empirical exploration of public service effectiveness, efficiency, and equity. J Public Adm Res Theory 20, 679701.
65.Merzel, C & D'Afflitti, J (2003) Reconsidering community-based health promotion: promise, performance, and potential. Am J Public Health 93, 557574.
66.Israel, BA, Schulz, AJ, Parker, EA et al. (1998) Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health 19, 173202.
67.Burke, JG, O'Campo, P, Peak, GL et al. (2005) An introduction to concept mapping as a participatory public health research method. Qual Health Res 15, 13921410.
68.Wang, C & Burris, MA (1997) Photovoice: concept, methodology, and use for participatory needs assessment. Health Educ Behav 24, 369387.
69.Popkin, BM (2017) Relationship between shifts in food system dynamics and acceleration of the global nutrition transition. Nutr Rev 75, 7382.
70.World Health Organization and Centers for Disease Control and Prevention (2010) Global School-based Student Health Survey. Available at (Accessed November 2017).
71.Almughamisi, M, George, T & Harding, S. (2017) Prevalence of overweight and obesity among children and adolescents in Saudi Arabia. Nutrition Society Summer Conference 2017: Improving nutrition in metropolitan areas. London, UK.
72.Miller, V, Yusuf, S, Chow, CK et al. (2016) Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet Global Health 4, e695e703.
73.Harding, S, Teyhan, A, Maynard, MJ et al. (2008) Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. Int J Epidemiol 37, 162172.
74.Huang, P, O'Keeffe, M & Harding, SH (2018) Fruit and Vegetable Consumption and Psychological Wellbeing in Adolescence: Evidence from the Multi-Ethnic Determinants of Adolescent Social Wellbeing and Health (DASH) Longitudinal Study. Department of Nutritional Sciences. London: King's College London.
75.Currie, CE, Elton, RA, Todd, J et al. (1997) Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey. Health Educ Res 12, 385397.
76.O'Donnell, G, Harding, SH & O'Keeffe, M. (2018) Inside the Mind of A Child: Assessing the External Influences on Unhealthy Food Choices on Black African and Black Caribbean Adolescents. Department of Nutritional Sciences. London: King's College London.
77.Krieger, N & Sidney, S (1996) Racial discrimination and blood pressure: the CARDIA Study of young black and white adults. Am J Public Health 86, 13701378.
78.Elia, C, Karamanos, A, Joao Silva, AM et al. (2017) Discordance between perceived body-size and actual body-size and psychological well-being in adolescence: evidence from the DASH longitudinal study. West Indian Med J 66, 10.
79.Cole, TJ, Bellizzi, MC, Flegal, KM et al. (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. Br Med J 320, 12401243.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed