Research Article Obesity in Somali Immigrant Women Due to Post-Migration Dietary Changes and Decreasing Self-Esteem?
A Qualitative Interview Study on Diet, Knowledge about Risk of Heart Disease, Inactivity, Body Image and Self-Esteem
Ellis Janzon and Ingrid Bolmsjö
The last-decade incidence of myocardial infarction (MI) has diminished dramatically in most age groups but not in middle-aged women in Sweden. There has been a large influx of immigrants and it has been shown that immigrant women have a higher BMI and are less physically active than Swedish women. Thereby they have a higher risk for heart disease. The aim of the study was to examine post-migration dietary changes, and knowledge about risks for heart diseases among Somali women. Furthermore, to examine the women’s perceptions of body image, self-esteem, and their knowledge about the positive effect of physical activity. The qualitative research method was used and eight Somali women aged 40 years or more, who have lived in Sweden longer than ten years, were interviewed with the help of a semistructured questionnaire. The study revealed that Somali migrated women in Sweden had changed their diet and experienced weight increase. They reported low self-esteem and little motivation for physical activity. They understood that they had a higher risk for heart disease as compared to Swedish women and they had, in general, a preference for big body size. The women of this study are, in combination with other risk factors, at a high risk of myocardial infarction. They all revealed a general knowledge about the relationship between obesity and inactivity and enhanced risks for heart disease. They had a preference for a larger female body image. They expressed low self-esteem, loneliness, and alienation from society. It is important to address the health issue among migrant Somali women in Sweden, but since this study had few informants, larger studies and more science is needed to further investigate the problem.
The themes that emerged were: • Effects of post-migration dietary in lifestyle changes, and scarcity versus abundance of food. • lack of knowledge and fear about disease • Weight gain and low self-esteem • Culture and body image • Loneliness and alienation • Somali culture and obstacles to physical activity Effects of Post-Migration Dietary in Lifestyle Changes and Scarcity versus Abundance of Food The women were asked if the move from Somalia to Sweden had affected them in any significant way. Six out of the eight respondents admitted that it had brought many changes in their dietary habits as well as their lifestyles, which had affected their health negatively. They had also faced a lot of obstacles in maintaining their previous high levels of physical activity.
Especially respondents that had migrated directly from rural settings expressed that they hardly knew themselves anymore. "I have changed because of the weather; my health has also undergone some changes. I have freedom in Sweden but all the same I feel I am carrying a heavy burden. I feel mentally unwell …In Somalia I was independent, doing everything for myself. I was engaged 24 hours in various activities… Now it is my daughters who shop for me. All I do is to sit at home and eat. I feel unhappy because I no longer run my own errands” (Informant 1). “Here the life made me lazy because I was used to running back and forth for my daily bread back in Somalia…Looking for daily bread was difficult but it helped the body. You become lighter, you become healthy due to the running (Informant 2). ”I have gained a lot of weight since I moved to Sweden due to the lack of activities” (Informant 4). I sit all the time at home cooking and eating… In Somalia I walked long distances, back and forth, without the use of transportation … If I had been walking like I used to do things would have been better for me” (Informant 6). Scarcity versus Abundance of Food The informants went through a lot of suffering and many traumatic experiences before migrating to Sweden. Some endured starvation and the lack of basic necessities of life due to the protracted war. For example, in settling down into their newly adopted homes, they began to consume those food items that were previously scarce, and also those that had been entirely unattainable or beyond their reach in their home country, in large quantities, to the detriment of their health: …I did not have the opportunity to eat chicken; in fact I did not eat a lot in Somalia. Seeing chicken in the shops in Sweden drove me mad. I never ate chicken in Somalia. When I went shopping with my husband and I saw the chicken I ordered 4- 5 pieces for one meal. I ate a lot of ice cream as well as chocolate“(Informant 3). …we usually boiled our meat and eat a lot of bananas because it is believed to help in the digestive process. We ate a lot of corn, which we fried. There were different types of tubers like yams but I didn`t eat them in Somalia and I used a lot of camel milk. We have a lot of greens but I don't eat a lot of vegetables now. We have many varieties of fruits but I eat a lot of guavas. In Somalia when I went to the market to buy meat I insisted on getting the fatty part of the meat because that is very tasty. I ate the chicken with the skin due to ignorance. My eating habits have changed because in Sweden food is plenty especially when you are jobless and the social services are providing for you.
This has led to a situation where I overindulge myself. I eat more fish than I used to…and I have also learnt to take off the skin of the chicken before eating it to avoid the fat which can affect one’s cholesterol level” (Informant 2). “I know some women who don’t even drink water. All they do all day long is to drink coffee and milk and sugar, so what happens? One puts on weight because one is not active and not able to burn calories one puts in the body” (Informant 3).
Here I sit all the time at home cooking and eating, but in Somalia food is not as abundant as it in Sweden. The weather is also very warm in Somalia… In Sweden on the contrary I am always at home eating and sitting in front of the television. I stay at home most of the time just cooking and eating (Informant 6). ..I ate three times a day, but in Sweden food has become my friend due to the loneliness and the lack of social activities, which has made me turn to food for comfort (Informant 4). “I don't care much about what I eat and how much. I eat big portions twice a day, while a Swedish woman will eat small portions at different times” (Informant 3).
Lack of Knowledge and Fear of Disease A general lack of knowledge about the risk factors of heart disease was expressed. Most of the informants were aware that their unhealthy eating habits increased their risk of getting heart disease and that the risk was higher than for their Swedish counterparts. As a result, most of the informants asked for more knowledge about healthy living/eating and about the benefits of being physically active. “I think I have a higher risk of getting a heart disease compared to Swedish women because of my eating habits. In my opinion most Africans lack knowledge about healthy eating.
We use fat, starch, and sugar in the wrong proportions. I eat and do not exercise enough to burn the energy. I put three teaspoons of sugar in my cup of tea. My daughter advised me to eat sweet potatoes but I don't like it; I prefer the normal potatoes. All my choices I think put me at a higher risk of getting heart disease compared to a Swedish woman… I think knowledgeable people should be sent to our organizations to give us talks about the benefits of being physically active as well as how to adopt good eating habits, so that the younger Somali women will not find themselves in the situation I find myself in today”(Informant 2). “I am often tired and to me it is a sign that my heart is in trouble… I am at a greater risk of getting heart problems if I compare myself to the healthy-looking thin Swedish women, but what can I do? I sometimes think of changing my situation, but I can’t do much about it” (Informant 1). “Compared with Swedish women I think I have a greater risk of developing heart problems. Already I think I have signs that indicate that all is not well with my heart. I am also tired most of the time… I think other Somali women, including me, should think about what they eat, what time of the day they eat” (Informant 6). “I think I have a higher risk of developing heart problems compared with a Swede. This is because most Swedes go out jogging, and they watch what they eat. I think Somali women need to be made aware of the dangers associated with eating too much sugar and fat. This is because these items are the major ingredients in the Somali diet” (Informant 3).
A Qualitative Interview Study on Diet, Knowledge about Risk of Heart Disease, Inactivity, Body Image and Self-Esteem
Ellis Janzon and Ingrid Bolmsjö
The last-decade incidence of myocardial infarction (MI) has diminished dramatically in most age groups but not in middle-aged women in Sweden. There has been a large influx of immigrants and it has been shown that immigrant women have a higher BMI and are less physically active than Swedish women. Thereby they have a higher risk for heart disease. The aim of the study was to examine post-migration dietary changes, and knowledge about risks for heart diseases among Somali women. Furthermore, to examine the women’s perceptions of body image, self-esteem, and their knowledge about the positive effect of physical activity. The qualitative research method was used and eight Somali women aged 40 years or more, who have lived in Sweden longer than ten years, were interviewed with the help of a semistructured questionnaire. The study revealed that Somali migrated women in Sweden had changed their diet and experienced weight increase. They reported low self-esteem and little motivation for physical activity. They understood that they had a higher risk for heart disease as compared to Swedish women and they had, in general, a preference for big body size. The women of this study are, in combination with other risk factors, at a high risk of myocardial infarction. They all revealed a general knowledge about the relationship between obesity and inactivity and enhanced risks for heart disease. They had a preference for a larger female body image. They expressed low self-esteem, loneliness, and alienation from society. It is important to address the health issue among migrant Somali women in Sweden, but since this study had few informants, larger studies and more science is needed to further investigate the problem.
The themes that emerged were: • Effects of post-migration dietary in lifestyle changes, and scarcity versus abundance of food. • lack of knowledge and fear about disease • Weight gain and low self-esteem • Culture and body image • Loneliness and alienation • Somali culture and obstacles to physical activity Effects of Post-Migration Dietary in Lifestyle Changes and Scarcity versus Abundance of Food The women were asked if the move from Somalia to Sweden had affected them in any significant way. Six out of the eight respondents admitted that it had brought many changes in their dietary habits as well as their lifestyles, which had affected their health negatively. They had also faced a lot of obstacles in maintaining their previous high levels of physical activity.
Especially respondents that had migrated directly from rural settings expressed that they hardly knew themselves anymore. "I have changed because of the weather; my health has also undergone some changes. I have freedom in Sweden but all the same I feel I am carrying a heavy burden. I feel mentally unwell …In Somalia I was independent, doing everything for myself. I was engaged 24 hours in various activities… Now it is my daughters who shop for me. All I do is to sit at home and eat. I feel unhappy because I no longer run my own errands” (Informant 1). “Here the life made me lazy because I was used to running back and forth for my daily bread back in Somalia…Looking for daily bread was difficult but it helped the body. You become lighter, you become healthy due to the running (Informant 2). ”I have gained a lot of weight since I moved to Sweden due to the lack of activities” (Informant 4). I sit all the time at home cooking and eating… In Somalia I walked long distances, back and forth, without the use of transportation … If I had been walking like I used to do things would have been better for me” (Informant 6). Scarcity versus Abundance of Food The informants went through a lot of suffering and many traumatic experiences before migrating to Sweden. Some endured starvation and the lack of basic necessities of life due to the protracted war. For example, in settling down into their newly adopted homes, they began to consume those food items that were previously scarce, and also those that had been entirely unattainable or beyond their reach in their home country, in large quantities, to the detriment of their health: …I did not have the opportunity to eat chicken; in fact I did not eat a lot in Somalia. Seeing chicken in the shops in Sweden drove me mad. I never ate chicken in Somalia. When I went shopping with my husband and I saw the chicken I ordered 4- 5 pieces for one meal. I ate a lot of ice cream as well as chocolate“(Informant 3). …we usually boiled our meat and eat a lot of bananas because it is believed to help in the digestive process. We ate a lot of corn, which we fried. There were different types of tubers like yams but I didn`t eat them in Somalia and I used a lot of camel milk. We have a lot of greens but I don't eat a lot of vegetables now. We have many varieties of fruits but I eat a lot of guavas. In Somalia when I went to the market to buy meat I insisted on getting the fatty part of the meat because that is very tasty. I ate the chicken with the skin due to ignorance. My eating habits have changed because in Sweden food is plenty especially when you are jobless and the social services are providing for you.
This has led to a situation where I overindulge myself. I eat more fish than I used to…and I have also learnt to take off the skin of the chicken before eating it to avoid the fat which can affect one’s cholesterol level” (Informant 2). “I know some women who don’t even drink water. All they do all day long is to drink coffee and milk and sugar, so what happens? One puts on weight because one is not active and not able to burn calories one puts in the body” (Informant 3).
Here I sit all the time at home cooking and eating, but in Somalia food is not as abundant as it in Sweden. The weather is also very warm in Somalia… In Sweden on the contrary I am always at home eating and sitting in front of the television. I stay at home most of the time just cooking and eating (Informant 6). ..I ate three times a day, but in Sweden food has become my friend due to the loneliness and the lack of social activities, which has made me turn to food for comfort (Informant 4). “I don't care much about what I eat and how much. I eat big portions twice a day, while a Swedish woman will eat small portions at different times” (Informant 3).
Lack of Knowledge and Fear of Disease A general lack of knowledge about the risk factors of heart disease was expressed. Most of the informants were aware that their unhealthy eating habits increased their risk of getting heart disease and that the risk was higher than for their Swedish counterparts. As a result, most of the informants asked for more knowledge about healthy living/eating and about the benefits of being physically active. “I think I have a higher risk of getting a heart disease compared to Swedish women because of my eating habits. In my opinion most Africans lack knowledge about healthy eating.
We use fat, starch, and sugar in the wrong proportions. I eat and do not exercise enough to burn the energy. I put three teaspoons of sugar in my cup of tea. My daughter advised me to eat sweet potatoes but I don't like it; I prefer the normal potatoes. All my choices I think put me at a higher risk of getting heart disease compared to a Swedish woman… I think knowledgeable people should be sent to our organizations to give us talks about the benefits of being physically active as well as how to adopt good eating habits, so that the younger Somali women will not find themselves in the situation I find myself in today”(Informant 2). “I am often tired and to me it is a sign that my heart is in trouble… I am at a greater risk of getting heart problems if I compare myself to the healthy-looking thin Swedish women, but what can I do? I sometimes think of changing my situation, but I can’t do much about it” (Informant 1). “Compared with Swedish women I think I have a greater risk of developing heart problems. Already I think I have signs that indicate that all is not well with my heart. I am also tired most of the time… I think other Somali women, including me, should think about what they eat, what time of the day they eat” (Informant 6). “I think I have a higher risk of developing heart problems compared with a Swede. This is because most Swedes go out jogging, and they watch what they eat. I think Somali women need to be made aware of the dangers associated with eating too much sugar and fat. This is because these items are the major ingredients in the Somali diet” (Informant 3).
