To conclude, there are some broader issues that it is important to highlight in relation to ME diet, weight and T2D. While there is room for improvement in how ethnicity data is collected, it is important to keep in mind that 'ethnicity' is a complex and contested concept (Walsh et al., 2018). Membership of any ethnic group is subjective to the individual, and this self-perceived identity might shift over time (Goff, 2019).
There are significant differences among generations of ME communities, meaning that something that might work for a first-generation of migrants who have moved to the UK might be completely inappropriate for second or third-generations who were born in the UK. There is not much about this aspect in the culturally appropriate health education literature, but this is something that requires more attention in the future, as the population is becoming more and more diverse. Furthermore, this increased diversity of the population also means that sometimes it is difficult to categorise ethnicity, as individuals might have different origins and backgrounds.
People from the same ME group usually share the same language and have common cultural values and religious beliefs. However, they are still extremely heterogeneous populations "with diverse and intersecting identities", quoting Davidson et al. (2021, p.7). As reported in this study, "[while] culturally sensitive adaptations are essential … they should avoid reinforcing stereotypes" (Davidson et al., 2021, p.7). This is to say that within the same ME community, individuals have different and specific needs and it will be impossible to find a solution that will fit everyone's needs. Rather, it is important to provide different services in different ways for healthcare to be 'person-centred' and cater for diverse needs.
Related to what mentioned above, the focus of this work has been on ethnicity, but intersectionality cannot been ignored when talking about ethnic minorities and health inequalities. It is well known that people from some ME groups tend to be poorer and live in more deprived areas than the general population, and there are inequalities between men and women (Davidson et al., 2021; Leung & Stanner, 2011). Therefore, it is fundamental to consider how these inequalities are linked and interact with each other. Academic research might help to try and disentangle the effects of different inequalities on health outcomes.
Lastly, in section 3 the concept of 'dietary acculturation' was introduced, referring to how the diet of ME groups changes after migration to Western countries. This usually entails that their diet gets worse, as people start eating more fast food that is high in energy, fat and salt (Leung & Stanner, 2011). The unhealthy food environment is a broad and deep problem in the UK and it requires significant attention beyond inequalities among ME groups.
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