Table 2

Domains affecting lifestyle behaviours in US South Asians

DomainsBehavioural impactsHow diet and physical activity choices are affectedExample quotations
ImmigrationIn the USA, unhealthy dietary choices and inactivity is easy.
  • Prevalence of cars, elevators and climate-controlled environments in the USA make it easier to be inactive.

  • Variety of foods and low cost oil, sugar, and dairy products in the USA lead to eating more and increasing fat and calorie intake.

  • Lack of vegetarian options results in less healthy diets.

  • Faster pace of life makes traditional, time-consuming cooking methods impractical, resulting in reliance on processed, canned and frozen foods.

‘When you come to this place [US] you wanna try first of all, all these kinds of foods, not realizing that they are harming your body right now, so I would think that they are not aware of it initially, they come to know after the fact.’ (Younger Woman)
Gender – MalesMen are expected to provide financially for their family, leaving little time for exercise or healthy eating.
  • Men are culturally primed to focus on academic success, affecting views of exercise as adults.

  • Men work long hours and skip meals during the day, making exercise difficult and resulting in overeating at night.

  • Saving money is more important than investing in health.

  • To secure a good marriage, a good education and job are more important than their physical appearance.

  • Little need to be physically attractive to spouse after children are born

‘There are a lot of issues like family, children, fee structure, planning finances, so health takes a backseat in that. It’s not like we- we don't… want to be healthy, we want to look good but, uh, the emphasis is- is currently on career, family’ (Younger Male).
Gender- femalesWomen are culturally expected to focus on family care and household duties, while personal healthcare is secondary.
  • Women ‘let themselves go’ after having a baby.

  • Exercise is viewed only a weight loss tool, not a lifestyle choice.

‘We Indian people spoiled our men by giving everything in their hands, so they are lazy so they want us to pay more attention… we say, oh I am going to gym—no, no, no, I need you here. I need this thing, and I need this thing to be done’ (Older Female).
Role of foodFood is central to South Asian culture. Food choice is driven by taste and ‘healthy foods’ are viewed as being less tasty.
  • Although the South Asian diet can be healthy, South Asian Americans choose the less healthy foods more often (eg, fried snacks), add in less healthy ingredients (eg, extra cheese or oil/ghee), cook healthy foods in unhealthy ways (eg, frying or overcooking vegetables), eat large portion sizes, and rarely make trade-offs by choosing healthy foods to counterbalance the unhealthy.

  • Women often provide family/guests with large servings to show affection, and people have grown accustomed to eating these large portions.

‘I went to a party … and there was a layer of [oil] in a big tray … so me and my friend … we just drained the oil out. And the lady who had cooked it, she saw us take-draining oil out so she took the food back in, put the oil back in and brought it out …. there’s some stubborn people like that’ (Older Female).