The Association Between Perceived Discrimination and BMI Trajectory: A Prospective Study of African American and White Adults

Body mass trajectories from adolescence to adulthood in the United States: Effects of racial identification and adverse childhood experiences

The non-Hispanic Black population in the U.S. has experienced one of the highest obesity rates, relative to the non-Hispanic White population and other racial groups. This study explores how adverse childhood experiences (ACEs) and racial identification influence body mass trajectories from adolescence to adulthood. Participants include non-Hispanic Black and non-Hispanic White individuals from the National Longitudinal Study of Adolescent to Adult Health (n = 5438). The outcome measure was body mass index (BMI). The Behavioral Risk Factor Surveillance System ACE Module and the CDC's Kaiser ACE research were used to create ACE categories. Multilevel growth curve models were utilized to address the study's objectives. BMI trajectories were steeper among female respondents who experienced multiple ACEs (β ̂ $$ \hat{\beta} $$ = 0.035; p < .01) than among females without any ACE. Among females, BMI trajectories were jointly moderated by ACEs and race (likelihood ratio test:χ 2 $$ {\chi}^2 $$ = 130.76, p < .001), showing stronger ACE effects among non-Hispanic Black respondents. However, ACEs were not statistically associated with mean BMI or BMI trajectories among male respondents. Results further indicated that the effects of multiple ACEs were more evident at early ages and had a more marked impact on BMI among non-Hispanic Black females than non-Hispanic White females. Unhealthy BMI gains, especially among females, could be reduced through targeted interventions designed to support non-Hispanic Black children and adolescents.

Social determinants of health, health disparities, and adiposity

Social determinants of health (SDoH), or the socioeconomic, environmental, and psychosocial conditions in which individuals spend their daily lives, substantially influence obesity as a cardiovascular disease (CVD) risk factor. The coronavirus disease 2019 (COVID-19) pandemic highlighted the converging epidemics of obesity, CVD, and social inequities globally. Obesity and CVD serve as independent risk factors for COVID-19 severity and lower-resourced populations most impacted by adverse SDoH have the highest COVID-19 mortality rates. Better understanding the interplay between social and biologic factors that contribute to obesity-related CVD disparities are important to equitably address obesity across populations. Despite efforts to investigate SDoH and their biologic effects as drivers of health disparities, the connections between SDoH and obesity remain incompletely understood. This review aims to highlight the relationships between socioeconomic, environmental, and psychosocial factors and obesity. We also present potential biologic factors that may play a role in the biology of adversity, or link SDoH to adiposity and poor adipo-cardiology outcomes. Finally, we provide evidence for multi-level obesity interventions targeting multiple aspects of SDoH. Throughout, we emphasize areas for future research to tailor health equity-promoting interventions across populations to reduce obesity and obesity-related CVD disparities.

Obesity among African American people in the United States: A review

Obesity is a growing public health crisis in the United States and is associated with a substantial disease burden due to an increased risk for multiple complications, including cardiovascular and metabolic diseases. As highlighted in this review, obesity disproportionately affects the African American population, women in particular, regardless of socioeconomic status. Structural racism remains a major contributor to health disparities between African American people and the general population, and it limits access to healthy foods, safe spaces to exercise, adequate health insurance, and medication, all of which impact obesity prevalence and outcomes. Conscious and unconscious interpersonal racism also impacts obesity care and outcomes in African American people and may adversely affect interactions between health care practitioners and patients. To reduce health disparities, structural racism and racial bias must be addressed. Culturally relevant interventions for obesity management have been successfully implemented that have shown benefits in weight management and risk-factor reduction. Strategies to improve health care practitioner-patient engagement should also be implemented to improve health outcomes in African American people with obesity. When managing obesity in African American people, it is critical to take a holistic approach and to consider an individual's social and cultural context in order to implement a successful treatment strategy.