Associations between Obesity, Obesogenic Environments, and Structural Racism Vary by County-Level Racial Composition.

Caryn Bell,Jordan Kerr,Jessica Young

doi:10.3390/ijerph16050861

Abstract

Obesity rates in the U.S. are associated with area-level, food-related characteristics. Studies have previously examined the role of structural racism (policies/practices that advantaged White Americans and deprived other racial/ethnic minority groups), but racial inequalities in socioeconomic status (SES) is a novel indicator. The aim of this study is to determine the associations between racial inequalities in SES with obesity and obesogenic environments. Data from 2007–2014 County Health Rankings and 2012–2016 County Business Patterns were combined to assess the associations between relative SES comparing Blacks to Whites with obesity, and number of grocery stores and fast food restaurants in U.S. counties. Random effects linear and Poisson regressions were used and stratified by county racial composition. Racial inequality in poverty, unemployment, and homeownership were associated with higher obesity rates. Racial inequality in median income, college graduates, and unemployment were associated with fewer grocery stores and more fast food restaurants. Associations varied by county racial composition. The results demonstrate that a novel indicator of structural racism on the county-level is associated with obesity and obesogenic environments. Associations vary by SES measure and county racial composition, suggesting the ability for targeted interventions to improve obesogenic environments and policies to eliminate racial inequalities in SES.

Highlights

The results demonstrate that a novel indicator of structural racism on the county-level is associated with obesity and obesogenic environments
Size, urbanization, percentage of physically inactive residents, median income, poverty rates, college graduation rates, unemployment rates, and homeownership rates varied by county racial composition
This study sought to assess the association between racial inequalities in socioeconomic status as indicators of structural racism with obesity and obesogenic environments and to determine whether these associations varied by racial composition

Summary

Introduction

Obesity is a health condition that predicts mortality [1,2,3], cardiovascular disease [4], and some cancers [5], and has complex determinants that range from physiological to sociocultural factors [6,7,8,9,10,11,12,13,14,15].Obesity rates in the U.S have grown in recent decades with some demographic groups experiencing higher prevalence rates like women, low socioeconomic status (SES), underrepresented minority groups, and rural residents [15,16,17,18,19,20,21,22,23]. Along with individual-level characteristics, various area-level factors like median income, poverty rates, and racial composition play an important role in obesity prevalence in the U.S [17,24,25,26,27,28,29,30,31,32,33,34,35,36]. Obesogenic environments have less healthy food access, such as fewer supermarkets and grocery stores, and more establishments with energy-dense foods such as fast food restaurants [28]. More fast food restaurants and less access to supermarkets and grocery stores has been associated with higher obesity rates [10,29,35,36]. Public Health 2019, 16, 861; doi:10.3390/ijerph16050861 www.mdpi.com/journal/ijerph

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