Diminished Protective Effects of Education, Income and Employment against Obesity Risk in Black Women at Reproductive Age: National Health and Nutrition Examination Survey (NHANES 1999-2016)

Abstract

Background: Socioeconomic status (SES) indicators protect individuals and populations against health problems such as obesity. Marginalizationrelated Diminished Returns (MDRs), however, refer to the weaker economic and health returns of education, employment, and income for Black than the returns for White people. Aims: To test the effects of three major SES indicators, namely educational attainment, employment, and income, on obesity for women at reproductive age, and to test variation in these associations by race. Methods: We used cross-sectional data from the National Health and Nutrition Examination Survey (NHANES). Sample was limited to non-Latino White and Black women at reproductive age (age between 20 and 44). Analytical sample was composed of 5237 women. Survey regressions were used to test the effects of education, employment, and income (independent variables) on obesity (dependent variable) and by race (moderator). Results: Overall, educational attainment and income were inversely associated with odds of obesity in our sample, however, we found significant interactions indicating that the effects of education, employment, and income were all weaker for Black than White women. Conclusions: In line with MDRs, and probably due to structural racism, social stratification, labor market discrimination, and different food options, obesity remains higher than expected in highly educated, employed, and highincome Black women, a pattern that is not seen in White women. Black middleclass women at reproductive age remain at risk for obesity. To eliminate racial disparities in perinatal outcomes, we need to go beyond low SES and address the perinatal needs of middle-class Black women, for whom obesity remains a health risk.