How Segregation Makes Us Fat: Food Behaviors and Food Environment as Mediators of the Relationship Between Residential Segregation and Individual Body Mass Index.

Sarah Lyons,Lorraine T. Dean,Cassandra Arroyo,James Aaron Hipp,Melody Goodman

doi:10.3389/fpubh.2018.00092

Abstract

Racial residential segregation affects food landscapes that dictate residents' food environments and is associated with obesity risk factors, including individual dietary patterns and behaviors. We examine if food behaviors and environments mediate the association between segregation and body mass index (BMI). Non-Hispanic Whites and Blacks living in the St. Louis and Kansas City metro regions from 2012 to 2013 were surveyed on dietary behaviors, food environment, and BMI (n = 1,412). These data were combined with the CDC's modified retail food environment index and 2012 American Community Survey data to calculate racial segregation using various evenness and exposure indices. Multi-level mediation analyses were conducted to determine if dietary behavior and food environment mediate the association between racial residential segregation and individual BMI. The positive association between racial segregation and individual BMI is partially mediated by dietary behaviors and fully mediated by food environments. Racial segregation (evenness and exposure) is associated with BMI, mediated by dietary behaviors and food environment. Elements of the food environment, which form the context for dietary behaviors, are potential targets for interventions to reduce obesity in residentially segregated areas.

Highlights

The prevalence of obesity in the United States has risen steadily across all demographic groups but is disproportionately prevalent among Black Americans
Regardless of race, How Segregation Makes Us Fat living in a neighborhood that has more than 25% Black residents increases the odds of being obese [3], suggesting that elements of the neighborhood environment play a role in individuallevel obesity
We extend research that has established the relationship between racial residential segregation and body mass index (BMI) [3, 13, 17, 18] to examine the mediating effect of food environment and dietary behaviors at the individual level on the association between residential segregation and BMI among working non-Hispanic White and Black Missouri residents

Summary

Introduction

Estimates suggest that Non-Hispanic Blacks have the highest age-adjusted rates of obesity (48%) compared to other racial/ethnic groups [1, 2]. Williams and Collins suggest that racial residential segregation is the cornerstone on which Black–White disparities in health status have been built because it shapes socioeconomic opportunity structures, determines access to health promoting resources and services, and constrains individual choices that affect health risks [6]. Massey and Denton classified five key dimensions of segregation: evenness, exposure, concentration, centralization, and clustering [7]. The effects of segregation are not borne only by Blacks of low-income status; due to discriminatory housing practices, “white flight” and experiences of interpersonal discrimination, Blacks are less able to reside in neighborhoods commensurate with their socioeconomic status, implying that they often live in economically and spatially non-distinct Black communities [10, 11]. Blacks continue to be the most residentially segregated racial group with average neighborhood racial composition rates in 2010 similar to those in 1960 [10,11,12]

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