Disparities In Body Mass Index Research Articles

Pathways linking socioeconomic status to obesity through depression and lifestyle factors among young US adults

Obesity and depression are two diseases of major public health importance. While both correlate with each other, potential pathways involving depression that would link socioeconomic status (SES) to lifestyle factors and obesity have not been systematically examined using nationally representative data. Using rich data on 2217 US young adults aged 20–39years from the 1999–2004 National Health and Nutrition Surveys (NHANES) and multivariate linear and logistic regression models, we examined associations between major depressive disorder (MDD), dietary intake, physical activity (PA), and measured body mass index (BMI) controlling for socio-demographic factors. Further, structural equation models (SEM) were fit to test pathway explaining SES disparities in BMI through MDD and lifestyle factors. Recent prevalence of MDD was lower among young US men than women (6.4% vs. 9.2%) although their prevalence of obesity was similar (21.2% vs. 22.7%). Among women, MDD was associated with higher BMI and inversely associated with PA, but not among men. MDD was specifically associated with increased risk of morbid obesity (BMI≥40) among women (OR: 2.88 (1.32, 6.30)). Using SEM, a main pathway linking SES to BMI among women was linking SES→food insecurity→MDD→PA→BMI. A main pathway linking MDD to BMI in both genders was going through PA rather than overall dietary quality. Gender and ethnic differences existed underlying how MDD, SES and lifestyle factors were associated with adiposity. Future prospective studies are needed to examine potential mechanisms using physiological markers of depression, lifestyle and obesity.

Neighborhood effects on BMI trends: Examining BMI trajectories for Black and White women

Racial disparities in obesity among women in the United States are substantial but the causes of these disparities are poorly understood. We examined changes in body mass index (BMI) trajectories for Black and White women as a function of neighborhood disadvantage and racial composition of the neighborhoods within which respondents are clustered. Using four waves of the Americans’ Changing Lives (ACL) survey, we estimated multilevel models predicting BMI trajectories over a 16-year period. Even after controlling for individual-level socio-demographics, risk and protective factors, and baseline neighborhood disadvantage and racial composition, substantial racial disparities in BMI persisted at each time point, and widened over time (p<0.05). Baseline neighborhood disadvantage is associated with BMI and marginally reduces racial disparities in BMI, but it does not predict BMI changes over time. However, without neighborhood-level variables, the BMI trajectory model is misspecified, highlighting the importance of including community factors in future research.

Neighborhood context and ethnicity differences in body mass index: A multilevel analysis using the NHANES III survey (1988–1994)

A growing body of literature has documented a link between neighborhood context and health outcomes. However, little is known about the relationship between neighborhood context and body mass index (BMI) or whether the association between neighborhood context and BMI differs by ethnicity. This paper investigates several neighborhood characteristics as potential explanatory factors for the variation of BMI across the United States; further, this paper explores to what extent segregation and the concentration of disadvantage across neighborhoods help explain ethnic disparities in BMI. Using data geo-coded at the census tract-level and linked with individual-level data from the Third National Health and Examination Survey in the United States (U.S.), we find significant variation in BMI across U.S. neighborhoods. In addition, neighborhood characteristics have a significant association with body mass and partially explain ethnic disparities in BMI, net of individual-level adjustments. These data also reveal evidence that ethnic enclaves are not in fact advantageous for the body mass index of Hispanics—a relationship counter to what has been documented for other health outcomes.

Income Disparities in Body Mass Index and Obesity in the United States, 1971-2002

Although obesity is frequently associated with poverty, recent increases in obesity may not occur disproportionately among the poor. Furthermore, the relationship between income and weight status may be changing with time. We use nationally representative data from the National Health and Nutrition Examination Surveys (1971-2002) to examine (1) income differentials in body mass index (calculated as weight in kilograms divided by the square of height in meters) and (2) change over time in the prevalence of obesity (body mass index, >or=30) at different levels of income. Over the course of 3 decades, obesity has increased at all levels of income. Moreover, it is typically not the poor who have experienced the largest gains. For example, among black women, the absolute increase in obesity is 27.0% (1.05% per year) for those at middle incomes, but only 14.5% (0.54% per year) for the poor. Among black men, the increase in obesity is 21.1% (0.77% per year) for those at the highest level of income, but only 4.5% (0.06% per year) for the near poor and 5.4% (0.50% per year) for the poor. Furthermore, all race-sex groups show income differentials on body mass index, but patterns show substantial variation between groups and consistency and change within groups over time. For example, white women consistently show a strong inverse gradient, while a positive gradient emerges in later waves for black and Mexican American men. The persistence and emergence of income gradients suggests that disparities in weight status are only partially attributable to poverty and that efforts aimed at reducing disparities need to consider a much broader array of contributing factors.

Race, Education, and Weight Change in a Biracial Sample of Women at Midlife

Overall rates of obesity have increased dramatically in the United States, yet African American women remain disproportionately represented among the overweight and obese. The excess weight observed in African American women is primarily considered a result of low socioeconomic status, but recent cross-sectional findings suggest otherwise. We examined the interactive effects of race and 3 levels of education (low [high school or less]; moderate [some college]; and high [college degree or more]) on body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) and changes in BMI over 4 years in 2019 middle-aged African American and white women from the Study of Women's Health Across the Nation (SWAN). Data were analyzed with mixed effects regression models. At baseline, we observed a significant race x education interaction (estimate, -3.7; 95% confidence interval, -5.3 to -2.1; P<.001) on BMI. Compared with whites, African Americans had higher BMIs, but only at the moderate (means, 32.1 and 29.2) and highest (means, 31.5 and 27.8) level of education. At the lowest level of education, African American and white women were similar in BMI (means, 31.1 [African American] and 31.2 [white]). Body mass index increased significantly for all women over follow-up (estimate, 0.22; 95% confidence interval, 0.17 to 0.26; P<.001), but increases did not differ by race, education, or race x education. Results were unchanged after adjustment for potential confounding variables. For middle-aged women, racial disparities in BMI are largely patterned by education, with the greatest disparities observed at higher levels of education. The absence of significant longitudinal effects suggests that these race-education patterns are set in place and well established before midlife.

Effect of environmental and genetic factors on education-associated disparities in weight and weight gain: a study of Finnish adult twins

Disparities in body mass index (BMI) between persons with different educational levels in Western countries are well documented, but the background of these education-associated disparities remains poorly understood. The objective was to examine the influence of environmental and genetic factors on education-associated disparities in self-reported BMI and weight change. Longitudinal postal surveys were performed in 1975, 1981, and 1990. The data were analyzed by using multivariate genetic models for twin data. The data derived from the Finnish Twin Cohort included 2482 monozygotic and 5113 dizygotic same-sex male and female twin pairs born between 1915 and 1957. Education-associated differences in BMI and in weight change were clear in 1975 and 1981, respectively, whereas no differences were seen in weight change between 1981 and 1990 when age and baseline BMI were adjusted for. The trait correlation between baseline BMI and educational attainment (-0.15 in men and women) was mainly due to correlations between additive genetic factors that contributed to BMI and education in men (-0.20; 95% CI: -0.25, -0.14) and women (-0.32; 95% CI: -0.40, -0.25) when adjusted for age. Among women, a weaker positive correlation was found for the unshared environmental effects contributing to the 2 traits (0.06; 95% CI: 0.02, 0.12). The same factors that affected the association between education and BMI in 1975 largely explained the association between education and weight change in 1981. The results suggest the possibility that common genetic factors affect educational attainment and body weight, which contribute to education-associated disparities in BMI in adulthood.