Racial Disparities In Obesity Research Articles

Effects of Race-Specific Prevalence and Racial Disparity Information About Obesity and Diabetes

ABSTRACT There are significant racial disparities in obesity and diabetes such that prevalence rates are higher among Black Americans than White Americans. This study examined effects of communicating the prevalence of obesity/diabetes and comparing race-specific prevalence rates between White and Black Americans to highlight racial health disparities. We conducted two preregistered, between-subjects randomized online experiments with an analytic sample of 1,232 U.S. adults (n = 609 for the obesity study and n = 623 for the diabetes study) stratified by race. In each experiment, we randomly assigned respondents to read an obesity/diabetes message 1) without disease prevalence information, 2) with the national obesity/diabetes prevalence rate, 3) with the race-specific obesity/diabetes prevalence rate among White Americans, 4) with the race-specific prevalence rate among Black Americans, or 5) comparing the race-specific prevalence rates between White and Black Americans, or 6) to a no-message condition. Results showed that diabetes prevalence information reduced the overestimation of race-specific diabetes prevalence. Comparing the obesity prevalence rate among White Americans to that of Black Americans increased support for policies to reduce racial health disparities, but also made Black respondents less likely to cut calories. Race-specific disease prevalence information and intergroup disease prevalence comparisons may have both positive and unintended consequences on message recipients. Health educators should be more cautious when communicating disease prevalence information.

The LSU AgCenter Healthy Communities Initiative: Community-Participatory Policy, Systems, and Environmental Change

The LSU AgCenter Healthy Communities Initiative: Community-Participatory Policy, Systems, and Environmental Change

Abstract IA045: Bio-behavioral approaches to reducing racial disparities in obesity and GI cancers

Abstract Obesity is associated with increased risk for all major gastrointestinal cancers. These chronic conditions are hypothesized to be linked via inflammation and/or hormones. Racial disparities persist for obesity with nearly 50% of non-Hispanic Black adults and 45.6% of Hispanic adults having obesity compared to 41.4% of non-Hispanic White adults. Similarly, Black and Hispanic individuals are at increased risk of developing and/or dying from some GI cancers compared to White individuals. Interventions targeting diet and physical activity offer one approach to reducing obesity and risk for developing GI cancers by reducing adiposity and via physiologic processes (e.g. modification of the gut microbiota) to promote a less carcinogenic environment in the GI tract. For example, dietary modifications can lead to weight loss and also modify the gut microbiota to lower risk for colorectal cancer. Previous research from our team has also identified racial differences in the gut microbiota suggesting that the gut microbiota is a viable target for intervention to reduce racial disparities in obesity and GI cancers. Strategies to reduce disparities in obesity and cancer using bio-behavioral approaches that focus on diet and the gut microbiota will be discussed. Citation Format: Tiffany L. Carson. Bio-behavioral approaches to reducing racial disparities in obesity and GI cancers [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA045.

African Americans' perceptions of nutrition interventions: a scoping review.

Nutrition education and policy, systems and environmental (PSE) change interventions may be able to address food insecurity and obesity, conditions which are disproportionately experienced by African Americans. Work that seeks to address these disparities and advance social justice should uplift and learn from participant voices, particularly from marginalised groups. This scoping review aimed to summarise the available literature describing African Americans' perceptions of and experiences participating in nutrition interventions. We conducted an electronic literature search with the assistance of a research librarian which encompassed six databases (MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX and ProQuest Dissertations & Theses) and identified thirty-five sources meeting our inclusion criteria. The majority of studies assessing African Americans' satisfaction with interventions examined educational interventions alone, and about half of the included studies assessed satisfaction through quantitative methods alone. The only studies which found participants to be dissatisfied with interventions used qualitative methods and examined interventions providing education alone. Future work should evaluate African Americans' experience with nutrition-focused PSE changes, interventions which may be better able to address racial disparities in obesity and food insecurity. Nutrition educators working with African Americans should also consider evaluating future interventions using qualitative inquiry, to obtain an in-depth understanding of participant experiences with interventions.

Black/White Disparities in Obesity Widen with Increasing Rurality: Evidence from a National Survey.

BackgroundRacial health disparities in obesity and obesity-related conditions and behaviors are well documented, although a small body of research suggests that geographic factors (e.g., socioeconomic status [SES] and rural/urban status) may alter the magnitude of these disparities.MethodsThis study explored how rurality moderates black/white health disparities using a nationally representative sample from the 2012 Behavioral Risk Factor Surveillance System (n=359,157). Respondents' county of residence was linked to the U.S. Census information to obtain the county-level Index of Relative Rurality (IRR). Weighted logistic regression was used to model obesity, diabetes, and lack of physical activity (PA) on race (black/white), IRR, and an interaction term of race and IRR, including covariates (age, sex, education, marital status, employment, and income).ResultsBlacks were significantly more likely to have obesity, diabetes, and a lack of PA compared with whites. Irrespective of race, rural respondents were significantly more likely to have obesity (odds ratio [OR] 1.035, confidence interval [95% CI] 1.028–1.043) and a lack of PA (OR 1.045, 95% CI 1.038–1.053) than respondents in more urban areas. For obesity and diabetes, the interaction term for black×IRR quintile was significant and positive, indicating an increase in the magnitude of the black/white disparity with increasing rurality.DiscussionThese findings underscore the need for policies and programs aimed to reduce racial disparities in obesity and related conditions to consider the geographic context in which these outcomes occur.

Abstract 11531: Exploring Associative Pathways and Gender Effects of Racial and Weight Discrimination with Sleep Quality, Physical Activity, and Dietary Behavior in Adults with Higher Body Mass Index and Elevated Cardiovascular Disease Risk

Introduction: Racial disparities in obesity and cardiovascular disease can partly be attributed discrimination. Racial discrimination (RD) and weight discrimination (WD) have been linked to higher psychological distress, lower sleep quality, less physical activity, and unhealthy diet, which can negatively impact weight. Better understanding the processes by which discrimination influences weight-loss factors would help create strategies for mitigating obesity disparities. Methods: This is a cross-sectional study of 745 primary care patients with a BMI ≥ 25 kg/m 2 (43.1% Female, M age =51 years) who were enrolled in a weight-loss trial. To investigate the direct and indirect (via psychological distress) pathways by which RD and WD may be associated with sleep quality, physical activity, and diet, and to explore gender as a moderator, we used Ordinary Least Square regression with bootstrapping. Validated surveys included EOD, PROMIS-29, LDBQ, REAP-S, IPAQ-SF. Results: We found that RD and WD were indirectly associated with lower sleep quality via psychological distress (WD: indirect=2.11, CI[1.218;3.092]; RD: indirect=0.93, CI[0.057;0.134]). Further, we found that for men, RD and WD were indirectly associated with less physical activity via psychological distress (WD: moderated mediation=491.67, CI[75.565;1040.877]; RD: moderated mediation=22.60, CI[0.080;51.828]). Finally, we found that RD and WD were directly associated with unhealthy diet (WD: direct=0.195, CI[0.076;0.314]; RD: direct=0.007; CI[0.001;0.012]). Conclusions: Weight-loss factors were associated with both racial and weight discrimination through different pathways depending on gender and type of outcome. Lower sleep quality was associated with discrimination via psychological distress for both gender groups. Lower physical activity was also linked to discrimination via psychological distress, however for men only. Associations between unhealthy diet and discrimination were direct and could not be explained by increases in psychological distress. Although more research is needed, our findings suggest that interventions to address discrimination and its psychological impacts could mitigate obesity disparities and improve cardiovascular health.

The determinants of racial disparities in obesity: baseline evidence from a natural experiment.

This paper uses baseline data from an observational study to estimate the determinants of racial and gender disparities in obesity. Samples of low-income workers in Minneapolis and Raleigh reveal that respondents in Minneapolis have lower Body Mass Indices (BMIs) than respondents in Raleigh. There are large, statistically significant race and gender effects in estimates of BMI that explain most of the disparity between the two cities. Accounting for intersectionality - the joint impacts of being Black and a woman - reveals that almost all the BMI gaps between Black women in Minneapolis and Raleigh can be explained by age and education differences.

Familial Financial Assistance and Body Mass Index in Black College Graduates.

Racial disparities in obesity are larger between Black and White college graduates compared to disparities among those who did not complete high school. A possible explanation is that Black adults with higher socioeconomic status (SES) experience unique obesogenic determinants. Black adults who have completed a 4-year college degree can report "uplift stress" from providing financial assistance to family members. The aim of this study is to determine whether the association between familial financial assistance and body mass index (BMI) varies among college-educated Black women and men. This study utilized data from an online survey of Qualtrics standing panels including 451 non-Hispanic Black college graduates. Respondents were asked if they had provided or received any monetary gift or financial help from a family member in the past 12months as well as their height and weight. Using linear regression and multiplicative interaction terms, the association between familial financial assistance and BMI was assessed by sex. Those who reported both giving and receiving familial financial assistance had higher BMI than those who neither gave nor received assistance (β = 2.80, standard error (s.e.) = 1.16). There was a significant interaction such that this association was observed among women only (β = 6.67, s.e. = 2.32). Future studies should seek to understand the gendered impact of familial financial assistance on BMI in college-educated Black women.

Racial disparities in obesity and comorbidities among women with early breast cancer.

e19061 Background: Both comorbidities and obesity (body mass index/BMI 30 or higher) are observed in women at the time of early breast cancer (EBC) diagnosis. This study investigates age and obesity and their association with disparities in comorbidities between black and white women at EBC diagnosis. Methods: This is a retrospective chart review of women with EBC (Stage I-III) treated at a single institution. Relative risk (RR) with 95% Confidence Interval (CI) for individual comorbidities are calculated for black compared to white patients, adjusted for age and BMI. Results: In a sample of 548 women, 26% are black and 74% are white. 18% of black patients vs 28% of white patients were age 65 or older (p = .01). 62% of black vs 33% of white patients had obesity (p < .0001). 63% of black vs 47% of white patients had 2 or more total comorbidities at diagnosis (p = .003). 33% of black vs 10% of white patients had 2 or more obesity-related comorbidities (p < .0001). 60% of black vs 32% of white patients had hypertension (p < .0001); 23% of black vs 6% of white patients had diabetes (p < .0001); and 28% of black vs 18% of white patients had high cholesterol (p = .02). In multivariable (MV) analysis adjusted for age and BMI, black women had 45% higher risk for hypertension [RR 1.45 (1.19-1.75), p = .0002)] and 44% higher risk for diabetes [RR 1.44 (1.02-5.86), p < .0001)] at EBC diagnosis. However, after adjustment, differences by race were no longer seen for > = 2 total comorbidities, > = 2 obesity-related comorbidities, heart disease, or thyroid disease. Conclusions: This study documents significant disparities between black and white women with EBC with regard to high rates of obesity, overall comorbidities and obesity-related comorbidities. Future research should assess the potential impact of weight management (avoiding weight gain) interventions in the first 2 years post diagnosis on improving OS and BCSS among patients with obesity and in reducing OS and BCSS disparities between black and white women.

MON-114 Patient Perceptions of Obesity: African American vs. Caucasian Adults in an Urban Endocrinology Clinic

Introduction: The prevalence of obesity in the U.S. is highest in non-Hispanic black adults (38.4%) and Hispanic adults (32.6%) compared to non-Hispanic white adults (28.6%). Despite known racial disparities in obesity, not much is known about why these differences exist.Objective: This study evaluated awareness of obesity, perceptions of obesity management, and barriers to adequate care in African American and Caucasian patients.Methods: A 48-question survey was administered in 2018–2019 to an urban Endocrinology clinic’s adult patients with a body-mass index (BMI) ≥ 30 kg/m2. Chi-squared or Fisher’s exact tests were used to compare variables between groups.Results: Of 137 respondents, 98 were African American and 39 were Caucasian. Most respondents were female (59–63.9%), had some college education (61.2–71.8%), and an annual income ≤ $50,000 (51.3–63.2%). Comorbidities included hypertension (64–66%), diabetes (73–79%), and arthritis (47–51%). Significantly more Caucasians than African Americans were aware of their BMI (65.8% vs 40%, p=0.0071). Both African Americans and Caucasians perceived their weight to be less than their actual BMI (African Americans: 23.2% perceived “obese” vs. 72.5% BMI 30–39.9 kg/m2 [p<0.001] and 6.3% perceived “extremely obese” vs. 27.6% BMI > 40 kg/m2 [p<0.001]; Caucasians: 37.8% perceived “obese” vs. 66.6% BMI 30–39.9 kg/m2 [p=0.02] and 8.1% perceived “extremely obese” vs. 33.3% BMI > 40 kg/m2 [p=0.01]). Over 90% in both groups agreed that obesity is related to hypertension, diabetes, heart disease, and early death, and 100% considered obesity treatable. Most (72.2–73.7%) recalled their health care provider (HCP) discussing obesity in the past year. Weight loss options discussed were similar between groups. Most discussed diet (70–82%) and exercise (59–62.2%) with HCPs, but few discussed formal weight loss programs (16.3–20.5%), anti-obesity medications (10%), or bariatric surgery (7–10.3%). Barriers were similar for both groups. Top barriers to diet were cost and lack of time and knowledge. Barriers to exercise were lack of time and inability to exercise. Top reasons for not discussing anti-obesity medications and bariatric surgery included concern for side effects or complications, lack of knowledge of the medications/procedures, and cost with surgery.Conclusions: This study found similar perceptions of obesity management among African American and Caucasian patients with obesity. Despite excellent awareness of obesity as a health problem, decreased awareness of BMI and misperception of weight status were present in both groups. Discussion of diet and exercise was frequent, but discussion of formal weight loss programs, anti-obesity medications, and bariatric surgery was poor. These findings suggest a need for greater patient education and discussion of BMI and treatment beyond diet and exercise for patients with obesity.

The Role of Weight Perception in Race Differences in BMI Among College Graduate and Non-College Graduate Women.

Racial differences in BMI increase with education. Weight perception may be an important factor in overweight and obesity in black women. The aim of this study was to determine the mediating role of weight underassessment on race differences in BMI in college graduates compared with non-college graduates. Weight perception was assessed among respondents to the 2007-2014 National Health and Nutrition Examination Survey (n = 4,871). Those who had BMI-assessed overweight or obesity and self-assessed underweight or about-right weight underassessed their weight. The associations between race and BMI through weight underassessment by college graduate status were determined using a moderated mediation analysis. Black women had higher BMI than white women (β = 2.72, SE = 0.28), and disparities were larger in college graduates (β = 3.50, SE = 0.25) compared with non-college graduates (β = 0.78, SE = 0.15). Non-college graduate black women were more likely to underassess their weight (z score = 0.43, SE = 0.05). Indirect associations between race and BMI through weight underassessment were found only among non-college graduates (z score = -0.02, SE = 0.01), but race differences in BMI remained after accounting for weight perception among college graduates and non-college graduates. This study demonstrates that a nuanced, intersectional understanding of weight perception and BMI among women is required to address racial disparities in obesity.

Disentangling Race, Poverty, and Place to Understand the Racial Disparity in Waist Circumference among Women.

In the U.S., 54.8% of non-Hispanic Black women are obese, a rate that is 1.4 times greater than in White women. The drivers of this racial disparity are not yet clearly understood. We sought to disentangle race, household poverty, neighborhood racial composition, and neighborhood poverty to better understand the racial disparity in obesity among women. We used data from the 1999-2004 National Health and Nutrition Examination Survey and the 2000 U.S. Census to examine the role of individual race, individual poverty, neighborhood racial composition, and neighborhood poverty on women's risk of obesity. We found that individual race was the primary risk factor for obesity among women. Neighborhood effects did not account for the racial disparity. Understanding that race is a social, not a biologic construct, more work is needed to uncover what it is about race that produces racial disparities in obesity among women.

Income and Marital Status Interact on Obesity Among Black and White Men.

Racial disparities in obesity among men are accompanied by positive associations between income and obesity among Black men only. Race also moderates the positive association between marital status and obesity. This study sought to determine how race, income, and marital status interact on obesity among men. Using data from the 2007 to 2014 National Health and Nutrition Examination Survey, obesity was measured as body mass index ≥30 kg/m2 among 6,145 Black and White men. Income was measured by percentage of the federal poverty line and marital status was categorized as currently, formerly, or never married. Using logistic regression and interaction terms, the associations between income and obesity were assessed by race and marital status categories adjusted for covariates. Black compared to White (OR = 1.19, 95% CI [1.03, 1.38]), currently married compared to never married (OR = 1.45, 95% CI [1.24, 1.69]), and high-income men compared to low income men (OR = 1.26, 95% CI [1.06, 1.50]) had higher odds of obesity. A three-way interaction was significant and analyses identified that income was positively associated with obesity among currently married Black men and never married White men with the highest and lowest probabilities of obesity, respectively. High-income, currently married Black men had higher obesity rates and may be at increased risk for obesity-related morbidities.

Family Income Reduces Risk of Obesity for White but Not Black Children.

Background: Although the protective effects of socioeconomic status (SES) on obesity and cardiovascular disease are well established, these effects may differ across racial and ethnic groups. Aims: Using a national sample, this study investigated racial variation in the association between family income and childhood obesity in White and Black families. Methods: This cross-sectional study used data from the National Survey of Children’s Health (NSCH), 2003–2004, a nationally representative survey in the United States. This analysis included 76,705 children 2–17 years old who were either White (n = 67,610, 88.14%) or Black (n = 9095, 11.86%). Family income to needs ratio was the independent variable. Childhood obesity was the outcome. Race was the focal moderator. Logistic regression was used for data analysis. Results: Overall, higher income to needs ratio was protective against childhood obesity. Race, however, interacted with income to needs ratio on odds of childhood obesity, indicating smaller effects for Black compared to White families. Race stratified logistic regressions showed an association between family income and childhood obesity for White but not Black families. Conclusions: The protective effect of income against childhood obesity is smaller for Blacks than Whites. Merely equalizing population access to SES and economic resources would not be sufficient for elimination of racial disparities in obesity and related cardiovascular disease in the United States. Policies should go beyond access to SES and address structural barriers in the lives of Blacks which result in a diminished health return of very same SES resources for them. As the likely causes are multi-level barriers, multi-level interventions are needed to eliminate racial disparities in childhood obesity.

The association between obesity and race among Brazilian adults is dependent on sex and socio-economic status.

To verify the association of race, independent of socio-economic status (SES), with obesity among Brazilian adults. We investigated data from the 2008-2009 Brazilian Household Budget Survey. Obesity was defined using the WHO classification. Self-declared race was classified as White, Black and 'Pardo' (Brown). Factor analysis with principal component extraction was used to derive the SES index. The association between race and obesity independent of SES, adjusted for demographic variables, was estimated using multiple logistic regression, accounting for the survey design. Interaction term between race and SES was tested. Brazilian households (n 55 970). Adults aged 20-65 years (n 80 702). The prevalence of obesity was 14·9 %. The first factor explained 51 % of the variance and was used as a SES indicator. Odds of obesity increased with increasing SES level for men and for Black women, whereas Brown and White women showed a decrease of obesity. The association between race and obesity was modified by SES level in both sexes. At lower level of SES (-2 sd), Black and Brown in comparison to White men had 35 and 27 % decreased odds of obesity, respectively. For women, at lower SES level, only Black compared with White women had 30 % decreased odds of obesity. At the higher SES level (+2 sd), Black women compared with White presented a threefold increase of obesity. Racial disparities in obesity are SES level- and sex-dependent in Brazil. Strategies exclusively targeting reductions in SES disparities are likely ineffective for decreasing racial disparities in obesity among women.

Data spanning three decades illustrate racial disparities in likelihood of obesity

ABSTRACT Obesity rates have risen significantly in recent decades, with underprivileged Americans associated with higher rates of the condition. Risks associated with obesity, furthermore, appear unequally distributed across different racial/ethnic groups, according to the literature. The present study examined racial disparities in obesity as a function of socioeconomic factors, using a sample of American adults from a 32-year longitudinal study. We accounted for the time factor as we evaluated obesity’s associations with selected socioeconomic factors; we also examined race/ethnicity’s moderating role in obesity–socioeconomic status associations over time. We used data from the National Longitudinal Survey of Youth (NLSY) to obtain a final sample of 118,749 person-waves for analysis. A subsample of person-waves numbering 65,702 represented data from White respondents; one numbering 31,618 represented data from Black respondents; and one numbering 21,429 represented data from Hispanic respondents. Needing to consider repeated measures of the same variables over time, we chose generalized estimated equations (GEE) for use in the data analysis. Speaking generally, the obtained results suggested that for the two smaller subsamples, minority race/ethnicity could have introduced disadvantages that helped explain links between obesity and race/ethnicity. Results also showed that White–Black disparities in obesity have widened slightly in the past three decades, while White–Hispanic disparities have stabilized during the same time period.

Longitudinal Associations of Neighborhood-level Racial Residential Segregation with Obesity Among Blacks.

Despite 50 years since the passage of the Fair Housing Act of 1968, the majority of black Americans continue to live in highly segregated communities. Differing exposure to obesogenic environments in segregated neighborhoods may contribute to racial disparities in obesity prevalence. We used prospective data from the Coronary Artery Risk Development in Young Adults (CARDIA) study to examine associations between levels of neighborhood-level racial residential segregation and incident obesity in black men and women. Obesity, determined by measured anthropometry, and residential segregation, measured using the local Gi*statistic, were recorded at baseline and follow-up at years 7, 10, 15, 20, and 25. We used marginal structural survival models to account for time-dependent confounding and for loss to follow-up. Black women living in highly segregated neighborhoods at the prior exam were 30% more likely to become obese during the follow-up period as compared with women living in neighborhoods with low levels of segregation after adjustment for sociodemographic and cardiovascular risk covariates (hazard ratio = 1.3 [95% confidence interval = 1.0, 1.7]). Cumulatively high exposure to segregation averaged across time points was associated with 50% higher hazard of obesity (hazard ratio = 1.5 [95% confidence interval = 1.0, 2.3]) among women. We observed few differences in obesity incidence among men by segregation levels. Fewer health-promoting resources, stressful neighborhood context, and social norms that are less stigmatizing of obesity may contribute to these findings, but more research on specific pathways leading from segregation to obesity is needed to understand differing patterns between men and women.

Abstract MP080: Contributions of Social, Behavioral, and Biological Factors to Racial Disparities in Incident Obesity: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: A combination of social, behavioral, and biological factors are hypothesized to account in large part for racial disparities in obesity, but few studies have shown this empirically. Thus, the goal of this study was to determine the extent to which these factors accounted for racial differences in the development of obesity in men and women over a 30-year period (mean follow-up 21.7 years). Methods: This study includes the 1,617 Black (743 men and 874 women) and 1,950 White (928 men and 1,022 women) CARDIA participants with complete data on all baseline covariates who were not obese at baseline (1985-1986; ages 18-30). A series of gender-stratified Cox proportional hazards models were run adjusting separately for socioeconomic, psychosocial, neighborhood, lifestyle, and physiological factors to determine the extent to which they explained race differences in incident obesity. Results: Among men, 36.9% of Whites and 43.7% of Blacks became obese over follow-up. In women, 33.7% of Whites and 60.3% of Blacks became obese. After adjusting for age and baseline BMI, Black men were 1.39 (95% confidence interval (CI): 1.19, 1.62) times more likely to become obese than White men (Table). Covariate adjustment reduced race differences by 34%; neighborhood factors were the strongest contributors. Black women were 1.63 (95% CI: 1.42, 1.88) times more likely to become obese than White women in the base model. This association was reduced by 57% in fully adjusted models. Lifestyle factors explained the largest proportion of the race difference, followed by individual-level socioeconomic factors and neighborhood conditions. Conclusions: Racial disparities in incident obesity, and the extent to which these disparities were explained by baseline covariates, differ for men and women. Whereas substantial attenuation occurred after adjustment for a wide variety of baseline covariates, race differences in obesity incidence remained significant.

Decomposing Racial Disparities in Obesity Prevalence: Variations in Retail Food Environment.

Racial disparities in obesity exist at the individual and community levels. Retail food environment has been hypothesized to be associated with racial disparities in obesity prevalence. This study aimed to quantify how much food environment measures explain racial disparities in obesity at the county level. Data from 2009 to 2010 on 3,135 U.S. counties were extracted from the U.S. Department of Agriculture Food Environment Atlas and the Behavioral Risk Factor Surveillance System and analyzed in 2013. Oaxaca-Blinder decomposition was used to quantify the portion of the gap in adult obesity prevalence observed between counties with a high and low proportion of African-American residents is explained by food environment measures (e.g., proximity to grocery stores, per capita fast-food restaurants). Counties were considered to have a high African-American population if the percentage of African-American residents was >13.1%, which represents the 2010 U.S. Census national estimate of percentage African-American citizens. There were 665 counties (21%) classified as a high African-American county. The total gap in mean adult obesity prevalence between high and low African-American counties was found to be 3.35 percentage points (32.98% vs 29.63%). Retail food environment measures explained 13.81% of the gap in mean age-adjusted adult obesity prevalence. Retail food environment explains a proportion of the gap in adult obesity prevalence observed between counties with a high proportion of African-American residents and counties with a low proportion of African-American residents.

Residential Segregation and Overweight/Obesity Among African-American Adults: A Critical Review.

The relationship between residential segregation and overweight/obesity among African-American adults remains unclear. Elucidating that relationship is relevant to efforts to prevent and to reduce racial disparities in obesity. This article provides a critical review of the 11 empirical studies of segregation and overweight/obesity among African-American adults. Results revealed that most studies did not use a valid measure of segregation, many did not use a valid measure of overweight/obesity, and many did not control for neighborhood poverty. Only four (36% of the) studies used valid measures of both segregation and overweight/obesity and also controlled for area-poverty. Those four studies suggest that segregation contributes to overweight and obesity among African-American adults, but that conclusion cannot be drawn with certainty in light of the considerable methodologic problems in this area of research. Suggestions for improving research on this topic are provided.