Social Determinants Of Obesity Research Articles

Sociodemographic and Mental Health Factors Associated with Obesity in Resettled Refugees in Syracuse, New York.

Resettled refugees have been exposed to stressful and life-threatening events preresettlement and are among the most marginalized and vulnerable groups in society. Postresettlement, they face challenges when assimilating to an unfamiliar host country, which renders them vulnerable to adverse health outcomes including obesity, a major public health burden. This study was conducted to examine the association of mental health and sociodemographic factors, including language proficiency and educational attainment, with obesity in first-generation resettled refugees. We used data from electronic health records from the Adult Ambulatory Medicine Clinic of the State University of New York Upstate, Syracuse, NY. The probability of being overweight and obese (class I and class II) relative to normal weight was estimated using fully adjusted multinomial logistic regression models with relative risk ratios (RRRs). Relative to male refugees, female refugees were more likely to have class I obesity (RRR=1.83; 95% confidence interval [CI]=1.19, 2.80) and class II obesity (RRR=4.07; 95% CI=2.41, 6.87). Limited English proficiency increased the risk of being overweight (RRR=2.02; 95% CI=1.29, 3.17) and having class II obesity (RRR=2.14, 95% CI=1.20, 3.81). A clinical mental health diagnosis increased the risk of class I (RRR=2.00; 95% CI=1.35, 2.96) and class II (RRR=1.76; 95% CI=1.15, 2.71) obesity. Having no formal education was associated with decreased risk of class II obesity (RRR=0.42; 95% CI=0.19, 0.90). Obesity prevalence and subsequent related morbidity continue to be major public health burdens in vulnerable, often underserved populations in the United States. Further investigation into social determinants of obesity in refugees in a community setting that captures the unique experiences of heterogenous refugee groups outside the clinical setting is warranted.

Economic, Cultural, Social Determinants of Black Women Obesity

Obesity is a widespread problem in the United States, particularly affecting Black communities. It is a public health problem, a long-term, cumulative issue of economic and social justice and inequality for this demographic group. Thus, the key to solving it is to eliminate persistent structural root causes. According to the Centers for Disease Control and Prevention (CDC), in 2022, the prevalence of obesity among African American adults is 49.5%, with Black women having the highest prevalence compared to other racial and ethnic groups. The main purpose of this study is to provide a comprehensive literature review that examines the multifaceted factors contributing to obesity among African American women, as well as systematise the determinants related to the economic well-being of the community, social factors, cultural patterns of lifestyle in the community, etc. The analysis revealed a clear inverse relationship between income and obesity among African Americans, with this trend being particularly pronounced among women than men and differing across age groups in black communities. The economic determinants of obesity in Black women are related to the fact that low-income households have limited access to affordable and nutritious food and are regularly exposed to stress related to financial difficulties, with so-called “food swamps” and “food deserts” being common in low-income areas. The social determinants of obesity are related to the fact that Black women face higher levels of racism and sexism than other demographic groups, and unequal social conditions cause structural disparities in health, education and employment. Psycho-social and cultural determinants (cultural norms of body image, social influencers, religion, social networks and family upbringing, etc.) play a key role in the emergence of the problem under study, so Black women often model their eating and physical activity habits by cultural traditions, and those who struggle with overweight may face stigma, social isolation and discrimination. The article makes recommendations for reducing obesity among Black women, which primarily relate to the development of culturally sensitive nutrition education programs, community-based health promotion programs, community-centered food policy advocacy, technology-based health platforms, public-private partnerships for affordable healthy food retail, etc.

Centering Patient Voices Through Community Engagement in Cardiovascular Research.

HomeCirculationVol. 147, No. 2Centering Patient Voices Through Community Engagement in Cardiovascular Research No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextCentering Patient Voices Through Community Engagement in Cardiovascular Research Tiffany M. Powell-Wiley, MD, MPH Tiffany M. Powell-WileyTiffany M. Powell-Wiley Correspondence to: Tiffany M. Powell-Wiley, MD, MPH, Building 10, Room 5-5332, 10 Center Dr, Bethesda, MD 20892. Email E-mail Address: [email protected] https://orcid.org/0000-0001-9488-4131 Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, and Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD. Search for more papers by this author Originally published9 Jan 2023https://doi.org/10.1161/CIRCULATIONAHA.122.061112Circulation. 2023;147:105–107FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Circulation is available at www.ahajournals.org/journal/circFor Sources of Funding and Disclosures, see page 107.Correspondence to: Tiffany M. Powell-Wiley, MD, MPH, Building 10, Room 5-5332, 10 Center Dr, Bethesda, MD 20892. Email tiffany.[email protected]gov

Theoretical Approaches to Research on the Social Determinants of Obesity

This article reviews selected theoretical approaches explaining the social determinants of obesity. The significance of this topic for medicine, public health, and other areas of obesity-related research is the growing body of evidence showing that the social environment is often key to understanding the risk of obesity. A review of relevant literature and analysis of empirical evidence linking theory to data in studies of obesity was performed. Several studies show that differences in social behavior and living conditions associated with SES, lifestyles, inequality, and other social variables have important roles in weight gain. Because the social determinants of obesity often begin in childhood, life course theory and its concepts of cumulative advantage/disadvantage and cumulative inequality are initially reviewed, followed by a discussion of how fundamental cause theory, health lifestyle theory, and cultural capital theory can be applied to obesity research. The stress process model and the concepts of social networks and neighborhood disadvantage concerning obesity are also included.

Social Determinants of Obesity and Stunting among Brazilian Adolescents: A Multilevel Analysis.

(1) Background: The purpose of this study was to identify the prevalence of obesity and stunting among Brazilian adolescents and its associations with social determinants of health (individual, family, and school), grounded on the necessity of investigating the determinants of nutritional problems within this population. (2) Methods: A population-based survey was administered to 16,556 adolescents assessed by the 2015 National School Health Survey. Multivariate models of obesity and stunting were estimated from Multilevel Poisson Regressions. (3) Results: The prevalence of obesity among Brazilian adolescents (10.0%; 95% CI: 9.4–10.6) was associated directly with indifference or dissatisfaction with body image, with eating breakfast four or fewer days a week, living with up to four people in the household, studying in private schools, and being from the South region, and was inversely associated with being female, 15 years old or older, with having the highest nutritional risk eating pattern, dining at fast-food restaurants, and eating while watching television or studying. The prevalence of stunting (2.3%; 95% CI: 2.0–2.8) was directly associated with the age of 15 years or older, and inversely associated with the lower number of residents living in the household, maternal education—decreasing gradient from literate to college level education, studying in urban schools, and being from the South and Central-West regions. (4) Conclusions: Obesity in adolescence presented behavioral determinants. Stunting and obesity have structural social determinants related, respectively, to worse and better socioeconomic position among Brazilian adolescents.

Abstract 16126: Cumulative Impact of Social Determinants of Health Risk Score on Obesity Among Young Adults in the United States

Introduction: The growing prevalence of obesity has created a major burden on the health care system. To date, studies examining social determinants of obesity in adults have mostly focused on individual social determinants of health (SDOH) components. In this study, we explore the influence of cumulative SDOH on obesity among young adults (< 45) as compared with middle- aged (45-64) and elderly (≥ 65) populations in the US. Methods: We examined cross-sectional data on 164,696 adult participants from the National Health Interview Survey (2013-17). For each individual, the unfavorable SDOH risk factor was identified from 39 sub-components, stemming from 6 general domains (economic stability, neighborhood and physical environment, community and social context, food, education, and healthcare system access). Risk factors were then aggregated to develop a cumulative score, wherein individuals were divided into quartiles. Obesity was calculated from self-reported height and weight and defined as BMI ≥ 30 kg/m 2 . Adults with a BMI <18.5 kg/m 2 were excluded from the analysis. Results: The age-adjusted prevalence of obesity was 32.5%, which translates to 78 million US adults annually. A linear increase in the prevalence of age-adjusted obesity was noted with increasing unfavorable SDOH prevalence across all age groups. In the overall population, those with the worst (4 th quartile) vs best (1 st quartile) SDOH profile had 1.47 higher odds of being obese in adjusted models. There was evidence, however, of effect modification by age (p-value for interaction < 0.001), with a stronger association of unfavorable SDOH risk with obesity in the young (<45 years) as compared with middle age and elderly (Table). Conclusions: A higher burden of SDOH is more strongly associated with obesity in young adults. Estimating and understanding the impact of SDOH may have practical implications for informing effective interventions to combat early adulthood obesity and its ensuing complications.

Reframing the early childhood obesity prevention narrative through an equitable nurturing approach.

High‐quality mother–child interactions during the first 2,000 days, from conception to age 5 years, are considered crucial for preventing obesity development during early life stages. However, mother–child dyads interact within and are influenced by broader socio‐ecological contexts involved in shaping child development outcomes, including nutrition. Hence, the coexistence of both undernutrition and obesity has been noted in inequitable social conditions, with drivers of undernutrition and overnutrition in children sharing common elements, such as poverty and food insecurity. To date, a holistic life‐course approach to childhood obesity prevention that includes an equitable developmental perspective has not emerged. The World Health Organization (WHO) Nurturing Care Framework provides the foundation for reframing the narrative to understand childhood obesity through the lens of an equitable nurturing care approach to child development from a life‐course perspective. In this perspective, we outline our rationale for reframing the childhood narrative by integrating an equitable nurturing care approach to childhood obesity prevention. Four key elements of reframing the narrative include: (a) extending the focus from the current 1,000 to 2,000 days (conception to 5 years); (b) highlighting the importance of nurturing mutually responsive child‐caregiver connections to age 5; (c) recognition of racism and related stressors, not solely race/ethnicity, as part of adverse child experiences and social determinants of obesity; and (d) addressing equity by codesigning interventions with socially marginalized families and communities. An equitable, asset‐based engagement of families and communities could drive the transformation of policies, systems and social conditions to prevent childhood obesity.

Abstract A026: Effects of values-based messaging and an ecological approach to communicate about sugar as a strategy to prevent cancer among Latinas

Abstract Introduction: An important aspect of Latino cancer prevention is reducing consumption of the sugar sweetened beverages (SSB) that account for many of the excess calories consumed and contribute to high rates of diabetes, obesity and other cancer risks. SSB consumption is powerfully influenced by social context, including targeted advertising and marketing, yet health promotion approaches focus on individual behavior, ignoring the social determinants of health (SDOH). Social justice based empowerment approaches suggest that literacy empowers people both to make better individual behavioral choices and to engage in activities that result in improved health for the overall community. Such approaches lend themselves to messaging about SDOH consistent with an ecological approach to health. Moreover, recent research in cancer communication has suggested that values-based appeals may increase receptivity to and engagement with messages, which then improve literacy and empowerment. This approach may be particularly useful for addressing disparities populations like Latinos. Aim: We tested the efficacy of messages about SDOH that invoke the values of social justice, standing up to exploitative authority, and familism, three values held strongly by young adult Latinos. We hypothesized that values-based SDOH messages would be more effective than traditional fear-based individual messaging. Methods: An unbalanced experimental design with Mexican-American women aged 18-29 (N=434). Control condition (N=73): A typical fear-based appeal on the individual harms of obesity. Experimental condition (N=361): 5 distinct values-based messages on the social determinants of obesity and diabetes. Main Outcomes: Receptivity to and acceptance of the messages. Secondary Outcomes: Public health literacy, SSB media literacy, empowerment. Analyses: Simple and multiple linear regression models accounting for the unbalanced design. Results: Consistent with hypotheses, the values-based messages communicating an ecological model of public health were more effective than the traditional fear appeal individual behavior message: Participants were more receptive to (p<.001) and accepting of (p<.01) values-based messages relative to control. Values-based messages increased SSB media literacy (p<.05) and the perceived efficacy of civic actions such as boycotting SSB (p<.05) and using social media to advocate about SDOH and sugar (p<.001). Values-based messages appear to work by engendering identification (p<.001) and activating social justice values (p<.05). Conclusion: Values-based messages about the individual harms and social causes of SSB overconsumption resonate more than the traditional health communication approach among young adult Latinas who are at increased risk of diet-related cancer. An ecological approach to cancer communication incorporating SDOH and individual behavior holds considerable promise for addressing cancer disparities among Latinos. Citation Format: Deepti Chittamuru, Susana Ramirez. Effects of values-based messaging and an ecological approach to communicate about sugar as a strategy to prevent cancer among Latinas [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A026.

Obesity: a sociological guide for health practitioners.

Obesity is a condition of excess body fat that has been identified as one of the most serious public health problems of the 21st century. Obesity is a leading preventable cause of death globally and increases the likelihood of cardiovascular disease, diabetes and various cancers. Obesity worldwide has tripled in the adult population over the past 40 years, with 13% of the world's adult population now obese, leading to calls for control of a global obesity epidemic. Causes of obesity can be delineated at individual, societal and systemic levels, highlighting the need for analysis that transcends the biomedical paradigm to explore the sociological influences of this condition. The pathophysiology of why obesity occurs has not changed within recent history, but the way that people live their lives and the cultural understandings that evolve within communities have. This article describes the interaction between obesity and the social environment, explores the meaning of obesity within the context of health and considers the social determinants of obesity within the community. It also discusses the influences of the professional-patient exchange in obesity, the comprehension of obesity as a disease and the challenges of addressing obesity within the healthcare system.

How can primary care help to reduce weight stigma?

BackgroundThe WHO recently recognised stigma as a fundamental cause for health inequalities. Weight stigma is associated with negative health consequences, and patients experience it commonly in healthcare settings. This study forms part of systematic review that aimed to understand how weight stigma can be reduced through the adoption of whole systems approaches.AimTo generate new understandings of the roles primary care can take in reducing weight stigma.MethodA systematic international literature review of peer-reviewed articles utilising EPPI guidance, and using PICOS terms in Web of Science searches. Recommendations for policy, practice and/or research were extracted and conceptually synthesised as guided by Research Unit for Research Utilisation.ResultsThe search identified 194 full texts with 540 total recommendations. Approximately 45% of recommendations (248 of 540) were coded under healthcare, of which 75% were in primary care including general practice (189 of 248). Findings indicate areas where weight stigma could be addressed in primary care: 1) Training; 2) Self-awareness; 3) Non-stigmatising approaches; 4) Formal patient assessments; 5. Coping strategies; 6) Organisational/structural support; 7) Cross-sector working; 8) Anti-discrimination legislation and classify obesity as a disease.ConclusionLiterature on reducing weight stigma focuses substantially on healthcare, and there is a range of approaches that could be taken. Tensions arise between the medicalisation of obesity and need to consider social determinants of obesity. Healthcare is only one of many settings in which the weight stigma needs to be addressed and whole systems approaches, for example working with local government, are required in particular to reduce health inequalities.

Does neighbourhood deprivation affect the genetic influence on body mass?

Most research into the role of gene-environment interactions in the etiology of obesity has taken environment to mean behaviours such as exercise and diet. While interesting, this is somewhat at odds with research into the social determinants of obesity, in which the focus has shifted away from individuals and behaviours to the types of wider obesogenic environments in which individuals live, which influence and produce these behaviours. This study combines these two strands of research by investigating how the genetic influence on body mass index (BMI), used as a proxy for obesity, changes across different neighbourhood environments measured by levels of deprivation. Genetics are incorporated using a classical twin design with data from Twins UK, a longitudinal study of UK twins running since 1992. A multilevel modelling approach is taken to decompose variation between individuals into genetic, shared environmental, and non-shared environmental components. Neighbourhood deprivation is found to be a statistically significant predictor of BMI after conditioning on individual characteristics, and a heritability of 0.75 is estimated for the entire sample. This heritability estimate is shown, however, to be higher in more deprived neighbourhoods and lower in less deprived ones, and this relationship is statistically significant. While this research cannot say anything directly about the mechanisms behind the relationship, it does highlight how the relative importance of genetic factors can vary across different social environments, and therefore the value of considering both genetic and social determinants of health simultaneously.

Parental Perceptions of the Social Environment Are Inversely Related to Constraint of Adolescents' Neighborhood Physical Activity.

Background: The current study examined relationships between the neighborhood social environment (parental perceived collective efficacy (PCE)), constrained behaviors (e.g., avoidance or defensive behaviors) and adolescent offspring neighborhood physical activity in low- versus high-incivility neighborhoods. Methods: Adolescents (n = 71; 11–18 years (14.2, SD ± 1.6); male = 37 (52%); non-white = 24 (33.8%); low-income = 20 (29%); overweight/obese = 40 (56%)) and their parents/guardians enrolled in the Molecular and Social Determinants of Obesity in Developing Youth study were included in the current study. Questionnaires measured parents’/guardians’ PCE, constrained outdoor play practices and offspring neighborhood physical activity. Systematic social observation performed at the parcel-level using Google Street View assessed neighborhood incivilities. t-tests and chi-square tests determined differences by incivilities. Multilevel regression models examined relationships between PCE and: (1) constrained behaviors; and (2) neighborhood physical activity. The Hayes (2013) macro determined the mediating role of constrained behaviors. Results: Parents who had higher PCE reported lower levels of avoidance (p = 0.04) and defensive (p = 0.05) behaviors. However, demographic variables (i.e., gender, race and annual household income) limited these results. The direct relationship between PCE and parent-reported neighborhood physical activity was statistically significant in high-incivility neighborhoods only. Neither avoidance nor defensive behavior mediated the relationship between PCE and neighborhood physical activity. Conclusions: PCE influences parenting behaviors related to youth physical activity. Community-based programs that seek to facilitate social cohesion and control may be needed to increase adolescents’ physical activity.

The Social Determinants of Obesity: Examining The Intersections of Race, Class, and Gender in African American Women

The Social Determinants of Obesity: Examining The Intersections of Race, Class, and Gender in African American Women

Individual and social determinants of obesity in strategic health messages: Interaction with political ideology

ABSTRACTAntiobesity health communication campaigns often target individual behavior, but these ads might inflate the role of individual responsibility at the expense of other health determinants. In a 2 × 2 full-factorial, randomized, online experiment, 162 American adults viewed antiobesity advertisements that varied in emphasizing social or individual causation for obesity through text and images. Locus for attribution of responsibility for obesity causes and solutions was measured, as was how these responses were moderated by political ideology. Participants who viewed text emphasizing individual responsibility were less likely to agree that genetic factors caused obesity. Conservative participants who viewed images of overweight individuals were less likely than liberal participants to agree that social factors were responsible for causing obesity. In addition, among conservative participants who viewed images of fast food versus images of overweight individuals, agreement that the food industry bore some responsibility mediated support for policy solutions to obesity. These findings, among others, demonstrate that awareness of multilevel determinants of health outcomes can be a precursor of support for policy solutions to obesity among those not politically inclined to support antiobesity policy. In addition, stigmatizing images of overweight individuals in antiobesity campaigns might overemphasize the role of individual behavior in obesity at the expense of other factors.

The Harm of Bioethics: A Critique of Singer and Callahan on Obesity

Debate concerning the social impact of obesity has been ongoing since at least the 1980s. Bioethicists, however, have been relatively silent. If obesity is addressed it tends to be in the context of resource allocation or clinical procedures such as bariatric surgery. However, prominent bioethicists Peter Singer and Dan Callahan have recently entered the obesity debate to argue that obesity is not simply a clinical or personal issue but an ethical issue with social and political consequences. This article critically examines two problematic aspects of Singer and Callahan's respective approaches. First, there is an uncritical assumption that individuals are autonomous agents responsible for health-related effects associated with food choices. In their view, individuals are obese because they choose certain foods or refrain from physical activity. However, this view alone does not justify intervention. Both Singer and Callahan recognize that individuals are free to make foolish choices so long as they do not harm others. It is at this point that the second problematic aspect arises. To interfere legitimately in the liberty of individuals, they invoke the harm principle. I contend, however, that in making this move both Singer and Callahan rely on superficial readings of public health research to amplify the harm caused by obese individuals and ignore pertinent epidemiological research on the social determinants of obesity. I argue that the mobilization of the harm principle and corresponding focus on individual behaviours without careful consideration of the empirical research is itself a form of harm that needs to be taken seriously.

Young children’s screen activities, sweet drink consumption and anthropometry: results from a prospective European study

This longitudinal study describes the relationship between young children's screen time, dietary habits and anthropometric measures. The hypothesis was that television viewing and other screen activities at baseline result in increased consumption of sugar-sweetened beverages (SSB) and increased BMI, BMI z-score and waist to height ratio (WHtR) two years later. A second hypothesis was that SSB consumption mediates the association between the screen activities and changes in the anthropometric measures. The study is a part of the prospective cohort study IDEFICS ("Identification and prevention of dietary and lifestyle-induced health effects in children and infants"), investigating diet, lifestyle and social determinants of obesity in 2 to 9-year-olds in eight European countries (baseline n=16,225, two-year follow-up; n=11,038). Anthropometry was objectively measured, and behaviours were parent-reported. The main hypothesis was supported, but the second hypothesis was not confirmed. The odds ratio of being in the highest quintile of % change in WHtR was 1.26 (95% CI: 1.17-1.36) and in BMI 1.22 (95% CI: 1.13-1.31), for each hour per day watching television. The odds ratio of having increased SSB consumption was 1.19 (95% CI: 1.09-1.29) for each hour per day watching TV. The associations for total screen time were slightly weaker. The results indicate substantial effects of TV viewing and other screen activities for young children, both on their consumption of sugary drinks and on an increase in BMI and central obesity. Our findings suggest that television viewing seems to have a stronger effect on food habits and anthropometry than other screen activities in this age group.

Riesgos asociados a la dieta occidental y al sedentarismo: la epidemia de obesidad

We describe the magnitude and trends of obesity in Spain and of its main determinants, associated both with the increase in energy intake and the reduction of energy expenditure. Such determinants include factors from the individual subjects and from their environment. We also present the main features of the strategy for the Nutrition, Physical Activity, and the Prevention of Obesity, fostered by the Ministry of Health, as well as plans and activities carried out by the Regional Governments,to control this health disorder. We conclude that effective and sustained implementation of these activities is badly needed. It should be made along with the monitoring of obesity and its determinants in the general population. Research in this field should also be strengthened because social determinants of obesity are not known in depth, and the effectiveness of many of the interventions proposed by the national and regional initiatives is not well established yet. Moreover, in the next future, the effectiveness of intervention models applied to control the smoking epidemic must be assessed to examine its usefulness in the control of obesity. An example of this type of interventions is the limitation of the publicity of nutrient-poor and energy-dense foods addressed to children.