Inequality as an Explanation for Obesity in the United States

Over the past several decades, there has been a sharp increase in obesity across all population groups in the United States. In fact, the United States has one of the highest rates of obesity compared to other countries throughout the world. Obesity has become a national public health concern because it is related to a number of negative health, social, psychological, and economic outcomes. It is particularly concerning because racial/ethnic minorities and populations with the least education and highest poverty rates bear the largest burden of obesity. In addition, disparities in obesity tend to be gendered, with women experiencing the largest disparities in obesity by income, education, and race/ethnicity. In this review, I describe how social inequality is linked to obesity in the United States. I highlight elements of disadvantage at the individual‐, family‐, school‐, and neighborhood‐level that are linked to energy intake and expenditure, which are directly related to obesity, and draw from evidence and theories from multiple fields of the social and medical sciences. I also highlight the important role stress may play in linking disadvantage to obesity, particularly for women. I argue that understanding the complex mechanisms and processes that link social inequality to obesity requires multidisciplinary and multilevel frameworks.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112293/1/j.1751-9020.2010.00355.x.pd

Race, ethnicity and the social context of disadvantage and its links to obesity and physical activity in adolescence and the transition to adulthood

My dissertation investigates the relationship between social disadvantage and obesity physical activity outcomes using the National Longitudinal Study of Adolescent Health (Add Health). Using a dynamic longitudinal model, I examine the impact of social disadvantage in adolescence on patterns of obesity and physical activity (PA) across the transition to young adulthood, a period when adult lifestyle behaviors are solidified and major racial/ethnic and socioeconomic disparities become apparent. The highest rates of obesity occur among the most disadvantaged population groups, racial and ethnic minorities, and those with the highest poverty rates and the least education. I draw on a life course framework and the ecological model of human development to conceptualize the mechanisms of social disadvantage that link race/ethnicity and low SES to obesity and low levels of PA. I use data from three waves of Add Health to track obesity and PA trajectories from adolescence (WII: ages 13-19 y.) into adulthood (WIII: ages 19-26 y.) and to measure factors at the individual, family, peer, school and neighborhood levels in adolescence (WI and WII) that shape these trajectories. My three specific aims investigate the role of social disadvantage in the social contexts of young people's lives and determine if they serve as mechanisms through which race/ethnic and SES disparities operate. These mechanisms include: (1) cumulative risk (CR) indices, which refers to the number of risk factors that exists in a child's social environment with the assumption that disadvantage is related to the accumulation of risk factors rather than a singular exposure; (2) Multilevel socioeconomic disadvantage--disadvantage present in the peer, school, and neighborhood context (e.g., proportion of peers/school/neighborhood with parents who have no high school diploma) and (3) parenting styles and practices. This dissertation contributes to social science research on racial and ethnic and socioeconomic health disparities by utilizing dynamic, interconnected and multilevel conceptualizations of the environment to study obesity and physical activity outcomes. In addition, by identifying alterable mechanisms operating in the social environments of disadvantaged populations that produce obesity and PA disparities, this research can inform policies and interventions aimed at eliminating them

Racial/ethnic differences in the relationship between wealth and health across young adulthood

Background Although the relationship between socioeconomic position (SEP) and health has been well documented, very few prior investigations have examined the time-varying association between wealth and health across race/ethnicity. This study examined the racial/ethnic differences in the wealth–health associations during young adulthood. Method Data were drawn from the National Longitudinal Survey of Youth 1997 with three time points, when respondents were aged 20, 25, and 30. The primary dependent variable was dichotomized self-rated health (SRH). Two indices of wealth were calculated: respondents’ own reported net worth and reported parental net worth in 1997. Other SEP indicators included household income, education, employment status, and parental education. Three racial/ethnic groups were examined: nonHispanic White, non-Hispanic Black, and Hispanic. Two-level logistic regression was performed, stratified by race/ethnicity. Results In the whole-sample analysis, racial/ethnic differences in SRH were not statistically significant, after controlling for wealth. For self-reported net worth during young adulthood, wealth has a incremental consistent effect on health among non-Hispanic White respondents and Hispanic respondents but not among Black respondents. Individual net worth and parental net worth were only significantly associated with health among the highest wealth quartiles among non-Hispanic Black respondents. Only individual net worth, not parental net worth, was significantly associated with SRH in the Hispanic sample. Conclusion This study examined racial/ethnic differences in time-varying relationship between wealth and health during young adulthood. Findings indicate that there are notable racial/ethnic differences in the patterning of wealth–health association that appear to emerge in early adulthood. Implications for asset-based policy and programs are discussed

Obesity Reduction Within a Generation: The Dual Roles of Prevention and Treatment

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93699/1/oby.2011.199.pd

Interpersonal discrimination and depressive symptomatology: examination of several personality-related characteristics as potential confounders in a racial/ethnic heterogeneous adult sample

Abstract Background Research suggests that reports of interpersonal discrimination result in poor mental health. Because personality characteristics may either confound or mediate the link between these reports and mental health, there is a need to disentangle its role in order to better understand the nature of discrimination-mental health association. We examined whether hostility, anger repression and expression, pessimism, optimism, and self-esteem served as confounders in the association between perceived interpersonal discrimination and CESD-based depressive symptoms in a race/ethnic heterogeneous probability-based sample of community-dwelling adults. Methods We employed a series of ordinary least squares regression analyses to examine the potential confounding effect of hostility, anger repression and expression, pessimism, optimism, and self-esteem between interpersonal discrimination and depressive symptoms. Results Hostility, anger repression, pessimism and self-esteem were significant as possible confounders of the relationship between interpersonal discrimination and depressive symptoms, together accounting for approximately 38% of the total association (beta: 0.1892, p < 0.001). However, interpersonal discrimination remained a positive predictor of depressive symptoms (beta: 0.1176, p < 0.001). Conclusion As one of the first empirical attempts to examine the potential confounding role of personality characteristics in the association between reports of interpersonal discrimination and mental health, our results suggest that personality-related characteristics may serve as potential confounders. Nevertheless, our results also suggest that, net of these characteristics, reports of interpersonal discrimination are associated with poor mental health.http://deepblue.lib.umich.edu/bitstream/2027.42/112604/1/12889_2013_Article_6001.pd

Interpersonal discrimination and depressive symptomatology: examination of several personality-related characteristics as potential confounders in a racial/ethnic heterogeneous adult sample

Background Research suggests that reports of interpersonal discrimination result in poor mental health. Because personality characteristics may either confound or mediate the link between these reports and mental health, there is a need to disentangle its role in order to better understand the nature of discrimination-mental health association. We examined whether hostility, anger repression and expression, pessimism, optimism, and self-esteem served as confounders in the association between perceived interpersonal discrimination and CESD-based depressive symptoms in a race/ethnic heterogeneous probability-based sample of community-dwelling adults. Methods We employed a series of ordinary least squares regression analyses to examine the potential confounding effect of hostility, anger repression and expression, pessimism, optimism, and self-esteem between interpersonal discrimination and depressive symptoms. Results Hostility, anger repression, pessimism and self-esteem were significant as possible confounders of the relationship between interpersonal discrimination and depressive symptoms, together accounting for approximately 38% of the total association (beta: 0.1892, p \u3c 0.001). However, interpersonal discrimination remained a positive predictor of depressive symptoms (beta: 0.1176, p \u3c 0.001). Conclusion As one of the first empirical attempts to examine the potential confounding role of personality characteristics in the association between reports of interpersonal discrimination and mental health, our results suggest that personality-related characteristics may serve as potential confounders. Nevertheless, our results also suggest that, net of these characteristics, reports of interpersonal discrimination are associated with poor mental health

Racial and Ethnic Disparities in Housing Instability during the COVID-19 Pandemic

Stable and adequate housing is critical in the midst of a pandemic; without housing, individuals and families cannot shelter in place to prevent the spread of disease. Understanding and combating housing hardships in vulnerable populations is therefore essential to a sound public health response. This study aims to explore the pandemic’s disproportionate impacts on housing-related hardships across racial/ethnic groups in the United States as well as the extent to which these disparities are mediated by households’ broader economic circumstances; namely, their pre-pandemic liquid asset levels and the experience of COVID-19-related job and income losses. Using a national survey of over 4,000 households, we find that Black and Hispanic respondents were more vulnerable to housing-related hardships during the pandemic than White respondents. These impacts were particularly pronounced in lower-income minority households. For Black respondents, who had much lower levels of pre-pandemic liquid assets than other groups, liquid assets acted as a strong mediator of housing hardship disparities between White and Black respondents. On the other hand, neither liquid asset amounts before the pandemic nor employment shocks during the pandemic explain the pandemic’s disproportionate impacts on Hispanic families. Our findings imply that housing became less stable for racial/ethnic minority groups as a result of the pandemic. In particular, the observed disparities, as well as the mechanisms driving them, demonstrate the necessity of policies and practices that target support to these economically marginalized groups. New file added 2021-04-13 with corrected numbers. Original file is available as a supplemental file

Trends in Body Mass Index in Adolescence and Young Adulthood in the United States: 1959–2002

AbstractPurposeThis study examined trends in body mass index (BMI) during the transition from adolescence to young adulthood by gender and race, using national data from the United States spanning for >40 years from 1959 and 2002. Although past research has investigated BMI trends separately in childhood/adolescence and adulthood, this study uniquely focused on the transition to adulthood (12–26 years) to identify the emergence of the obesity epidemic during this critical life-stage.MethodsLongitudinal and cross-sectional data were obtained from four nationally representative surveys: National Health and Nutrition Examination Survey, National Longitudinal Study of Adolescent Health, National Health Interview Survey, and National Longitudinal Surveys of Youth (NLSY79 and NLSY97). The analysis tracked age trends in BMI by time, which allowed for the examination of how BMI changed during the transition to adulthood and whether the patterns of change varied by period. Data best suited for trend analysis were identified. Age trends in BMI by gender and race were graphed and regression analysis was used to test for significant differences in the trends using the National Health and Nutrition Examination Survey and National Longitudinal Study of Adolescent Health.ResultsBMI increased sharply in the adolescent ages, beginning in the 1990s and among young adults around 2000. This age pattern of BMI increase was more dramatic among females and blacks, particularly black females.ConclusionsBMI increased during the transition to adulthood and these increases have grown larger over time. Obesity prevention efforts should focus on this high-risk transition period, particularly among minority populations

Racial and Ethnic Differences in the Association Between Obesity and Depression in Women

Background: It is generally accepted that obesity and depression are positively related in women. Very little prior research, however, has examined potential variation in this relationship across different racial/ethnic groups. This paper examines the association between obesity and depression in non-Hispanic White, non-Hispanic Black, and Mexican American women. Methods: The sample included women aged 20 years and older in the 2005?2008 National Health and Nutrition Examination Surveys (n=3666). Logistic regression was used to assess the relationship between obesity and depression syndrome (assessed using the Patient Health Questionnaire-9), after adjusting for covariates. We then investigated whether this association varied by race/ethnicity. Results: Overall, obese women showed a 73% greater odds of depression (odds ratio [OR]=1.73; 95% confidence interval [CI]=1.19, 2.53) compared with normal weight women. This association varied significantly, however, by race/ethnicity. The obesity-depression associations for both Black and Mexican American women were different from the positive association found for White women (ORBlack*obese=0.24; 95% CI=0.10,0.54; ORMexican American*obese=0.42; 95% CI=1.04). Among White women, obesity was associated with significantly greater likelihood of depression (OR=2.37; 95% CI=1.41, 4.00) compared to normal weight. Among Black women, although not statistically significant, results are suggestive that obesity was inversely associated with depression (OR=0.56; 95% CI=0.28, 1.12) relative to normal weight. Among Mexican American women, obesity was not associated with depression (OR=1.01; 95% CI=0.59, 1.72). Conclusions: The results reveal that the association between obesity and depression varies by racial/ethnic categorization. White, but not Black or Mexican American women showed a positive association. Next research steps could include examination of factors that vary by race/ethnicity that may link obesity to depression.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140124/1/jwh.2012.4111.pd