Socioeconomic Correlates of Obesity in African-American and Caribbean-Black Men and Women

Sleep, Health Outcomes and Body Weight (SHOW) study: a measurement burst design study on sleep and risk factors for obesity in black emerging adults in North Carolina, USA

INTRODUCTION

Black emerging adults (18-28 years) have the highest risk of short sleep duration and obesity. This increased risk may be partly explained by greater stress levels, which may result from race-related stress (racial discrimination and heightened race-related vigilance) or living in more disadvantaged home and neighbourhood environments. Insufficient sleep may also impact obesity risk via several weight-related mechanisms including energy balance, appetite and food reward, cortisol profiles and hydration status. This paper describes the rationale, design and methods for the Sleep, Health Outcomes and Body Weight (SHOW) study. This study aims to prospectively assess the effects of sleep, race-related stress and home/neighbourhood environments on weight-related mechanisms and obesity markers (body weight, waist circumference and fat mass) in 150 black emerging adults.

METHODS AND ANALYSIS

The SHOW study follows a measurement burst design that includes 3, 7-day data collection bursts (baseline, 6-month and 12-month follow-ups). Sleep is measured with three methods: sleep diary, actigraphy and polysomnography. Energy balance over 7 days is based on resting and postprandial energy expenditure measured via indirect calorimetry, physical activity via accelerometry and self-reported and ad libitum energy intake methods. Self-reported methods and blood biomarkers assess fasting and postprandial appetite profiles and a behavioural-choice task measures food reward. Cortisol awakening response and diurnal cortisol profiles over 3 days are assessed via saliva samples and chronic cortisol exposure via a hair sample. Hydration markers are assessed with 24-hour urine collection over 3 days and fasting blood biomarkers. Race-related stress is self-reported over 7 days. Home and neighbourhood environments (via the Windshield Survey) is observer assessed.

ETHICS AND DISSEMINATION

Ethics approval was granted by the University of North Carolina at Greensboro's Institutional Review Board. Study findings will be disseminated through peer-reviewed publications, presentations at scientific meetings and reports, briefs/infographics for lay and community audiences.

Changes in Prevalence of Idiopathic Intracranial Hypertension in the United States Between 2015 and 2022, Stratified by Sex, Race, and Ethnicity

BACKGROUND AND OBJECTIVES

With the obesity epidemic within the United States, the prevalence of idiopathic intracranial hypertension (IIH) is predicted to rise. IIH prevalence and racial disparities have rarely been reported in the United States. The purpose of this study was to evaluate the prevalence of IIH in a large national database while stratifying by sex, age, race, and ethnicity.

METHODS

This was a cross-sectional epidemiologic evaluation conducted in the TriNetX US Collaborative network using data from 2015 to 2022. Patients with an International Classification of Diseases code of IIH and papilledema or unspecified papilledema were included in the study. Any secondary cause of intracranial hypertension including cerebral neoplasms and hydrocephalus were excluded from the study. IIH trends were later compared with TriNetX cohort obesity trends. Prevalence and prevalence odds ratios (ORs) were calculated in Microsoft Excel and R Studio.

RESULTS

Among 85 million patients in this database, a 1.35 times increase in the prevalence of IIH occurred between 2015 and 2022 from 7.3 (95% CI 6.9-7.7) individuals per 100,000 to 9.9 (95% CI 9.5-10.3) individuals per 100,000 in 2022. In 2022, Black female individuals had the highest prevalence of IIH with 22.7 individuals per 100,000 compared with the 13.7 White female individuals per 100,000. Patients aged 11-17 years showed the largest growth of IIH prevalence with female individuals increasing by 10 individuals per 100,000 by 2022. Overall, Black and Hispanic patients had the largest prevalence OR of IIH at 1.66 (95% CI 1.49-1.85) and 1.33 (95% CI 1.14-1.56), respectively, compared with White female patients.

DISCUSSION

IIH is a rapidly increasing health care concern for the US population, particularly among adolescent patients. Black and Hispanic female individuals are most predominately affected by this incapacitating disorder.

Understanding Obesity in African American Women Using Leininger's Theory

In the United States, African American (AA) women suffer from higher rates of obesity as compared with Caucasians or Asians. Unfortunately, most weight management interventions have been unsuccessful in maintaining weight loss. Prior research has revealed that AA women face unique barriers in managing obesity; therefore, more research is warranted to address this problem. Leininger's theory is used to understand obesity through a cultural lens. The constructs of the sunrise model are defined as a means to intervene when providing nursing care through cultural preservation, accommodation, and repatterning. We conclude that culture care theory offers a theoretical framework to assist nurses in providing culturally sensitive care to Black women with obesity. Nurses caring for this population can utilize this theory to tailor interventions specific to the cultural needs of women to improve outcomes in the management of obesity. In this article, we use AA and Black interchangeably to represent Americans whose ancestors originate from Africa.

Obesity among African American people in the United States: A review

Obesity is a growing public health crisis in the United States and is associated with a substantial disease burden due to an increased risk for multiple complications, including cardiovascular and metabolic diseases. As highlighted in this review, obesity disproportionately affects the African American population, women in particular, regardless of socioeconomic status. Structural racism remains a major contributor to health disparities between African American people and the general population, and it limits access to healthy foods, safe spaces to exercise, adequate health insurance, and medication, all of which impact obesity prevalence and outcomes. Conscious and unconscious interpersonal racism also impacts obesity care and outcomes in African American people and may adversely affect interactions between health care practitioners and patients. To reduce health disparities, structural racism and racial bias must be addressed. Culturally relevant interventions for obesity management have been successfully implemented that have shown benefits in weight management and risk-factor reduction. Strategies to improve health care practitioner-patient engagement should also be implemented to improve health outcomes in African American people with obesity. When managing obesity in African American people, it is critical to take a holistic approach and to consider an individual's social and cultural context in order to implement a successful treatment strategy.

Comprehensive Review of Cardiovascular Disease Risk in Nonalcoholic Fatty Liver Disease

Nonalcoholic Fatty Liver Disease (NAFLD) is a growing global phenomenon, and its damaging effects in terms of cardiovascular disease (CVD) risk are becoming more apparent. NAFLD is estimated to affect around one quarter of the world population and is often comorbid with other metabolic disorders including diabetes mellitus, hypertension, coronary artery disease, and metabolic syndrome. In this review, we examine the current evidence describing the many ways that NAFLD itself increases CVD risk. We also discuss the emerging and complex biochemical relationship between NAFLD and its common comorbid conditions, and how they coalesce to increase CVD risk. With NAFLD's rising prevalence and deleterious effects on the cardiovascular system, a complete understanding of the disease must be undertaken, as well as effective strategies to prevent and treat its common comorbid conditions.

Racial Disparities in Methylation of NRF1, FTO, and LEPR Gene in Childhood Obesity

Childhood obesity has affected the health of millions of children around the world despite vigorous efforts by health experts. The obesity epidemic in the United States has disproportionately afflicted certain racial and ethnic minority groups. African American children are more likely than other children to have obesity-related risk factors such as hyperlipidemia, diabetes, cardiovascular disease, and coronavirus disease (COVID-19). For the reduction in obesity-related health inequalities to be successful, it is essential to identify the variables affecting various groups. A notable advancement in epigenetic biology has been made over the past decade. Epigenetic changes like DNA methylation impact on many genes associated with obesity. Here, we evaluated the DNA methylation levels of the genes NRF1, FTO, and LEPR from the saliva of children using real-time quantitative PCR-based multiplex MethyLight technology. ALU was used as a reference gene, and the Percent of Methylated Reference (PMR) was calculated for each sample. European American children showed a significant increase in PMR of NRF1 and FTO in overweight/obese participants compared to normal weight, but not in African American children. After adjusting for maternal education and annual family income by regression analysis, the PMR of NRF1 and FTO was significantly associated with BMI z-score only in European American children. While for the gene LEPR, African American children had higher methylation in normal weight participants as compared to overweight/obese and no methylation difference in European American children. The PMR of LEPR was significantly negative associated with the obesity measures only in African American children. These findings contribute to a race-specific link between NRF1, FTO, and LEPR gene methylation and childhood obesity.

Pushing Past Limits: How Efficacious Is High-Effort Coping for Self-Rated Health among African American and Caribbean Black Women?

Due to systemic oppression, Black women experience distinct risks across the life course, such as exposure to various stressors that shape lower ratings of self-rated health. This is important given that self-rated health is a stronger indicator of current morbidity and subsequent mortality than physician assessments. However, there has been limited consideration of the role of coping in shaping self-rated health among this group. John Henryism, or high-effort coping, is a culturally relevant coping style that reflects the broader societal, cultural, and historical context that shapes lived experiences of Black populations navigating racism and capitalism in the U.S., and has received limited consideration in health research among Black women. Additionally, less is known regarding how ethnicity shapes John Henryism and health processes among Black women specifically. Therefore, the present study examined the association between John Henryism and self-rated health among African American and Caribbean Black women (n = 1580) collectively, and explored this association among Caribbean Black women specifically, utilizing the National Survey of American Life (NSAL 2001-2003). Findings show that while John Henryism was not directly associated with self-rated health among either group, once sociodemographic characteristics and stress exposure were accounted for, John Henryism was associated with lower odds of fair or poor self-rated health among both groups.

Association between Proximity to Food Sources and Dietary Behaviors in Black and White College Graduates

OBJECTIVES

Unequal access to healthy food environments is often implicated in racial inequities in health and behaviors that are largest among college graduates. The aim of this study was to determine associations between perceived proximity to food sources and dietary behaviors between black and white college graduates.

METHODS

In a cross-sectional online survey of dietary behaviors between black and white adults who have a ≥ 4-year bachelor's degree, respondents were asked how long it typically takes for them to get to grocery stores and fast-food restaurants from home. We used ordinal logit regression models to assess associations between perceived proximity to food sources and dietary behaviors.

RESULTS

Among black men, perceiving that a grocery store was ≥ 10 minutes from their home was associated with lower fruit consumption (beta=-0.94, SE=0.48). Perceiving that a grocery store was ≥ 10 minutes from their home was associated with more frequent fast-food consumption among black men (beta=1.21, SE=0.39), Black women (beta=0.98, SE=0.34), and white men (beta=0.74, SE=0.30).

CONCLUSIONS

The associations between perceived proximity to food sources and dietary behaviors differ by race and sex among college graduates with important implications for racial disparities in diet quality and obesity across SES.

Effect of excessive gestational weight gain on insulin sensitivity and insulin kinetics in women with overweight/obesity

OBJECTIVE

Obesity increases the risk for pregnancy complications and maternal hyperglycemia. The Institute of Medicine developed guidelines for gestational weight gain (GWG) targets for women with overweight/obesity, but it is unclear whether exceeding these targets has adverse effects on maternal glucose metabolism.

METHODS

Insulin sensitivity (assessed using the Matsuda Insulin Sensitivity Index), β-cell function (assessed as insulin secretion rate in relation to plasma glucose), and plasma insulin clearance rate were evaluated using a frequently sampled oral glucose tolerance test at 15 and 35 weeks of gestation in 184 socioeconomically disadvantaged African American women with overweight/obesity.

RESULTS

Insulin sensitivity decreased, whereas β-cell function and insulin clearance increased from 15 to 35 weeks of gestation in the entire group. Compared with women who achieved the recommended GWG, excessive GWG was associated with a greater decrease in insulin sensitivity between 15 and 35 weeks. β-cell function and plasma insulin clearance were not affected by excessive GWG.

CONCLUSIONS

These data demonstrate that gaining more weight during pregnancy than recommended by the Institute of Medicine is associated with functional effects on glucose metabolism.

Metabolic Links to Socioeconomic Stresses Uniquely Affecting Ancestry in Normal Breast Tissue at Risk for Breast Cancer

A primary difference between black women (BW) and white women (WW) diagnosed with breast cancer is aggressiveness of the tumor. Black women have higher mortalities with similar incidence of breast cancer compared to other race/ethnicities, and they are diagnosed at a younger age with more advanced tumors with double the rate of lethal, triple negative breast cancers. One hypothesis is that chronic social and economic stressors result in ancestry-dependent molecular responses that create a tumor permissive tissue microenvironment in normal breast tissue. Altered regulation of N-glycosylation of proteins, a glucose metabolism-linked post-translational modification attached to an asparagine (N) residue, has been associated with two strong independent risk factors for breast cancer: increased breast density and body mass index (BMI). Interestingly, high body mass index (BMI) levels have been reported to associate with increases of cancer-associated N-glycan signatures. In this study, we used matrix assisted laser desorption/ionization (MALDI) imaging mass spectrometry (IMS) to investigate molecular pattern changes of N-glycosylation in ancestry defined normal breast tissue from BW and WW with significant 5-year risk of breast cancer by Gail score. N-glycosylation was tested against social stressors including marital status, single, education, economic status (income), personal reproductive history, the risk factors BMI and age. Normal breast tissue microarrays from the Susan G. Komen tissue bank (BW=43; WW= 43) were used to evaluate glycosylation against socioeconomic stress and risk factors. One specific N-glycan (2158 m/z) appeared dependent on ancestry with high sensitivity and specificity (AUC 0.77, Brown/Wilson p-value<0.0001). Application of a linear regression model with ancestry as group variable and socioeconomic covariates as predictors identified a specific N-glycan signature associated with different socioeconomic stresses. For WW, household income was strongly associated to certain N-glycans, while for BW, marital status (married and single) was strongly associated with the same N-glycan signature. Current work focuses on understanding if combined N-glycan biosignatures can further help understand normal breast tissue at risk. This study lays the foundation for understanding the complexities linking socioeconomic stresses and molecular factors to their role in ancestry dependent breast cancer risk.

Race, Ethnicity, and Age Differences in Social Relationships and Obesity: Findings From the National Survey of American Life

ObjectiveThe purpose of this study was to examine race, ethnicity, and age differences in the association between social relationships and body weight in a nationally representative sample of African American, Caribbean Black, and non-Hispanic White adults. Methods: Data were drawn from the 2001-2003 National Survey of American Life (N = 5684). Multiple linear regressions were conducted to examine the links between race, ethnicity, and age with social relationships and weight. Results: Although African American respondents had higher BMI than non-Hispanic White respondents, Caribbean Black respondents did not differ from White respondents in BMI. Emotional support from family members was both positively and negatively associated with weight depending on age, race, and ethnicity. Discussion: Social relationships are an important contributing factor to obesity and obesity-related risks in adults. Study findings demonstrate the intersection of race, ethnicity, and age and how these complex relationships influence the association between social relationships and body weight.

Stress Exposure and Physical Health among Older African American and Caribbean Black Women

Objectives: This study assessed whether multiple stress exposures and stress accumulation explained differences in physical health among Afro-Caribbean and African American women in older adulthood. Whether specific stressors uniquely influenced the health of African American and Afro-Caribbean women was also examined. Methods: Data were drawn from the National Survey of American Life (NSAL) (N=867; 50 years and older). Physical health was assessed by multiple chronic conditions, functional limitations, and self-rated health. Weighted binary logistic regression and ordered logistic regression analyses were conducted. Results: Compared to Afro-Caribbean women, African American women had worse physical health and greater stress exposure. Nonetheless, stress exposure did not explain ethnic differences in physical health. The association between specific measures of stress and physical health was dependent on the stressor and physical health measure. Discussion: Findings emphasize the importance of ethnic variation in health and stress exposure among older US Black women. Study implications are discussed.

Prevalence and contributing factors to recurrent binge eating and obesity among black adults with food insufficiency: findings from a cross-sectional study from a nationally-representative sample

BACKGROUND

Living in a food-insecure or food insufficient household may increase risk for binge eating and obesity. Because racial disparities in food access, obesity, and access to treatment for disordered eating exist, it is important to examine these relationships in Black populations.

METHODS

We conducted a secondary analysis of data from the National Survey of American Life (N = 4553), a nationally-representative sample of Black Americans, including African Americans and Afro-Caribbeans. Logistic regression was used to explore the association of food insufficiency with obesity and binge eating.

RESULTS

In the total sample of Black Americans, the prevalence of food insufficiency was 10.9% (95% CI 10.0-11.8%). Food insufficiency was not significantly associated with obesity in Black Americans, but when associations were explored in analyses stratified by ethnicity and sex, food insufficiency significantly predicted an increased odds of obesity in Afro-Caribbeans (odds ratio [OR] = 1.47, 95% CI 1.01, 2.13). Individuals experiencing food insufficiency were more likely to report recurrent binge eating in the last 12 months (3% v 2%, P = 0.02) and a lifetime history of binge eating (6% v 3%, P = 0.004) compared to those who were food sufficient. After adjusting for socio-demographic factors, food insufficiency was not significantly associated with recurrent binge eating in Black Americans or in sex- and ethnicity-stratified analyses.

CONCLUSION

The present study reveals a more complex relation between food insufficiency and binge eating than previously thought-although an association existed, it was attenuated by an array of sociodemographic factors. Our results also underscore the importance of considering ethnicity as different patterns emerged between African American and Afro-Caribbean participants.

Toxic stress and burnout: John Henryism and social dominance in the laboratory and STEM workforce

Persons Excluded from science because of Ethnicity and Race (PEERs) face chronic exposure to interpersonal stressors, such as social discrimination, throughout their scientific careers, leading to a long-term decline in physical and mental health. Many PEERs exhibit John Henryism, a coping mechanism to prolonged stress where an individual expends higher levels of effort and energy at the cost of their physical and mental health. In this article, we discuss how social dominance may increase John Henryism within the STEM community; the causes, effects and costs of John Henryism; and highlight solutions to combat these social adversity stressors within the academic institution.

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 12 months 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.

Relationships of Educational Attainment and Household Food Insecurity with Obesity: Findings from the 2007-2016 National Health and Nutrition Examination Survey

This study aimed to determine whether 1882 Black young adults' educational attainment was associated with their obesity ([BMI] ≥ 30) and whether this association varied with household food insecurity. Data from interviews with Black young adults and a medical examination from the 2007-2016 National Health and Nutrition Examination Survey were analyzed. Modified Poisson regressions with robust standard errors were used. Educational attainment was not associated with obesity (prevalence ratio [PR] = 1.05, 95% confidence interval [CI]: 0.85, 1.30) after adjusting for age, sex, marital status, smoking status, drinking status, income, health insurance status, physical activity level, and household food insecurity. The interaction between educational attainment and household food insecurity was also not significant (PR = 1.11, 95% CI: 0.56, 2.19) after adjusting for the same covariates. These findings indicated that college graduates were as likely to be obese as those with less education, and the relationship between educational attainment and obesity did not vary with household food insecurity. Future studies should conduct longitudinal analyses of these relationships. There is a need to identify the roles that education, household food insecurity, and other measures of socioeconomic status play in Black young adults' obesity.

Life course socioeconomic position and body composition in adulthood: a systematic review and narrative synthesis

INTRODUCTION

Multiple systematic reviews have investigated the relation between socioeconomic position (SEP) and body mass index (BMI) throughout the life course. However, BMI does not capture quantity and distribution of fat and muscle, which are better indicators of obesity than BMI, and have been independently linked to adverse health outcomes. Less is known about the relation between SEP and body composition, and the literature has not been reviewed. We therefore systematically reviewed the literature on the association between life course SEP and body composition in adulthood.

METHODS

A protocol was registered on PROSPERO (CRD42019119937), and the review followed PRISMA guidelines. An electronic search of three databases (MEDLINE, Embase Classic + Embase and SPORTDiscus) was conducted. Original studies in the English language were included that examine the association between any recognised measure of SEP at any age and body composition (fat mass, fat-free mass, ratio and distribution) in adulthood, measured using a direct technique, i.e., not an anthropometric measure. A narrative synthesis was conducted.

RESULTS

A total of 47 papers were included in the final review, none were from low-income countries (LICs). Greater advantage in childhood and adulthood was associated with lower fat levels in high-income countries (HICs). Associations in the opposite direction were found exclusively in middle-income countries (MICs). No studies in MICs reported associations for childhood SEP. For measures of lean mass, the majority of papers reported no association, or greater advantage in adulthood associated with higher lean mass, with little variation between HICs and MICs. Associations in HICs are more often observed in women than men.

CONCLUSION

The results indicate that fat measures follow similar patterns to those seen for BMI, and that women in HICs are more likely to experience inequalities in both fat and lean measures. Further research in LICs and MICs is needed.