How Segregation and Discrimination Racialized the Obesity Epidemic

Duke Today, July 22, 2019.

DURHAM, N.C. — America’s costly obesity epidemic disproportionately afflicts black and Latino populations, according to a new report from Duke University.

The report from the Samuel DuBois Cook Center on Social Equity at Duke says residential segregation and a lack of upward social mobility helped create racial disparities in obesity rates, and it provides recommendations for change.

The report illuminates how “protective factors” that can help prevent obesity in the general population often do not insulate blacks.

The key difference is neighborhoods: Predominantly African-American neighborhoods often lack key health-promoting resources such as parks and access to fresh foods. Those stark neighborhood differences, in turn, result from discriminatory housing policies.

“The impact of discrimination is pervasive and occurs in all arenas of everyday life.  Discrimination’s adverse effect on maintenance of healthy weight and well-being is virtually as pernicious as its effects on employment and income,” said William A. Darity Jr., co-author of the report, Samuel DuBois Cook Professor of Public Policy, African and African American Studies and economics at Duke, and director of the Cook Center.

In America, nearly 40 percent of adults are obese, resulting in health care costs of some $190 billion each year to manage preventable diseases. Black and Latino adults in the U.S. have disproportionately higher rates of obesity — 46.8 percent and 47.0 percent, respectively, versus 37.9 percent for white adults, according to National Center for Health Statistics. These high-weight individuals experience not only higher medical bills but also discriminatory hiring practices that result in lower job attainment and incomes, the report says.

Furthermore, protective factors that can reduce individuals’ risks of negative health outcomes have varying effects across race, class and gender, says the report, “Inequity in Place: Obesity Disparities and the Legacy of Racial Residential Segregation and Social Immobility.”

For example, income serves as a protective factor against obesity in children, but higher income is less protective for black children than it is for white children. 

“For whites, increased income and educational attainment tend to yield increased access to resources that promote healthy weight maintenance. But for blacks of similar status, racism-driven mechanisms often prevent them from accessing those same resources,” said Imari Z. Smith, lead author and an associate in research at the Cook Center.

Residential segregation is one such mechanism. Through years of racially discriminatory rental and sale practices, predominantly black neighborhoods have been systematically demarcated and devalued. Predominantly black neighborhoods disproportionately feature lower access to fresh food (in neighborhoods known as food deserts), higher access to fast food and other unhealthy options (food swamps), and reduced access to opportunities for physical activity.

As a result, health-promoting resources are inequitably available to blacks and whites. The authors note that neighborhood characteristics — not genetic or cultural factors — are the key drivers of differing obesity rates between blacks and whites. Once factors like age, income and education are considered, black and white women living in the same neighborhoods face similar odds of obesity.

The report features 10 sweeping policy suggestions to reduce the racial obesity disparity, including increasing investment in safe and high-quality neighborhood parks and recreation centers; reducing the existing weight-loss requirement for obesity treatment covered by Medicare and Medicaid; implementing federal programs to provide future generations with the wealth that remove economic barriers to weight management; and updating zoning laws to reduce the prevalence of food deserts and food swamps.

The authors also call for more policies that accommodate and respect people of all sizes, which could have magnified effects for people doubly burdened by obesity and racial discrimination.             

“Research shows that discrimination negatively affects individual health, with weight discrimination being associated with the decreased ability to fight inflammation, metabolize foods and regulate blood sugar,” said Smith. “Given the racial disparity in obesity outcomes and chronic stress measures, added racial discrimination experienced by blacks has the potential to further amplify the physiological impacts of weight discrimination.”

Click here to download a PDF of the full research report. 

An online version of this release is at https://today.duke.edu/2019/07/how-segregation-and-discrimination-racialized-obesity-epidemic.

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