The Order of Feather Color

Racism and Obesity: Where Does the Problem Lie?

The overlap between systemic racism and obesity is unmistakable. Obesity is a condition that burdens the health of Black, Hispanic and Indigenous people more than others. It is a key factor that has made these communities more susceptible to severe symptoms and death from COVID-19. A new paper in the Journal of Internal Medicine offers an fresh perspective on this disproportionate harm. Perhaps the severe harm of obesity in people of color results directly from systemic racism.

To address the health effects of systemic racism will require more than medicine. It will require us to solve the core public health issues where obesity and racism meet, say Dan Aaron and Fatima Cody Stanford in their paper.

Racism, Not Biology

Chronic stress from experiencing everyday racism contributes to a person’s risk of obesity. Just as weight stigma makes obesity worse, so does racism. The stress of everyday discrimination then leads to a systemic inflammatory response. Systemic inflammation is a key feature of obesity. In addition, people may respond to acute stressors with unhealthy patterns of eating.

All of this is a biological response to racism. But racism is a social phenomenon. Without the social and economic systems that perpetuate it, there is no physiologic reason for people of color to suffer more from obesity. Those systems also limit the access of racial and ethnic minorities to nutrition and healthcare that can reduce the impact of obesity.

Acknowledging the Disease and Its Causes

Some have suggested that obesity itself is a racist construct. But Aaron and Stanford reject that rationale. Obesity affects White, Black, and Brown people, though the extent of the problem is greater in some communities. Obesity itself is a disease marked by excess adiposity and systemic inflammation. The inflammation that comes with obesity is likely a reason that outcomes are so much worse for COVID-19 if a person has obesity.

Racism is not the sole cause of obesity. But it makes the impact worse in people of color. Diagnosis and care for obesity is less common. Black and Hispanic patients are less likely to receive the most effective treatments because of poor access to care.

Working for Solutions

We sometimes hear that obesity is not a priority for health organizations. “We are focusing on social determinants of health first,” is how one large health plan put it to us recently. However, Aaron and Stanford suggest that this makes no sense. They ask that “we take collective responsibility for obesity by tackling the social determinants of health in earnest.” Not by artificially separating them.

In short, we must come to terms with the intersection of race and obesity with probing research. We need to root out systemic racism because it leaves people of color more vulnerable to obesity. We must ensure access to effective care, healthy nutrition, and healthy places to live. The list is long, but the challenge is one we must meet for the sake of our health and prosperity.

Click here for the paper from Aaron and Stanford, here for further perspective from Sara Bleich and Jamy Ard.

The Order of Feather Color, photograph © Prabhu B Doss / flickr

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March 8, 2021