Perceived Racism in Relation to Weight Change in the Black Women's Health Study
Introduction
Obesity is an established risk factor for numerous health conditions, including cardiovascular disease, and mortality 1, 2, 3. Black women have a higher prevalence of overweight, obesity, and extreme obesity than white women 4, 5. Between 1999 and 2002, 77% of black women were overweight or obese and 14% were extremely obese (body mass index [BMI] ≥35.0) compared with 57% and 5.5%, respectively among white women (5).
Despite extensive research, the observed racial disparities in obesity are poorly understood (6). Stress has been associated with weight gain and obesity in both animals 7, 8 and humans 9, 10, 11. Specifically, psychosocial stress associated with low income and low education has been associated with weight gain (10), and it is hypothesized that such stress results in neuroendocrine-autonomic dysregulation which, in turn, influences the accumulation of excess body fat 12, 13, 14. Racial discrimination may be an important psychosocial stressor in the lives of black women 15, 16, 17. Cross-sectional studies in non-U.S. populations have found associations of internalized racism with increased obesity (18) and waist circumference 19, 20. A cross-sectional study in the United States found an association of experiences of racial discrimination with increased obesity (21), while another found an inverse relationship with waist-to-hip ratio (22). The sample sizes in these studies were relatively small, ranging from 129 (18) to 1,956 (21) study subjects.
In the present report, we prospectively evaluate the association of perceived racism with weight change over 8 years of follow-up among 43,103 U.S. black women, using data from the Black Women's Health Study (BWHS). We also explore whether perceived racism is associated with change in waist circumference.
Section snippets
Methods
The human subjects' protocol for this study was approved by the Boston University Medical Center and Howard University Cancer Center Institutional Review Boards. The BWHS is a follow-up study of U.S. black women that began in 1995 when 59,000 women aged 21–69 years enrolled through postal health questionnaires, which were sent mainly to subscribers of Essence magazine, members of selected black women's professional organizations, and friends and relatives of early respondents. Participants
Results
In 1997, half of the study sample was under the age of 40. The median weight was 72.6 kg (range, 38.6–135.8 kg), and 31% of the women had a BMI that was ≥30 kg/m2. Overall, 34% of women reported one or more experiences of everyday racism occurring at least one time per month, and 80% reported at least one major discriminatory event in their lifetime. As shown in Table 1, younger age, higher BMI, more years of education, current smoking, alcohol consumption, nulliparity, higher energy, fat, and
Discussion
To our knowledge, this is the first study to prospectively examine self-reported perceptions of racism in relation to changes in weight and waist circumference. We observed a positive association between perceived racism and weight gain. The association was similar for everyday racism and lifetime racism and was present within all levels of BMI, education, coping, and geographic region. Change in waist circumference was also associated with perceived racism. Because the first report of waist
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