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

Abstract

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.

FIGURE 1

Obesity is a chronic disease characterized by altered distribution and metabolism of the adipose tissue. Multiple environmental, genetic, and physiologic factors determine the distribution and metabolism of the adipose tissue. Adiposity can manifest as atherosclerosis or visceral adiposity, which affects a range of organs, leading to complications, including CVD and T2D. In contrast, subcutaneous adiposity has a lesser impact on disease. Adiposity collectively negatively affects quality of life, clinical outcomes, risk factors for disease, and prognosis. CKD, chronic kidney disease; CVD, cardiovascular disease; NAFLD, nonalcoholic fatty liver disease; T2D, type 2 diabetes. ^aFor example, socioeconomic factors and lack of access to healthy food, physical exercise, and health care

FIGURE 2

The racial discrimination system and its impact on obesity in African American people. Racial disparities exist within a wide range of systems in the United States, including housing, public health, education, employment, and food access. These disparities are connected through a complex web of reciprocal feedback relationships that give rise to a self‐perpetuating system of racial discrimination. Racial disparities in these systems also impact the risk of obesity and related behaviors among African American people [8, 26, 27, 47, 48, 52, 53, 54, 55, 56, 57, 90, 91].

FIGURE 3

Recommendations for managing obesity in African American people [43, 45, 62, 63, 64, 65, 66, 67, 69, 89]. HCP, health care practitioner