Obesity Among Blacks in General

Obesity Among Blacks in General and Floridians in Particular

An Examination of the Epidemiology, Causes and Potential Solutions to Obesity among African-Americans Today

The costs associated with obesity in the United States were more than $117 billion in 2000 (Diet-Related Chronic Diseases, 2001). Obesity rates in the United States have increased dramatically over the past 30 years (Anderson, Butcher & Levine, 2003). Among American adults in general, obesity rates have more than doubled from the early 1970s to the late 1990s; during the same time period, obesity rates nearly tripled among children. Unfortunately, even these disturbing numbers do not provide a complete picture of the problem as it relates to African-Americans since they tend to experience higher rates of obesity than their white counterparts across the board in all age groups. While researchers continue to investigate causation and possible solutions, the unfortunate fact remains that obesity represents a very serious health threat and predisposes blacks to a wide range of potentially life-threatening conditions including diabetes and hypertension. This paper provides a discussion of the epidemiology and incidence of obesity for African-Americans in general and the State of Florida in particular. An examination of health threats posed by obesity among this segment of the population and potential solutions to the problems is followed by proposed budget plan for helping educate at-risk citizens. Finally, a summary of the research is provided in the conclusion.

Review and Discussion

Epidemiology of Obesity among African-Americans.

Complex problems require complex solutions and the incidence, distribution, and control of obesity among black Americans today is no exception. In terms of lifestyle and health behavior, Drevenstedt (1998) reports that more black men than white men smoke (there is only a negligible difference for women); high blood pressure and obesity are more common among blacks, and blacks tend to be diagnosed and/or treated for their chronic diseases at later stages of the diseases than their whites counterparts. Other researchers believe that genetics play a strong role in determining whether an individual will become obese (Anderson et al., 2003). Research to date has identified a strong correlation between parent and child obesity, although such a correlation may be attributable in part to either to genetic or common environmental factors, because families share both such factors.

According to these researchers, there is strong evidence that there is a genetic component to obesity based on an influential study of identical twins; however, large-scale genetic change is believed to occur too slowly to account for the observed increase in obesity in the United States over the last 30 years. "More likely," they say, "genetics determine whether one is susceptible to the disease of obesity, and environmental factors then determine whether the conditions are right for individuals to 'catch' the disease" (Anderson et al., p. 30). Certainly, from a physiological perspective, the "cause" of obesity is well understood but as noted above, the condition of obesity, like other disorders, is perhaps better described in the scholarly literature than it is understood: "If one takes in more calories than one expends, then one gains weight. The question then, is what has upset the delicate balance between calorie expenditure and intake, such that more people are overweight and obese?" (Anderson et al., p. 31). The possible causes of obesity among African-Americans today are discussed further below.

Causes of Obesity among African-Americans.

Obesity is a more prevalent problem for African-American females than males, and has therefore been the focus of much of the research to date (Fitzgibbon & Flynn, 1996). Noting that obesity is also more prevalent among people in low socioeconomic status groups and given that more than half (51.2%) of African-American women live below the poverty level today, Fitzgibbon and Flynn point out that obesity is regarded as a significant threat to the health of many low-income African-American women. Based on these alarming statistics, these researchers investigated the factors that contributed to the development of obesity in this population. According to Fitzgibbon and Flynn, "A number of reasons have been put forth to explain the high prevalence of obesity among African-American females: genetic predisposition, higher energy intake, and reduced energy expenditure. A recent survey of African-Americans suggested that the high-risk, high-fat eating patterns that contribute to the high prevalence of obesity-related medical hazards during adulthood are established during childhood" (p. 616). Despite these findings, African-American females are no more likely to be obese than nonminority females during their childhood years; in fact, the weight differential between black and white American females does not increase until adolescence.

Consequently, identifying those factors that serve to influence the adoption of high-risk behaviors during childhood may provide a better understanding of how to prevent the increased incidences of obesity among this population during adolescence. A potential cause cited by Fitzgibbon and Flynn was a culturally sanctioned body ideal that celebrated a heavy body image. "Body image is one's perception of current body size," they say. "A body image ideal is one's desired body size. The body image ideals adopted by African-American females may be connected to the high-risk behaviors that lead to obesity in this population" (p. 616). The research into body image to date suggests there is a relationship between the development of heavier vs. thinner ideals that occur during childhood and the prevalence of specific eating disorders that takes place during adolescence and adulthood.

For instance, Fitzgibbon and Flynn point out that white girls with normal weight have ideals that are typically thinner than their body images during childhood and adolescence. In sharp contrast to the heavy body image celebrated among blacks, the thinner white body image predisposes this segment of the population to a higher incidence of anorexia and bulimia during adolescence and adulthood than their African-American counterparts. Conversely, Fitzgibbon and Flynn note that African-American females, who have heavier ideals than white females during childhood and adolescence, will be at higher risk than their white female counterparts of becoming obese during adolescence and adulthood. To explain the difference in body image ideals, these authors suggest there is a fundamental socioeconomic component wherein an abundance of food represents prosperity to the poor while such considerations are not common among the more affluent. "This theory may provide a partial explanation for why African-American women," they say, "many of whom have had to struggle against poverty in this country, value as their ideal, heavier body weights than whites" (p. 616). Having established that blacks experience higher incidences of obesity across the board compared to whites, it is important to understand what health threats this condition represents; such potential threats are discussed further below.

Health Threats Posed by Obesity.

According to Kristin Flynn and Marian Fitzgibbon (1996), although 33% of American white women are obese, almost half (49%) of all African-American women are obese. As a result and "not surprisingly," they note, "obesity-related mortality rates due to cardiovascular disease, stroke, and diabetes are also higher among African-American women" (p. 615). Diseases such as diabetes mellitus that are predisposed by obesity are preventable yet they continue to have a devastating effects on the health status of African-Americans in general, and females in particular today (Collins, 1996; Flynn & Fitzgibbon, 1996).

According to Collins, lifestyle behaviors are responsible for a variety of illnesses among African-American females; Collins notes that previous researchers found that American black women had a higher prevalence of obesity, a strong factor for non-insulin-dependent diabetes mellitus. Collins notes that, "Among people with diagnosed diabetes, 82% of adults were black, obese women as compared with 62% of white women. Diabetes among African-Americans is almost two times higher than in white women, and in 1990 the age-adjusted death rate from diabetes in blacks was 25.4%, in white women the rate was 9.5% per 100,000" (p. 5). In fact, among all women ages 18 to 74 years, just over one-quarter (26.3%) of white women suffer from hypertension compared with 38.6% of black women (Collins, 1996).

As can be seen in Table 1 below, black women experience more hypertension than their white counterparts at every age category:

Table 1. Age-Specific Hypertension Prevalence among American Black and White Women (as of year end 1995).

Age

Percentage

White vs. Black

18 to 24

2.3 vs. 9.6

25 to 34

5.7 vs. 15.3

35 to 44

16.6 vs. 37.0

45 to 54

6.3 vs. 67.0

55 to 64

50.0 vs. 74.3

65 to 74

66.2 vs. 82.9 (Source: Collins, 1996, p. 63).

Further, the disparity becomes even more dramatic after the age of 40 years. While this data clearly shows that hypertension is very common in black women and virtually ubiquitous in some of their age groups, the reason or reasons are for such disparities remain unclear. According to Collins, "Clearly, obesity and stress play a role, but they are not the whole answer. Elucidation of these enigmatic factors may eventually lead to the fashioning of effective strategies for prevention, treatment, and cure" (p. 62). In fact, African-Americans have the highest rates of hypertension in the world, affecting more than 33% of the population; blacks also develop hypertension at an earlier age than whites, and tend to have more severe high blood pressure, and are less likely to receive treatment. Blacks also have a 320% higher rate of hypertension-related end-stage renal disease than the general population (Diet-Related Chronic Diseases, 2001).

According to a study of diet-related chronic diseases among black men in Florida, it was found that almost two-thirds of blacks in Florida are estimated to be at risk for health problems related to being overweight. The percent of the total population that is at risk for health problems related to being overweight compared to the State of Florida in shown in Table 2 below.

Table 2. Percentage of Black/White Population at Risk for Overweight Health Problems - Florida vs. The U.S. (Source: Diet-Related Chronic Diseases, 2001).

Florida National

Black 62.4-65.4

White 52.0-56.0

The authors of this study point out that many blacks do not eat a sufficient amount of vegetables and other foods that require the recommended levels of nutrition. Clearly, there is more involved in the epidemiology and causation of obesity among blacks in America today than many might think, but there are some potential solutions to the problem which are discussed further below.

Potential Solutions to the Problem.

Many of the diseases that are especially threatening to the health status of African-American women such as obesity can be mitigated through education and long-term changes in lifestyle behavior (Collins, 1996). Low-income, African-American, pre-adolescent girls, though, may be unmotivated to actively participate in prevention programs that emphasize the adoption of exercise and low-fat eating patterns if it is for the purpose of maintaining a slender body (Fitzgibbon & Flynn, 1996). Notwithstanding the need to respect the cultural ideals that exist among any given population, it is equally important to help educate those citizens who are at high-risk of developing life-threatening conditions because of their accepted lifestyle behaviors that may contribute to such conditions. Education has been shown time and again to be the best alternative to communicating these important messages to those who at most at risk, and it does not have to be expensive. A proposed budget plan for educating such high-risk citizens is provided below.