When it comes to obesity, there is no shortage of areas to lay blame, from the supersized American diet to neighborhoods that lack safe spaces to walk or exercise to food manufacturers who scientifically engineer cheap, fatty, salt-and-sugar-laden products that all but guarantee overeating.
Yet when it comes to solving the problem, society usually focuses on individuals, blaming them for being too indulgent, too sedentary, or too lacking in discipline to lose weight. The Black community, which has disproportionately higher rates of obesity than the white community, is particularly susceptible to those attitudes, given the country’s history of racial tropes and stereotypes involving body weight.
The Real Skinny on Treating Obesity
But a new research paper from the American Heart Association points out that obesity is a multifaceted health problem shaped by social and economic barriers that Black Americans and people in lower-income communities routinely face. Personal discipline isn’t the only factor in the struggle to maintain a healthy weight. And despite the rise of breakthrough anti-obesity drugs like Ozempic or Wegovy, the paper says, more collaboration between government, health care professionals, community organizations and individuals is still needed.
An individual’s lifestyle is one factor, but obesity comes from more than just overeating or lacking exercise.
“Obesity rates are highest among Black children and adults, low-income families, people living in rural areas, and adults with a high school education or less,” the AHA statement says. “[G]enetic factors can contribute to the development of obesity, [but] previous studies have found that genetic predisposition is not the primary driver of high obesity rates.”
These issues, plus the stigma of being overweight, and the financial costs of treating obesity worsened by a lack of health insurance, make the disease difficult to treat..
Dr. Fatima Cody Stanford, AHA’s vice chair of the scientific statement writing group, said in a statement that people with fewer resources are more likely to develop obesity “because of a combination of factors,” from the type of job they have to whether their neighborhood is quiet enough for a good night’s sleep.
“We must recognize that obesity is not a personal choice,” said Stanford, an associate professor of medicine and pediatrics and an obesity medicine physician scientist at Massachusetts General Hospital and Harvard Medical School. “It is highly influenced by multiple social and environmental factors,” and people with fewer resources are more likely to struggle with weight.
“This is a critical component for addressing the obesity epidemic in the U.S. and obesity-related health conditions, including cardiovascular disease,” she said.
An Issue that Crept Up Over 60 Years
Since the U.S. first began measuring obesity rates in 1960, adult obesity has risen sharply. Back then, just over 13% of adults aged 20 to 74 were defined as obese; by 2018, obesity among adults aged 20 had more than tripled to just over 42%, with roughly 9% diagnosed with severe obesity.
Data from 2023, the most recent numbers available, finds that obesity affects around 4 in 10 adults and more than 21% of children ages 2 to 19. The disease significantly increases the likelihood of being diagnosed with high blood pressure, cardiovascular disease, and Type 2 diabetes — all of which disproportionately affect Black people.
When it comes to lifestyle, Individuals whose employment requires shift work, as well as people whose neighborhoods are noisy or have intense nighttime light, are also at increased risk for obesity. These factors interrupt the body’s natural sleep-wake cycle and can prevent individuals from getting enough high-quality sleep.
Such disruptions are strongly associated with an increased risk of obesity and related diseases.
Although weight-loss drugs like Wegovy, Ozempic, and others in the GLP-1 class have taken the market by storm, they are also priced out of reach for most low-income patients. Paradoxically, however, simply acknowledging their use can exacerbate weight stigma: even celebrities like Oprah Winfrey and the pop star Lizzo have been confronted with questions and criticism about using them.
Meanwhile, landmark research confirms that overweight or obese people face wide-ranging stigma and discrimination in the workplace and in healthcare settings, as well as in education and the media. They can also have difficulty in interpersonal relationships, all of which increases mental health struggles and can make individuals avoid seeking medical treatment.
“The most effective weight management programs are culturally and socially informed and involve stakeholders from across all levels of society working together to support people at risk for or living with obesity. Improving the affordability of fruits and vegetables specific to cultural diets, increasing access to healthy weight management programs, promoting physical activity, and advocating for public policies such as insurance coverage of obesity medications are key strategies that could have large societal impacts,” Stanford said.
