Black women want to be healthy. However, there are many barriers to addressing obesity in Black women. Obesity is a complex disease with multiple contributing factors. For Black women, culture, racial discrimination, and weight bias also impact obesity rates. The Part I of this series, we discuss the flaws of BMI. In Part II, let's discuss the role of racism, bias, and culture in Black women's obesity rates.
Racial Discrimination
Racial discrimination contributes to obesity in many ways.
Dr. Sabrina Strings' book "Fearing the Black Body: The Racial Origins of Fat Phobia" offers historical and sociological perspectives. For example, the full-figured body was less accepted as the beauty standard as slavery and racism increased. In addition, Dr. Strings convincingly demonstrates that thinness was idealized to dehumanize enslaved Black people further. Click here to read my response to Dr.String's Scientific American Article.
On the individual level, the effects of racial discrimination are a stressor for Black women. Stress can be either mental or physical. Often one type of stress triggers the other. Racial discrimination causes mental stress, which causes physical symptoms such as weight gain. Specifically, stress interrupts several essential weight-controlling hormones. Cortisol, insulin, leptin, and ghrelin are just a few weight-controlling hormones stress impacts.
Systemic racism and racial discrimination also impact obesity at the public health level. For example, the harmful effects of racism affect food policy, neighborhood planning, and more.
Furthermore, Black women experience racism and weight bias at high rates. Considering the known associations between racism and obesity, this may contribute to the high rates of obesity in Black women.
Cultural Expectations and Beauty Standards
There is also added stress from cultural expectations and beauty standards.
Cultural beauty aesthetics, such as high-maintenance hairstyles and preference for a "curvy figure," can influence obesity rates. Equally, there is the pressure to be thin from healthcare and mainstream media. Black women are left to decide which body type is "best." Self-acceptance can feel elusive with the pressure to conform to conflicting "norms."
The body positivity movement offers relief from the stress of body-type conformity. But even in these spaces, historically, the
body positive movement didn't address the racial bias experienced by Black women.
Fortunately, there is a shift to recognize the needs of Black women in the body-positivity movement. Celebrities such as Lizzo and DJ Tiff McFierce are outspoken in embracing their "God-given confidence." At its best, body positivity promotes health and wellness without the negativity of body conformity.
Positivity can help shed the shame and stigma associated with weight bias.
While we differ in our understanding of the disease of obesity, the Health At Every Size (HAES) movement is worth mentioning. Starting in 2003, HAES is "a continuously evolving alternative to the weight-centered approach to treating clients and patients of all sizes."
Still, HAES, Embrace You Weight & Wellness, and I align on many points. For instance, to optimize the individual well-being, it's crucial to promote self-acceptance, stop obsessing over the scale, and end weight stigma and bias.
Moving Forward
As a Black woman and a physician, I have personally and professionally seen the harmful effects of obesity. It goes beyond culture and cosmetic preferences. Still, it is unhealthy and detrimental to force a person to fit one body type.
We are indeed at a pivotal time in history. Justice Ketanji Jackson was just welcomed as the first Black woman Supreme Court Justice of the United States. However, we are still attempting to rectify the widespread harmful effects of racism. In Obesity Medicine, we must acknowledge the impact of past and current biases. As we make the necessary adjustments to ensure the best diagnosis as well as treatment for all, especially Black women.
I look forward to continuing this conversation in person. So join me at the Obesity Medicine Association Spring Submit for "Obesity and Black Women: What Are Missing?". Register here.
In the interim, join the Overcoming Obesity Club and me every Thursday from 12-1 pm EST on Clubhouse. Click here to join.
Related Resources featuring Dr. Sylvia Gonsahn-Bollie, MD
The Obesity Disparity in Black Women: How to Be More Inclusive, Physician Weekly
Black Health Learning Academy: Obesity is A Disease
How to Unlearn Weight Bias, Livestrong.Com
Why Can BMI Be Problematic in the BIPOC Community? , Everyday Health
Why the Body Mass Index Is So Often Misleading According to Doctors, Prevention Magazine
Scientific American, Readers Respond to July 2020 Issue for Fighting the Racist Roots of Obesity
References
Byrd, A. S., Toth, A. T., & Stanford, F. C. (2018). Racial Disparities in Obesity Treatment. Current obesity reports, 7(2), 130–138. https://doi.org/10.1007/s13679-018-0301-3
Stanford, et al. (2019). “Race, Ethnicity, Sex, and Obesity: Is It Time to Personalize the Scale?” Mayo Clin Proc. 94(2):362-369. https://www.mayoclinicproceedings.org/action/showPdf?pii=S0025-6196%2818%2930807-3 on 10/30/2020
Agyemang, P., & Powell-Wiley, T. M. (2013). Obesity and Black Women: Special Considerations Related to Genesis and Therapeutic Approaches. Current cardiovascular risk reports, 7(5), 378–386. https://doi.org/10.1007/s12170-013-0328-7