Obesity and Heart Disease Risk in Black People

This article is part of Health Divide: Heart Disease Risk Factors, a destination in our Health Divide series.

Racial and ethnic minorities experience disproportionately poorer health outcomes for almost all chronic diseases, especially heart disease, with obesity being a prominent trigger for these negative health outcomes.

Obesity increases morbidity and mortality in the Black community and its related complications are major drivers of rising healthcare costs, diminished health-related quality of life, and the recent decline in U.S. life expectancy, with the greatest effect seen in Black communities.

Obesity in the Black Community

Zoe Hansen / Verywell

Clinical obesity has been directly linked to cardiovascular disease because it increases your risk of dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. All of these conditions alone are major independent risk factors for heart disease which can lead to heart attack, amputation, and stroke

This article will cover how obesity increases heart disease risk in Black people.

What Is Obesity?

Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese.

Admittedly, BMI is an outdated measure that is still widely used to determine whether one is overweight or obese but combined with weight, body composition (where the majority of the fat on your body resides), and waist circumference, it can be a valuable tool to help you know where you stand. 

Race and Obesity

Four in 10 Americans, totaling about 100 million, are obese according to the Centers for Disease Control and Prevention (CDC). Among African-American adults, nearly half—48%—are clinically obese compared to 32.6% of White people.

The Black community persistently experiences food insecurity at higher rates than the White community and faces added social, economic, and environmental challenges. Years of systemic oppression have resulted in obesity rates that are higher than it’s ever been in the Black community.

Black People and Obesity

According to the CDC and National Institutes of Health (NIH), more than 75% of the Black community is considered overweight or obese, with Black women experiencing even higher rates of obesity.

As a result, 42% of the Black community has hypertension, and Black people are 30% more likely to die from heart disease than White people.

Why Obesity Is a Risk Factor for Heart Disease

Black people who have obesity, compared to those with a healthy weight, are at increased risk for many serious diseases and health conditions that can increase the risk of heart disease, including:

How Does Obesity Increase Your Heart Disease Risk?

When you're obese, the body requires more blood to supply oxygen and nutrients, which causes an increase in blood pressure. An increase in blood pressure increases your risk of heart disease.

Underlying Cause of Obesity Disparities

Obesity is a complex health condition resulting from a combination of behavioral, environmental, and genetic factors.

Many low-income Black communities have higher rates of unemployment and therefore by proxy, have:

  • Higher rates of physical inactivity
  • Sedentary lifestyle
  • Poor diet

To make matters worse, many Black people who live in urban environments that have a dearth of healthy food options—called food deserts—are targets of junk food marketing by fast-food companies.

COVID-19 Weight Gain in the Black Community

The pandemic weight gain is especially troubling. Sedentary lifestyles have become the norm with rising unemployment rates, poor mental health, and stay-at-home orders.

Risk Factors in Black People

There are many risk factors for obesity.

Risk factors can be alterable—that is, you can change them—like how you eat or exercise, or inalterable—unchanging—like your family history and genetics.

The following is a list of risk factors that are not specific to Black people but must certainly be considered by members of this community:

  • Lack of physical activity
  • Unhealthy eating behaviors
  • Lack of sleep
  • High amounts of stress
  • Sedentary lifestyle
  • Lack of exercise
  • Childhood inactivity (childhood obesity is at crisis level in the United States with Black communities having some of the highest rates in the country)
  • Low socioeconomic status
  • Living in an unsafe and impoverished neighborhood
  • Living in a food desert (particularly an area with few grocery stores or healthy food options and a high number of fast-food restaurants)
  • Exposure to chemicals known as obesogens can change hormones and increase fatty tissue in the body
  • Family history and genetics. Research shows that obesity can run in families via a complex set of genes passed down from parents to their children, but the number of genes and the mechanism by which their DNA is associated with obesity have not been elucidated. 

Biological Sex and Obesity

Your biological sex also affects your obesity risk. In the United States, Black or Latinx people who are born female are more likely to be obese than Black or Latinx people who are born male.

Women are also more likely to have polycystic ovary syndrome (PCOS), an endocrine disorder that results in a hormonal imbalance that can affect fertility and lead to weight gain.

A recent study found that Black people who identified as having a low family income, little to no education, or under-/unemployed were more likely to be obese. Receipt of public assistance was also strongly associated with obesity in Caribbean-Black men and women. Conversely, those who reported higher levels of income, education, occupation, or living in a residence within a neighborhood with a supermarket had lower rates of obesity.

Discussing Your Weight With a Healthcare Provider

Your weight should be a topic of discussion with your healthcare provider since it is an important indicator of overall health.

Finding a Trustworthy Healthcare Provider

Discussing your weight with a healthcare provider may be difficult for you for a myriad of reasons. Therefore it is imperative that you seek out an empathic, equitable, and unbiased healthcare provider who will take the time and attention needed to address this issue, understanding that it may take some time to figure out a plan that works best for you.

Many Black people report that they are more likely to feel comfortable with Black healthcare providers and more likely to adhere to certain preventive measures delivered by Black healthcare providers.

While Black healthcare providers are more likely to practice in underserved communities, often concentrated in urban areas, more rural areas may have few, if any.

As of 2018, 5.4% of physicians identified as Black despite Black Americans making up 13.4% of the U.S. population. Fortunately, there are initiatives in place to increase this number, and websites like Blackdoctor.org and FindABlackDoctor.com have created search engines that help you find Black healthcare providers more easily. 

Prejudice in Health Care

Implicit bias—a type of prejudice in which racial stereotypes are formed without conscious intention—is often experienced by Black people, unbeknownst to the non-Black healthcare provider, which compromises care.

Black healthcare providers are more likely to provide culturally-specific care—listening to their patients' concerns and empathizing with their plights. 

For many Black people, finding a trustworthy healthcare provider is often centered around finding a Black healthcare provider. That alone raises the chances of getting the quality of care you need. A history of biased and substandard care from White healthcare providers is one reason why Black people are more trusting of Black healthcare providers.

Questions to Ask

Knowing what questions to ask is a major factor in choosing the right healthcare provider. This helps set expectations, which ensures you will receive quality care.

Some questions you may want to ask your healthcare provider include:

  • How much experience do you have in nutrition science and weight loss management?
  • How do you approach weight-loss management?
  • Do you work with a lot of people who experience obesity? What percentage are Black?
  • What are my risk factors as a Black person who struggles with their weight?
  • Is there anything I can do today to make sure I do not become obese or make my situation better?
  • How do you ensure that all your patients receive culturally competent and culturally specific care?
  • Do you meet after hours? Do you have an emergency contact number?
  • I’m unsure if I am ready to make drastic changes today, how frequently do you meet with patients? How long are the visits?
  • What are all my treatment options? 

An Integrative Treatment Approach

Understanding your risk factors for obesity is important in how you will either prevent or treat it.

The following are the components of an integrative approach that addresses the many factors that contribute to obesity risk.

Medication

Using medication to treat a medical condition—even deadly ones like obesity—is sometimes seen as taboo in the Black community, but research shows that using medication as prescribed by your healthcare provider to help manage your underlying health conditions is a great way to promote healing. 

There are a host of medications that can help you lose weight or curb weight gain. They usually work one of three ways:

  • You feel less hungry
  • You feel full sooner
  • Your body has a harder time absorbing fat from the foods you eat

Some common prescription medications approved to treat overweight and obesity include:

Losing Weight At a Healthy Pace

The goal isn’t to lose all the weight as quickly as possible. Losing weight in a healthy way starts with meeting small achievable goals. Even modest weight loss of 5 to 10% can make a dramatic impact on your health, helping to improve blood sugar, blood pressure, and triglyceride levels.

Of note, phentermine, benzphetamine, diethylpropion, and phendimetrazine may all be used to curb appetite, but they should not be used in those with heart disease or hypertension.

Medication treatment is most effective when combined with lifestyle modifications and is best when used to meet new weight loss goals after first trying traditional lifestyle measures. Studies show that adding prescription weight management medications to your current weight loss plan can help you lose 10% or more of your starting weight, although results vary by medication and by person.

Therapy 

You do not have to fight obesity alone, but some Black people might feel like they do. Stigma—and the forces that create the stigma—sometimes make it difficult for individuals to reach out to a trained health professional for help.

The Danger of Normalizing Obesity

Some people in the Black community have normalized obesity, justifying an unhealthy weight and lifestyle in the name of body positivity. While there is no place for fat-shaming, there is no place, either, for obesity-normalizing, in light of the chronic and in light of the fact that obesity is a risk factor for many chronic medical conditions.

Your healthcare provider may suggest behavioral therapy if you are struggling with your weight.

Research has shown that intensive behavioral therapy—a form of talk therapy—can help you lose weight and keep it off by helping you to re-imagine your eating and exercise habits.

While therapy has been shown to be an effective weight management tool, it is no substitute for making lifestyle changes. 

Lifestyle 

Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction.

The following healthy habits may prevent obesity or lead to lifesaving weight loss, protecting your heart in the process:

  • Regular exercise
  • Eating a heart-healthy diet
  • Never smoking and limiting alcohol
  • Getting quality sleep

Stress Management 

High levels of stress are associated with poor health habits like late-night snacking, lack of exercise, a sedentary lifestyle, and smoking.

Limiting stress has immeasurable value in preventing obesity. 

Ways you can manage stress include:

  • Taking breaks at work
  • Talking to supportive friends
  • Eating healthy
  • Going for a run after work or school

The goal isn’t to avoid stress at all costs—that’s nearly impossible to do—but to find ways to address stressful situations in a healthy way and limit the amount of negative stress that you experience. Even more, working with a healthcare provider and/or a therapist can help you figure out the best treatment plan to meet your specific goals. 

Group Exercise

Group exercise sessions are a proven method to prevent obesity. Not only are you getting a vigorous workout, but often people form strong support groups.

Group exercise classes may include:

  • Circuits
  • Aquatic fitness
  • Walking programs
  • Low-impact workouts
  • Stability ball workouts
  • Indoor cycling
  • Small-group training

Group exercise programs are even more effective when they're done with friends.

The reasoning behind the effectiveness of group workouts over individual workouts is that communal meetings keep people accountable, increasing commitment to a fitness routine. Also, people give each other a boost or a competitive edge. One study found that people were able to hold a plan for 27% longer when working out with a partner. Lastly, group workouts help you to diversify your workouts, making them less likely to become mundane and unenjoyable. 

Surgery

Prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery.

Resources

The following national resources can be accessed by anyone who is seeking help managing their weight. The resources below provide Black-specific treatment and can connect you with Black providers:

There are many other local resources that can also be accessed from places like churches and community health centers.

Of note, OCAN’s newest initiative, the Obesity Care Now campaign, is leading the fight to modernize outdated policies that stigmatize obesity as a choice, rather than a complex chronic disease.

This network of health organizations is calling on Congress and the Biden administration to follow the science and address health inequities by providing evidence-based treatment options for the tens of millions of Americans who lack access to comprehensive obesity care.

Summary

Racial and ethnic minorities experience disproportionately poorer health outcomes for almost all chronic diseases, especially heart disease, with obesity being a major driver.

Obesity increases morbidity and mortality in the Black community and its related complications are major drivers of rising healthcare costs, diminished health-related quality of life, and the recent decline in U.S. life expectancy, with the great effect seen in Black communities. 

A Word From Verywell 

The issue with being overweight is not simply aesthetics in terms of body shape and size. Obesity is a deadly condition that can put your health in serious jeopardy. Diabetes, high blood pressure, sleep apnea, kidney disease, and the development of certain types of cancer are just some of the medical obesity-related conditions that are disproportionately impacting the Black community. Even more, these conditions are curbing life expectancy for the first time in decades, leading society to confront the reality that people today may not live as long as their parents. 

If you are struggling with your weight, therapy and stress management are useful tools to curb obesity but they are no substitute for making lifestyle changes. Preventing obesity, by making lifestyle decisions such as getting appropriate amounts of exercise and choosing foods that support your weight loss goals, are the most effective ways to meet your long-term weight loss goals. 

Frequently Asked Questions

  • What’s the link between race and clinical obesity in America?

    Black and Latinx populations have higher rates of obesity compared to White Americans, largely due to systemic inequalities that make it difficult for these groups to achieve their best health. Obesity is admittedly complex and no one-size-fits-all approach will work for Black America but the visual of the overweight older Black adult is far too common, and it rests on all members of society to support anti-obesity missions that aim to create a better life for the community.

  • What does being overweight do to the heart?

    Being overweight puts you at higher risk to develop conditions like high blood pressure or diabetes that can lead to heart disease. Obesity can also cause your heart to work hard. Obese individuals require more blood to supply oxygen and nutrients to their bodies which causes an increase in blood pressure. Over time this can lead to heart failure.

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