Can Racially Segregated Neighborhoods Increase the Likelihood of Obesity?

There are significant gender and racial disparities in obesity burden among Americans. Fifty-seven percent of black women and 37 percent of black men are obese compared with 34 percent of white women and 33 percent of white men. Could racial residential segregation be driving these disparities? Although overall racial residential segregation has declined in the United States, the majority of Black Americans continue to live in highly segregated neighborhoods. To understand whether these spatial patterns influence the disproportionate rates of obesity among Black Americans, researchers examined the association between neighborhood level racial residential segregation and the development of obesity among Black residents across four major cities over the course of 25 years.

To conduct the analysis, researchers used data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a longitudinal study that tracked the health outcomes of more than 5,000 black and white adults ages 18 to 30 living in Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California between 1985 and 2011. The CARDIA study included a baseline exam of residents’ health with follow-up exams at 7, 10, 15, 20, and 25 years. Using the CARDIA data, researchers sampled 2,207 participants who identified as non-Hispanic Black and who were not obese at the baseline examination. Researchers analyzed the participants’ measured height and weight to track obesity over time and linked neighborhood-level US Census Bureau data to participants’ home addresses at each examination to measure neighborhood-level segregation. Researchers broke down the results by sex and adjusted for participants’ educational attainment, physical activity, smoking status, and household income.

Overall, segregation decreased over time among participants. At baseline, 81 percent of women lived in highly segregated neighborhoods, 12 percent lived in neighborhoods with medium levels of segregation, and 7 percent lived in neighborhoods with low levels of segregation. At the 25-year exam, the percentages of women living in high-, medium-, and low-segregation neighborhoods were 54 percent, 22 percent, and 24 percent, respectively. Similar patterns were seen for men. At baseline, 80 percent of men lived in highly segregated neighborhoods. At the 25-year mark, only 55 percent of men lived in highly segregated neighborhoods. Among the study participants, Black women living in highly segregated neighborhoods had lower levels of educational attainment, household income, and physical activity and higher levels of smoking than women living in neighborhoods with lower levels of segregation.

Key findings

• Black women living in highly segregated neighborhoods at the baseline examination were 40 percent more likely to be obese than women living in neighborhoods with low levels of poverty.
• Black women living in highly segregated neighborhoods during a prior exam were 30 percent more likely to become obese during the follow-up period, as compared with women living in neighborhoods with low levels of segregation.
• Black women who had cumulatively high exposure to segregation over the course of the study had a 50 percent higher chance of developing obesity during the follow-up period than those who had low cumulative exposure to segregation.
• Among Black men, there was little evidence of differences in obesity development between neighborhoods with high, medium, or low levels of segregation.

Research implication

• Long-term exposure to segregation is most associated with the development of obesity among Black women. The authors suggest that fewer health-promoting resources, stressful neighborhood context, and social norms that are less stigmatizing of obesity may contribute to these patterns of obesity, but they conclude that more research on specific pathways leading from segregation to obesity is needed to understand differing patterns between men and women.

Photo by Red Confidential/Shutterstock