Ann Arbor June 17, 2022

Obesity increases the risk of health conditions such as hypertension, coronary heart disease, and diabetes. Recent findings have also revealed that obesity is a risk factor for hospitalization and death due to COVID-19. In a new supplement to the American Journal of Preventive Medicine, published by Elsevier, researchers identify the complex contributors to obesity and obesity-related health disparities and propose strategies for improving the wellbeing of populations impacted by these disparities.

This supplement, “Obesity-Related Health Disparities: Addressing the Complex Contributors,” highlights research findings from investigators and projects supported by the Obesity Health Disparities Research Center (OHDRC). The OHDRC is a National Institute on Minority Health and Health Disparities (NIMHD) funded Center of Excellence that supports transdisciplinary, multilevel, and multidomain research to understand the complex contributors to obesity and obesity-related health disparities. The OHDRC uses the State of Alabama and the Deep South region as a model to study and investigate the biological, behavioral, and social factors related to obesity.

The OHDRC applies the NIMHD’s Research Framework to inform the center’s work and research.

The common theme running throughout this supplement is that obesity is not simply a medical or biological condition. “These articles identify strategies to better measure and identify modifiable and non-modifiable risk factors for obesity and help us understand the influence and interaction of these factors on obesity and related conditions,” explain Guest Editors Mona N. Fouad, MD, MPH, Senior Associate Dean for Diversity and Inclusion, Heersink School of Medicine, and Professor and Director, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, and Gareth Dutton, PhD, Endowed Professor of Diabetes Prevention and Control, Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

“Researchers, clinicians, policymakers, and other stakeholders can utilize these articles to inform healthcare and public policy approaches in a way that improves the overall health and wellbeing of populations impacted by obesity and obesity-related health disparities,” Dr. Fouad and Dr. Dutton add.

The supplement demonstrates that rigorous and comprehensive methods are needed to account for the multiple and interrelated contributors to obesity, including fundamental social, behavioral, and biological factors. Similarly, these research reports show that a complex problem like obesity requires multilevel and multidomain solutions to better address it. Rather, a variety of social determinants and other factors contribute to obesity risk and impact the prevention and treatment of this and related conditions.

Of particular note, contributions to the supplement highlight theoretical approaches to explain social determinants of obesity; protective factors that may mitigate the negative associations between neighborhood disadvantage and health; links between financial wellbeing, stress, and weight gain; and the impact of COVID-19 for individuals with obesity and weight-related comorbidities.

William C. Cockerham, PhD, Department of Sociology and Division of Preventive Medicine, University of Alabama at Birmingham, reviews selected theoretical approaches to explain the social determinants of obesity. Increasing evidence highlights the importance of the social environment in relation to the risk of obesity. He analyzes empirical evidence linking theory to data in obesity studies. Broadly, those with lower socioeconomic status are more likely to have higher rates of obesity and related health conditions.

“The social determinants of obesity are not the entire story of excessive weight gain, but are key variables in the process, sometimes acting independently of biological causes and sometimes acting together to cause people to become obese,” Dr. Cockerham notes. “Consequently, biomarkers are increasingly being utilized in sociological studies of weight gain, as is the use of social variables in gene-environment studies, to provide more thorough assessments of the causes of obesity. Future developments in theories of obesity in the social sciences will likely incorporate both biological and genetic views of the causal factors of obesity into their models where feasible.”

Sylvie Mrug, PhD, Department of Psychology, University of Alabama at Birmingham, and colleagues present a novel investigation of whether children’s perceptions of parenting moderate the prospective relationship between childhood neighborhood adversity and adult health indicators. Contrary to some prior research, this study did not find links between neighborhood disadvantage and adult weight status. The authors highlight how parenting styles play a role in the long-term effects of neighborhood disadvantage of health. Specifically, inconsistent discipline and low parental nurturance were found to exacerbate the adverse relationship between neighborhood characteristics and adult health. They conclude that future interventions that enhance consistent and nurturing parenting may help reduce the long-term associations of neighborhood disadvantage with health.

There are established links between financial wellbeing, stress, and weight gain. In an article on the financial correlates of midlife obesity, Joseph D. Wolfe, PhD, Department of Sociology, University of Alabama at Birmingham, extends this research by identifying that property debt, unsecured debt, and bankruptcy have significant and relatively large associations with midlife obesity. He highlights the importance of future obesity prevention interventions to target populations experiencing financial difficulties related to debt and bankruptcy. “As obesity inequalities persist and grow in the coming years, it is imperative that researchers should also explore the legal and political systems that help or hinder individuals resolving financial problems,” he concludes.

Drew J. Gunnells, MD, Department of Surgery, University of Alabama at Birmingham, and colleagues explore whether patients with obesity and a history of COVID-19 should delay surgery, and if so, for how long. They report that postoperative mortality is almost six times higher for those previously infected with COVID-19 within two weeks prior to surgery. They suggest that increasing the time from COVID-19 diagnosis to surgery may reduce the risk of complications.

Dr. Fouad observes, “The impact of this supplement extends beyond continuing research. Ultimately, it allows our teams to share their innovative findings that can improve the overall health and wellbeing of populations impacted by obesity and obesity-related health disparities.”

“In my research through the OHDRC, I work directly with women in the community who are impacted by obesity,” Dr. Dutton adds. “To change this, I ask myself how we can use new trends and technology to motivate people and build healthy, sustainable habits. So far, our interventions have seen positive numbers—but we’re not done. This supplement allows us to add to the growing body of evidence identifying solutions that address obesity and related conditions.”

Notes for editors

Supplement: Obesity-Related Health Disparities: Addressing the Complex Contributors

American Journal of Preventive Medicine, volume 63, supplement 1 (July 2022), published by Elsevier

The supplement is openly available at https://www.ajpmonline.org/issue/S0749-3797(22)X0008-1.

Guest Editors: Mona N. Fouad, MD, MPH, Senior Associate Dean for Diversity and Inclusion, Heersink School of Medicine, and Professor and Director, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA, and Gareth Dutton, PhD, Endowed Professor of Diabetes Prevention and Control, Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

This supplement issue is sponsored by funding from the National Institute on Minority Health and Health Disparities via the Obesity Health Disparities Research Center, an NIMHD “Center of Excellence” at the University of Alabama at Birmingham.

Featured articles

“Theoretical Approaches to Research on the Social Determinants of Obesity,” by William C. Cockerham, PhD (https://doi.org/10.1016/j.amepre.2022.01.030)

“Childhood Neighborhood Disadvantage, Parenting, and Adult Health,” by Sylvie Mrug, PhD, Malcolm Barker-Kamps, MS, Catheryn A. Orihuela, PhD, Amit Patki, MS, and Hemant K. Tiwari, PhD (https://doi.org/10.1016/j.amepre.2022.01.028)

“The Financial Correlates of Midlife Obesity,” by Joseph D. Wolfe, PhD (https://doi.org/10.1016/j.amepre.2022.02.013)

“Increased Risk of Post-Operative Mortality Associated With Prior COVID-19 Infection,” by Connie C. Shao, MD, M. Chandler McLeod, MS, PhD, Suneetha Thogaripally, MEng, Michael J. Mugavero, MD, MHSc, Lauren T. Gleason, MD, MSPH, Isabel C. Dos Santos Marques, MD, Daniel I. Chu, MD, MSPH, and Drew J. Gunnells, MD (https://doi.org/10.1016/j.amepre.2022.01.035)

Full text of this supplement is also available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or ajpmmedia@elsevier.com. Journalists wishing to interview the Guest Editors or the authors should contact Adam Pope at arpope@uab.edu.

About the American Journal of Preventive Medicine

The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org.

About UAB Obesity Health Disparities Research Center (OHDRC)

UAB Obesity Health Disparities Research Center (OHDRC) is driven to reduce obesity and obesity-related health disparities in Alabama. The Center supports transdisciplinary, multilevel, and multidomain research to understand the complex contributors to obesity and related health disparities. The OHDRC fosters collaborative research, supports young investigators, and partners to build healthier communities. The OHDRC, Grant Number U54MD000502, is a Minority Health and Health Disparities Research Center initiative funded through the National Institute of Minority Health and Health Disparities Centers of Excellence Program. www.uab.edu/medicine/obesity.

About Elsevier

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