Race, place, and obesity: the complex relationships among community racial/ethnic composition, individual race/ethnicity, and obesity in the United States

Abstract

Objectives: We explored the association between community racial/ethnic composition and obesity risk.

Methods: In this cross-sectional study, we used nationally representative data from the Medical Expenditure Panel Survey linked to geographic data from the US Decennial Census and Census Business Pattern data.

Results: Living in communities with a high Hispanic concentration (≥ 25%) was associated with a 0.55 and 0.42 increase in body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) and 21% and 23% higher odds for obesity for Hispanics and non-Hispanic Whites, respectively. Living in a community with a high non-Hispanic Asian concentration (≥ 25%) was associated with a 0.68 decrease in BMI and 28% lower odds for obesity for non-Hispanic Whites. We controlled for individual- and community-level social, economic, and demographic variables.

Conclusions: Community racial/ethnic composition is an important correlate of obesity risk, but the relationship differs greatly by individual race/ethnicity. To better understand the obesity epidemic and related racial/ethnic disparities, more must be learned about community-level risk factors, especially how built environment and social norms operate within communities and across racial/ethnic groups.

FIGURE 1—

Differences in body mass index associated with community racial/ethnic composition by individual race/ethnicity: 2002–2007 Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality. Note. BMI = body mass index (defined as weight in kilograms divided by the square of height in meters). These estimates represent expected differences in BMI between individuals living in communities where 25% or more of the residents are of the specified race/ethnicity and those living in communities where no minority group makes up more than 25% of the population, adjusted for all variables in shown in Table 1. Lines represent 95% confidence intervals.

FIGURE 2—

Odds ratios for being obese associated with community racial/ethnic composition by individual race/ethnicity: 2002–2007 Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality. Note. BMI = body mass index (defined as weight in kilograms divided by the square of height in meters). These estimates represent odds ratios for being obese associated with living in communities where 25% or more of the residents are of the specified race/ethnicity relative to those living in communities where no minority group makes up more than 25% of the population, adjusted for all variables in shown in Table 1. Lines represent 95% confidence intervals.