Disease in the Heart of Dixie: An Analysis of Obesity Indicators and Racial Disparities in Alabama

Abstract

Purpose: Obesity in the U.S. is one of the most serious public health issues. Within the U.S., the state of Alabama suffers the 5th highest rate of adult obesity. Ample research has focused on obesity indicators and disparities nationally. Comparatively little has been done to examine state-level trends. Narrowing the scope to Alabama enables the detection of characteristics of the obesity crisis unique to the state, useful for policymakers, and otherwise obscured. The purpose, therefore, is to analyze racial disparities in and significant indicators of obesity. Methods: I use age-adjusted multivariate logistic regressions to assess the impact of race, physical activity, fruit and vegetable intake, income, education, and smoking habits on the predicted probability of obesity. The models were stratified by sex to account for the distinct effect of race on women. Additional models explore the ways in which geographic inequities are exacerbating the racial disparities observed. Results: Racial disparities in Alabama are significantly stronger than in the rest of the U.S. (p<0.1). Among women in Alabama, the effect of being black (against a white baseline) in the full model was statistically significant (p<0.01). Black women were 16.4% more likely to be obese controlling for all covariates, making race the strongest predictor of obesity of all independent variables in the model. Physical activity, income, education, and smoking habits were negatively associated with obesity. Among men, racial disparities in obesity prevalence were not statistically significant. Physical activity and smoking habits were significantly correlated with obesity (p<0.01), but income and education were not. Additional models suggest that geographic inequities could be a primary cause of racial disparities. Conclusions: Due to compounding factors, African American women and those living in the Black Belt region constitute the most vulnerable populations in Alabama. Culturally competent policies should be pursued in consideration of these trends and in order to overcome health inequities.