Elsevier

Social Science & Medicine

Volume 199, February 2018, Pages 157-166
Social Science & Medicine

The weight of racism: Vigilance and racial inequalities in weight-related measures

https://doi.org/10.1016/j.socscimed.2017.03.058Get rights and content

Highlights

  • With cultural racism, vigilance and discrimination hold different meanings by race.

  • Vigilance (not discrimination) was related to waist circumference for Black women.

  • Discrimination (not vigilance) was related to waist circumference for White women.

Abstract

In the United States, racial/ethnic inequalities in obesity are well-documented, particularly among women. Using the Chicago Community Adult Health Study, a probability-based sample in 2001–2003 (N = 3105), we examined the roles of discrimination and vigilance in racial inequalities in two weight-related measures, body mass index (BMI) and waist circumference (WC), viewed through a cultural racism lens. Cultural racism creates a social environment in which Black Americans bear the stigma burden of their racial group while White Americans are allowed to view themselves as individuals. We propose that in this context, interpersonal discrimination holds a different meaning for Blacks and Whites, while vigilance captures the coping style for Blacks who carry the stigma burden of the racial group. By placing discrimination and vigilance within the context of cultural racism, we operationalize existing survey measures and utilize statistical models to clarify the ambiguous associations between discrimination and weight-related inequalities in the extant literature. Multivariate models were estimated for BMI and WC separately and were stratified by gender. Black women had higher mean BMI and WC than any other group, as well as highest levels of vigilance. White women did not show an association between vigilance and WC but did show a strong positive association between discrimination and WC. Conversely, Black women displayed an association between vigilance and WC, but not between discrimination and WC. These results demonstrate that vigilance and discrimination may hold different meanings for obesity by ethnoracial group that are concealed when all women are examined together and viewed without considering a cultural racism lens.

Introduction

Ethnoracial inequalities in obesity, indexed with body mass index (BMI) or waist circumference (WC) have been widely documented in Americans, particularly in American women (Ogden et al., 2014). Recent estimates indicate that 82% of non-Hispanic Black women and 77% of Hispanic women are either overweight or obese while 63% of non-Hispanic White women are overweight or obese (Wang and Beydoun, 2007). More concerning is the inequality in visceral adiposity, often proxied by WC, as this type of adiposity is a particular risk factor for many chronic diseases such as cardiovascular disease and diabetes (Despres and Lemieux, 2006; C. M. Y. Lee et al., 2008). Data indicate that 54% of non-Hispanic White women are centrally obese while 70% of non-Hispanic Black and 60% of Mexican American women are centrally obese (Wang and Beydoun, 2007). The inequalities in obesity, particularly those that proxy visceral adiposity, may then result in a cascade of health, social, and economic consequences that burden non-White adults with decreased life chances compared to White adults.

Chronic psychosocial stress may play an important role in obesity inequalities. First, research indicates that consumption of high calorie, high saturated fat foods in response to psychological stress results in the release of certain biochemicals known to reduce feelings of stress (Dallman et al., 2003, Dallman et al., 2005). Moreover, psychosocial stress alters metabolism to result in visceral adipose deposition specifically (Dallman et al., 2005). Second, there are racial inequalities in psychosocial stress and social stressors (Jackson et al., 2010, Schulz et al., 2005, Turner, 2009).

However, there are only a handful of empirical studies in which the authors examine the associations between psychosocial stress and racial inequalities in either obesity or the weight-related measures that may capture the development of obesity. For example, chronic stress during adolescence was linked to greater increases in BMI for Black compared to White girls (Tomiyama et al., 2013). Everyday discrimination as a stressor is related to weight-related measures within and across racial groups; notably, however, it does not appear to explain racial inequalities in these measures (Cunningham et al., 2013, Hunte, 2011, Hunte and Williams, 2009, Lewis et al., 2010).

The paucity of empirical literature may be due to the use of stress measures that are not racially-salient and biologically-meaningful. We examine discrimination and vigilant coping style within a cultural racism framework to clarify the ways in which these psychosocial stressors are related to racial inequalities in weight-related outcomes. As we discuss below, cultural racism, through the specific processes of racialization and stigmatization, results in racially-divergent meanings of discrimination and racism for Black and White adults. While a culturally-racialized social environment may present increased exposures to interpersonal discrimination for Blacks compared to Whites, we propose that the overall burden stigmatization of blackness results in chronic vigilance for potential prejudice, discrimination, and racism – and that this vigilance is particularly salient for the health of Blacks.

Furthermore, consistent with the literature on discrimination and health across racial group (Hunte, 2011, Hunte and Williams, 2009, Lewis et al., 2009), we propose that discrimination remains salient for the health of Whites. This salience may be due to the implicit understanding of White privilege and American sense of fairness. Because Whites do not carry the burden of the racial group membership, they perceive unfair treatment as individuals rather than representatives of their group (DiAngelo, 2011, Feagin, 2013, Grillo and Wildman, 1991, Wildman and David, 1994). By placing discrimination and vigilance within the context of cultural racism, we operationalize existing survey measures and develop statistical models that clarify the equivocal nature of the literature on discrimination and inequalities in weight-related measures and provide clues as to the root causes of the overall racial inequalities in obesity.

In the paper, we begin with a discussion of the psychology and sociology literature on cultural racism. We weave together scholarship not regularly applied to public health literature to suggest that cultural processes – girded by racial inequities in power – result in a racialized social environment in which Black (and other non-White ethnoracial) group members are routinely stigmatized (Fleming et al., 2012, Lamont et al., 2014, Link and Phelan, 2014). The process of racialization results in a shared understanding of the social meanings of race and racial categories within a society (Lamont et al., 2014). Stigmatization results in the natural psychological and emotional vigilance by marginalized group members (Fleming et al., 2012, Goffman, 1974, Lamont and Mizrachi, 2012, Link and Phelan, 2014). We then discuss the concept of racism-related vigilance, developed from the qualitative literature on the burden of racism, capturing anticipatory and ruminative stress (Essed, 1991, Feagin, 1991). Previous work suggests that vigilance, unlike other types of psychosocial stressors and strain, explains racial inequalities in health including hypertension prevalence (Hicken et al., 2014) and sleep difficulty (Hicken et al., 2013a).

Using a probability-based sample of Chicago that includes non-Hispanic White, non-Hispanic Black and Hispanic adults aged 18 years and older, we examine the role of discrimination and vigilance in the racial inequalities in two weight-related measures, BMI and WC. We show that vigilance, as a reflection of the psychological burden of cultural racism, is related to WC for Black but not White women. Furthermore, we show that discrimination, which may reflect the strength of contemporary racialization processes in which Whites are able to view themselves as raceless individuals within a society that promotes equality and fairness, is related to WC for White but not Black women.

Racism, defined as:

[a] system of dominance, power, and privilege based on racial group designations … where members of the dominant group create or accept their societal privilege by maintaining structures, ideology, values, and behavior that have the intent or effect of leaving nondominant-group members relatively excluded from power, esteem, status and/or equal access to societal resources. (Harrell, 2000, p.43, emphasis added)

is considered by many a bedrock of historical and contemporary American society (Bobo et al., 1997, Bonilla-Silva, 1997, Bonilla-Silva, 2010). Racism does not require explicit intent or personal dislike on the part of its dominant actors. Rather, it is woven into our social structure and institutions, allowing for unequal life experiences and chances based on the socially-constructed racial group membership categories.

This working definition includes both the interwoven structural and cultural aspects of racism (Jones, 1997). We focus on the cultural racism which places focus on the socially accepted “ideology, values, and behavior,” ultimately set by the dominant power group. Cultural racism is a particularly insidious form of racism as it operates on the level of our shared social subconscious (Carter, 2007, Jones, 1997, Sue, 2003). The processes that comprise cultural racism are invisible to many, but the result is a reified set of ideologies, values, and behaviors that are defined by the dominant racial group, which in the US is the White, Christian, middle-class, male group. Moreover, while the cultural processes that result in the America racial hierarchy are invisible to many, the fact that cultural racism is infused through our institutions (e.g., education, labor) means that there are visible social, political, and economic consequences (Jones, 1997, Lamont et al., 2014). And, with the invisibility of the processes, our institutions appear neutral and rational, with the visible racially unequal consequences apparently arising only from poor ideology, values, and behavior on the part of non-dominant racial groups (Bobo et al., 1997, Bonilla-Silva, 2010, Lamont et al., 2014).

Cultural racism is developed and maintained through multi-level processes. At the micro (individual) level, psychologists have shown that humans use cognitive processes, categorizing and classifying the world around us, in an effort make sense of large amounts of information (Allport, 1979, Macrae et al., 1994). This alone does not drive cultural racism – it is our classification schema as well as the meanings assigned to these categories, that is problematic (Hatzenbuehler et al., 2013, Link and Phelan, 2001). At the macro (societal) level, sociologists discuss notions of symbolic power or the imposition of the dominant class's traditions, behaviors, and values as the standard (Bourdieu, 1984). These symbolic and cultural power inequalities are arguably as strong as the economic and material inequalities more often discussed in sociology (Lamont et al., 2014).

At the meso-level are the processes that link the doxa to the individuals as they navigate the social world. Specifically, two classes of processes – identification and rationalization – are thought to drive racial inequalities in social, economic, and political power, and, we argue, in health (Hatzenbuehler et al., 2013, Lamont et al., 2014, Link and Phelan, 2001). These processes mobilize the dominant classification systems, resulting in a large-scale shared cultural set of meaningful mores and values. Identification processes dynamically set the contemporary shared meanings of a racial group while rationalization processes institutionalize these racial meanings in a way that delinks the original racialized process, making the institutional practices appear neutral (and rational). We focus on the first set of processes here, in the interest of space, as they are more relevant to our specific research question. Identification processes involves racialization (Omi and Winant, 1994) as the recognition of a phenotype, particularly the constellation of phenotypes that indicate social race (e.g., skin color, hair texture) and assignment of shared meaning to this phenotype. Aspects of cultural racism dynamically shift to fit contemporary social mores through these cultural processes of identification and rationalization. In tandem, identification involves stigmatization (Goffman, 1974, Link and Phelan, 2001) as the process by which groups are labeled, stereotyped, and ultimately marginalized. These cultural processes that dynamically maintain contemporary flavors of cultural racism result in the continual misrecognition of blackness (and whiteness), with visible effects on health and health inequalities.

Citizens of a democratic society desire more than a fair distribution of resources, but also of the recognition of their humanity and uniqueness (Harris-Perry, 2011). However, in the United States, cultural racism results in a misrecognition of Black men and women – the attachment of crude, stigmatizing stereotypes that mischaracterize their humanity and obscure within group variation (Harris-Perry, 2011). With the misrecognition of Black Americans, and blackness more broadly comes with at least two consequences. First is the increased exposure to prejudice and interpersonal discrimination (Link and Phelan, 2001). Discrimination and its relation to health is well-discussed and we leave the details to several excellent reviews (Lewis et al., 2015, Williams et al., 2008, Williams et al., 2012, Williams and Mohammed, 2009).

A second consequence of cultural racism is the need for Black Americans to develop adaptive strategies to negotiate everyday (White) social space (Allport, 1979, Major and Vick, 2005) – by which we mean the social spaces that Americans inhabit to conduct everyday life such as the workplace and classroom, and even stores, parks, and other public spaces (Feagin, 1991). There is a diverse literature, mostly qualitative, on the thoughts and behaviors of Black Americans as they traverse ordinary life and we highlight three main themes.

First, there is a growing literature on the ways in which Black Americans attend to self-presentation (Della et al., 2002, Fleming et al., 2012, Goffman, 1969; H. Lee and Hicken, 2016, Sue et al., 2008). We highlight two aspects in particular – attention to appearance and attention to speech. For example, a Black male study participant at an American Ivy League school, discussed how he considered his appearance each day before leaving home:

I kind of find myself thinking a lot before I leave my house, like: Do I look too threatening? Like, maybe I shouldn't wear this, maybe I shouldn't wear that. Sometimes, when I didn't even need my backpack, but I'd carry it with me anyway … (Torres and Charles, 2004, p.124)

Similarly, other studies document how Black men and women speak in certain ways to receive good service or to be taken seriously, using a “white-on-white voice”, as one study participant phrased it (Feagin and Sikes, 1994, pp.54–55).

Scholars also argue that there is a level of risk assessment and management when deciding when and where to engage dominant White space. For example, in one study, a Black physician discussed how he decides when to avoid social obligations, stating that he needs to think about whether it is a personal or professional situation and whether or not he may be truly welcome (Feagin and Sikes, 1994). The researchers of this study noted “the tragic legacy of Black Americans of having to know one's place” and commented on the pain in this participant's words (Feagin and Sikes, 1994, p.275).

Finally, the stigmatizing misrecognition may also result in Black Americans needing to mentally and emotionally prepare themselves for negotiating everyday White social space (Allport, 1979, Major and Vick, 2005). For example, one study participant described how she prepared for parent-teacher conferences with her child's teachers:

...[I]t's like you get tense. Because you know...I know this person is going to say something that's going to make me, my heart rate [go up], or maybe have to hold back my tears while I'm talking to them... with a White person, you know that some level of racism is going to hop out of their mouth... And so you have to prepare your body for that. (Nuru-Jeter et al., 2009, p.35)

This preparation may be due to previous interpersonal experiences with prejudice and discrimination, but may also be due to vicarious experiences. Furthermore, these vicarious experiences may be with those in one's immediate social network (e.g., sister, neighbor) or, with the rise of smart phones and social media, with any other Black Americans (e.g., Sandra Bland, Tamir Rice). In sum, engagement in chronic vigilant thoughts and behaviors in order for one's humanity to be properly recognized is an important source of racism-related stress.

Research points to two aspects of stress that may be particularly relevant for racial health inequalities. First, anticipatory stress is the activation of the biological stress response system in anticipation of a potentially stressful situation. Notably, research shows that the anticipation of the situation alone – even in the absence of the actual situation– is enough to activate the stress response system. This is a normal, healthy part of human physiology. However, chronic anticipatory stress may result in wear and ultimate dysfunction of the stress response system (McEwen, 1998). Second, ruminative stress occurs with the prolonged cognitive representation of a stressful situation. Ruminative stress can transform an acute stressor (e.g., loss of job) into a chronic stressor that repeatedly activates the biological stress response system (Brosschot et al., 2005, Brosschot et al., 2006).

Cultural racism may result in the need for vigilant thoughts and behaviors – and we propose that these thoughts and behaviors reflect an underlying anticipation and rumination about navigating everyday White social spaces (e.g., work, school, shopping). The small literature in this area supports this notion. First, researchers showed that the anticipation of prejudice resulted in a greater blood pressure reaction compared with the anticipation of a more general stressor (Sawyer et al., 2012). Specifically, Latina college student study participants were asked to give a speech about their qualifications as a lab partner. Some of the students were led to believe that their audiences held racist views about Latino Americans while others were led to believe that their audiences held racial views normative for the campus. The group assigned to the “racist” audience had a markedly greater increase in blood pressure as they were preparing their speeches compared to the group assigned to the “racially normative” audience (Sawyer et al., 2012). These stress biology changes are reflected in the qualitative literature as well, as exemplified above by the study participant preparing for her parent-teacher conferences.

Second, research suggests that, in samples of Black Americans, chronic vigilance is related to dysfunction of the biological stress response system (Clark et al., 2006) and multiple physical and mental health measures including depressive symptoms, self-rated health, and a count of chronic conditions (H. Lee and Hicken, 2016). Finally, research using probability-based samples suggests that vigilance plays an important role in racial inequalities in health. For example, vigilance, but not other types of stressors (e.g., poverty), explained the Black-White inequalities in sleep difficulty (Hicken et al., 2013a), a potentially major determinant of numerous chronic diseases. In other work, researchers reported that when vigilance was low, Black-White inequality in hypertension prevalence was relatively small and explained entirely by hypertension risk factors such as smoking and body mass index (BMI) (Hicken et al., 2014). However, at higher levels of vigilance, the hypertension inequalities were substantially greater and not explained by any of the risk factors (Hicken et al., 2014).

To date there is no work on vigilance and weight-related measures. However, other research on stress and weight-related measures provide support for the notion that vigilance may be positively associated with weight and may furthermore explain racial inequalities in weight. First, research indicates that stress results in metabolic changes that result in visceral adipose deposition (Dallman et al., 2005). Second, others have shown that obesogenic foods result in the release of biochemical that eases feelings of stress (Dallman et al., 2003, Dallman et al., 2005). Finally, research suggests that environmental cues and social mores affect the stress coping approaches adopted by different social groups (Jackson et al., 2010). Specifically, Black women may adopt obesogenic coping behaviors to address stress to preserve mental well-being (Jackson et al., 2010).

We hypothesize that for Black, but not White, adults, chronic vigilance, as a reflection of the burden of racialized stigma, will be related to weight-related measures. We further hypothesize that interpersonal discrimination, as a reflection of the racialized White privilege with the American sense of fairness, will be associated with weight-related measures for White but not Black adults. The small literature on discrimination and weight-related outcomes suggests that discrimination is associated with weight for both Black and White women (Cunningham et al., 2013, Hunte, 2011, Lewis et al., 2011) or perhaps only for White women (Hunte and Williams, 2009). Several studies including only Black adults show that discrimination is associated with weight-related measures (Cozier et al., 2009, Cozier et al., 2014, Vines et al., 2007). However, vigilance was not examined and we hypothesize that, in the face of vigilance, the burden of interpersonal discrimination does not have as strong an impact. Finally, we hypothesize that these associations will be particularly strong with regard to the weight-related measure that more closely proxies the stress-related visceral adipose deposition, WC.

Section snippets

Dataset

We used data from the Chicago Community Adult Health Study (CCAHS), a cross-sectional survey designed to examine the biological, social, and environmental correlates of adult physical and mental health. The CCAHS is a multi-stage probability sample of 3105 adults, aged 18 years and older, living in Chicago. Face-to-face interviews were conducted and direct physical measurements were taken between 2001 and 2003 with a response rate of 71.8%.

Variables

We examine both WC and BMI because, although they are

Results

Our results suggest that these psychosocial stress measures operate in relation to weight for women but not men. Therefore, due to space constraints, we will discuss the results for women here and provide results for men in supplemental tables. Black women had higher mean WC (97 cm) and BMI (31 kg/m2) compared to both Hispanic (92 cm and 32 kg/m2, respectively) and White women (86 cm and 26 kg/m2, respectively, Table 1). Furthermore, Black women also reported the highest level of vigilance;

Discussion

Framing our discussions around cultural racism, we examined the relation between the vigilance that may result from cultural racism and racial inequalities in weight-related measures. Our results suggest that vigilance and discrimination have different meanings for health depending on race. For White women, interpersonal discrimination, rather than vigilance, was positively related to WC and BMI. However, for Black women, it was vigilance, rather than discrimination, that was positively related

Acknowledgments

A.K. Hing benefited from facilities and resources provided by the California Center for Population Research at UCLA (CCPR), which receives core support (P2C-HD041022) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

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