Pathways between race, structural racism, and obesity across census tracts in the United States

Aims To examine direct and indirect pathways between race/ethnicity, contemporary structural racism, and obesity prevalence across census tracts in the United States. Materials and Methods The final analytic sample consisted of 11 457 census tracts across 201 counties, within 38 states. Obesity prevalence was based on CDC PLACES data. Structural racism was defined using the structural racism effect index (SREI). Proportion of African American/Black (AAs), non‐Hispanic white (NHW), Hispanic, and Asians within a census tract were based on Census data. Structural equation modelling in Stata v17 was used to investigate direct and indirect relationships between race, structural racism, and obesity. Results Mean prevalence of obesity was 31.8%. Structural racism was directly associated with higher obesity (0.70, p < 0.001). AA race was directly associated with higher prevalence of obesity (0.67, p < 0.001), and indirectly via structural racism (0.23, p < 0.001). NHW was directly associated with higher prevalence of obesity (0.47, p < 0.001), and was associated with lower structural racism (−0.43, p < 0.001). Hispanic race was directly associated with higher prevalence of obesity (0.32, p < 0.001) but was not associated with structural racism. Asian race was directly associated with lower prevalence of obesity (−0.06, p < 0.001), and lower structural racism (−0.29, p < 0.001). Conclusions AA and NHW had a positive direct relationship with obesity, whereas Asians had a negative relationship. For AAs, there was a strong positive indirect relationship via structural racism. For NHWs and Asians, there was a negative indirect relationship via structural racism. Based on these results, structural racism and its impact on obesity are more pronounced for AA compared to other racial/ethnic groups.