Racial and Gender Disparities in Obesity

The following article was written by Dr. Alaa Diab as a CardioNerds Conference Scholar for

Women’s Cardiometabolic Health and Wellness Retreat

“Black women with obesity have a higher risk of heart attack and stroke by 117% than white women with obesity, if they have any two cardiometabolic risk enhancing factors like diabetes and hypertension” said Dr. Fatima Cody Stanford, Associate Professor of Medicine, Pediatrics Obesity Medicine Physician Scientist, and Equity Director at Massachusetts General Hospital Endocrine Division. Dr. Stanford shed the light on the ethnic and racial disparities in women’s cardiometabolic health at the Cardiometabolic Health Women’s Master Class at Rancho Palos Verdes, California.

Obesity is an epidemic in the United States with an increased prevalence of 30.5% to 41.9% in 2020.¹ The theory of simple calories input versus calories output is now outdated per Dr. Stanford, as obesity is now known to be a multi-factorial disorder affected by genetics, the environment, behavior, and even development.² It has been found that certain genes affect susceptibility to the obesogenic environment.³ For example, one of the identified genotypes is BDNF rs12291063 where changes in expression can have significant impact on body weight regulation.⁴ At the neurohormonal level, the digestive tract hormones along with hormones from the pancreas and adipose tissue directly affect the arcuate nucleus in the hypothalamus, which is translated to either food seeking or fasting behavior.

Furthermore, Dr. Stanford explained that body fat differs between males and females, where males tend to accrue more visceral fat and females accrue subcutaneous fat. Visceral fat has been found to increase the risk of cardiovascular disease which puts males at a higher risk than pre-menopausal females.⁵ Nevertheless, if the subcutaneous fat is present at the abdominal areas, it’s as cardio-metabolically toxic as visceral fat, mainly due to the higher rates of lipolysis increasing plasma lipids and circulating pro-inflammatory molecules.⁶

In a study of 126 healthy, premenopausal women with a BMI of 27-30 kg/m² who underwent weight loss to achieve a BMI <25, it was found that inflammatory markers of tumor necrosis factor-α (TNF-α), soluble TNF receptor-I (sTNFR-I), sTNFR-II, C-reactive protein (CRP), and interleukin-6 (IL-6) were significantly decreased with weight loss.⁷ However, while all inflammatory markers decreased among white women, only IL-6 and CRP decreased in African American women.⁷ Such findings of racial disparities indicate the need for early focus on obesity prevention and prompt intervention.

Understanding that obesity is a multi-factorial disease process helps in addressing the different factors towards lower cardiovascular disease risk. This can be done by lifestyle modifications which entails behavioral changes, limiting the obesogenic environment, and with downstream technological advances, the implementation of precision medicine with identified obesity enhancing genes. Evidence-based weight loss strategies must be further studied and implemented especially for women and racial minorities where the gap in obesity-related diseases disproportionately affect this patient population.

Critical point from @askdrfatima : the location/distribution of adipose tissue predicts associated cardiometabolic risk @CMHC_CME #CMHCWomensMC @PamTaubMD @ErinMichos @CBallantyneMD pic.twitter.com/g6Rv18HknY

— Michael Wilkinson (@MWilkinsonMD) September 10, 2022

ICYMI: @askdrfatima spoke with Healio about highlights from her presentation on racial and ethnic disparities in cardiometabolic disease, particularly obesity #CMHCWomensMC @CMHC_CME #CardioTwitter @healiowomen @MassGeneralNews https://t.co/lITVz8n2XI

— Cardiology Today (@CardiologyToday) September 13, 2022

As women approach menopause:
Distribution of adiposity transitions from gynoid to android, leading to an increase in risk of CVD#CMHCWomensMC @CMHC_CME @askdrfatima pic.twitter.com/a9bO1KZf5t

— Alaa Diab, MD MPH (@DrAlaaDiab) September 10, 2022

Next up: An unparalleled speaker, researcher, & leader: @askdrfatima!

Discussing the crucial topic of ethnic and racial disparities in women's cardiometabolic health#CMHCWomensMC pic.twitter.com/PvwHHIkBTb

— Jessie Holtzman (@jholtzman3) September 10, 2022

References.

1. Adult obesity facts. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/data/adult.html. Published May 17, 2022. Accessed October 2, 2022.
2. Grundy SM. Multifactorial causation of obesity: implications for prevention. Am J Clin Nutr. 1998 Mar;67(3 Suppl):563S-72S. doi: 10.1093/ajcn/67.3.563S. PMID: 9497171.
3. Walley AJ, Asher JE, Froguel P. The genetic contribution to non-syndromic human obesity. Nat Rev Genet. 2009 Jul;10(7):431-42. doi: 10.1038/nrg2594. PMID: 19506576.
4. Mou Z, Hyde TM, Lipska BK, Martinowich K, Wei P, Ong CJ, Hunter LA, Palaguachi GI, Morgun E, Teng R, Lai C, Condarco TA, Demidowich AP, Krause AJ, Marshall LJ, Haack K, Voruganti VS, Cole SA, Butte NF, Comuzzie AG, Nalls MA, Zonderman AB, Singleton AB, Evans MK, Martin B, Maudsley S, Tsao JW, Kleinman JE, Yanovski JA, Han JC. Human Obesity Associated with an Intronic SNP in the Brain-Derived Neurotrophic Factor Locus. Cell Rep. 2015 Nov 10;13(6):1073-1080. doi: 10.1016/j.celrep.2015.09.065. Epub 2015 Oct 29. PMID: 26526993; PMCID: PMC4644471.

5. Palmer BF, Clegg DJ. The sexual dimorphism of obesity. Mol Cell Endocrinol. 2015 Feb 15;402:113-9. doi: 10.1016/j.mce.2014.11.029. Epub 2015 Jan 8. PMID: 25578600; PMCID: PMC4326001.
6. Leeners B, Geary N, Tobler PN, Asarian L. Ovarian hormones and obesity. Hum Reprod Update. 2017 May 1;23(3):300-321. doi: 10.1093/humupd/dmw045. PMID: 28333235; PMCID: PMC5850121.
7. Fisher G, Hyatt TC, Hunter GR, Oster RA, Desmond RA, Gower BA. Markers of inflammation and fat distribution following weight loss in African-American and white women.Obesity (Silver Spring). 2012;20(4):715-720. doi:10.1038/oby.2011.85