摘要：Objectives . We examined whether perceived chronic discrimination was related to excess body fat accumulation in a random, multiethnic, population-based sample of US adults. Methods . We used multivariate multinomial logistic regression and logistic regression analyses to examine the relationship between interpersonal experiences of perceived chronic discrimination and body mass index and high-risk waist circumference. Results . Consistent with other studies, our analyses showed that perceived unfair treatment was associated with increased abdominal obesity. Compared with Irish, Jewish, Polish, and Italian Whites who did not experience perceived chronic discrimination, Irish, Jewish, Polish, and Italian Whites who perceived chronic discrimination were 2 to 6 times more likely to have a high-risk waist circumference. No significant relationship between perceived discrimination and the obesity measures was found among the other Whites, Blacks, or Hispanics. Conclusions . These findings are not completely unsupported. White ethnic groups including Polish, Italians, Jews, and Irish have historically been discriminated against in the United States, and other recent research suggests that they experience higher levels of perceived discrimination than do other Whites and that these experiences adversely affect their health. It is estimated that 2 of every 3 adults in the United States are overweight or obese. 1 , 2 Obesity is a major risk factor for chronic health conditions, such as type 2 diabetes, coronary heart disease, hypertension, stroke, some forms of cancer, and osteoarthritis. 3 Although it is widely accepted that high-fat diets and physical inactivity are preventable risk factors, 4 obesity continues to increase. 1 , 2 , 5 There is a growing interest in the relationship between psychosocial risk factors and excess body fat accumulation. 6 – 16 In particular, some evidence suggests that psychosocial stressors may play a role in disease progression in general and in excess body fat in particular. 7 , 8 , 17 The key factors underlying physiological reactions to psychosocial stress have not been completely elucidated, but McEwen and Seeman 17 and others 7 , 18 , 19 posit that the continued adaptation of the physiological system to external challenges alters the normal physiological stress reaction pathways and that these changes are related to adverse health outcomes. 8 , 17 , 18 , 20 For example, in examining the association between psychosocial stress and excess body fat accumulation, Björntorp and others have suggested that psychosocial stress is linked to obesity, especially in the abdominal area. 7 , 8 Perceived discrimination, as a psychosocial stressor, is now receiving increased attention in the empirical health literature. 21 – 24 Such studies suggest perceived discrimination is inversely related to poor mental and physical health outcomes and risk factors, including hypertension, 24 , 25 depressive symptoms, 26 – 28 smoking, 29 – 31 alcohol drinking, 32 , 33 low birthweight, 34 , 35 and cardiovascular outcomes. 36 – 38 Internalized racism, the acceptance of negative stereotypes by the stigmatized group, 39 has also been recognized as a race-related psychosocial risk factor. 40 Recent studies have also suggested that race-related beliefs and experiences including perceived discrimination might be potentially related to excess body fat accumulation. Three of these studies 9 , 13 , 41 showed that internalized racism was associated with an increased likelihood of overweight or abdominal obesity among Black Caribbean women in Dominica 41 and Barbados 13 and adolescent girls in Barbados. 9 These researchers posit that individuals with relatively high levels of internalized racism have adopted a defeatist mindset, which is believed to be related to the physiological pathway associated with excess body fat accumulation. However, Vines et al. 16 found that perceived racism was associated with lower waist-to-hip ratios among Black women in the United States. Although the assessment of race-related risk factors varied across these studies, the findings suggest that the salience of race-related beliefs and experiences may be related to excess body fat accumulation. Collectively, the results of these studies are limited. First, because they examined the relationship between race-related beliefs and experiences and excess body fat only among women, we do not know if this relationship is generalizable to men. 13 , 16 , 41 Second, these studies only examined this relationship among Blacks, even though perceived unfair treatment because of race/ethnicity has been shown to be adversely related to the health of multiple racial/ethnic population groups in the United States 42 – 49 and internationally. 27 , 50 – 55 Third, none of the studies have examined the relationship between excess body fat accumulation and perceived nonracial/nonethnic experiences of interpersonal discrimination. Some evidence suggests that the generic perception of unfair treatment or bias is adversely related to health, regardless of whether it is attributed to race, ethnicity, or some other reason. 45 , 55 , 56 Fourth, none of these studies included other measures of stress. We do not know if the association between race-related risk factors and obesity is independent of other traditional indicators of stress. Using a multiethnic, population-based sample of adults, we examined the association of perceived discrimination and obesity independent of other known risk factors for obesity, including stressful major life events. Additionally, because reports of perceived racial/ethnic discrimination and non-racial/ethnic discrimination vary by racial/ethnic groups 24 , 45 , 46 , 57 and because Whites tend to have less excess body fat than do Blacks and Hispanics, 1 , 3 we examined the relationships between perceived discrimination and excess body fat accumulation among Hispanics, non-Hispanic Whites, and non-Hispanic Blacks.
