摘要：Objectives. We examined whether racial discrimination is associated with increased body mass index (BMI) and obesity among Asian Americans. Further, we explored whether this association strengthens with increasing time in the United States. Methods. We analyzed data from the 2002 to 2003 National Latino and Asian American Study (n=1956). Regression models tested whether reports of racial discrimination were associated with BMI and obesity, after accounting for weight discrimination, age, gender, marital status, ethnicity, generation, employment, health status, and social desirability bias (the tendency to seek approval by providing the most socially desirable response to a question). Results. We found that (1) racial discrimination was associated with increased BMI and obesity after we controlled for weight discrimination, social desirability bias, and other factors and (2) the association between racial discrimination and BMI strengthened with increasing time in the United States. Conclusions. Racial discrimination may be an important factor related to weight gain among ethnic minorities. Stress caused by disadvantaged social status may be related to obesity. Two elements provide the foundation for this observation. First, stress may have adverse physiological consequences, including increased risk for obesity and allostatic load, the “wear and tear” on organ systems that contributes to health problems. 1 Stressors activate the hypothalamic–pituitary–adrenal axis system, releasing cortisol and other glucocorticoids. Glucocorticoids may stimulate appetite and blunt the satiety system. 2 Cortisol increases fat retention, particularly in the abdominal region. 3 Moreover, stressors may selectively increase the intake of “comfort foods” over other foods among humans and other animals. 4 , 5 Stress may also be related to abdominal and general obesity. Daily stress, 6 anxiety, 7 and depressed mood 8 , 9 are related to visceral obesity. Among monozygotic twins, stress-induced hormonal changes result in greater intra-abdominal fat deposits in the twin with higher stress. 10 Further, obesity, indicated by a high body mass index (BMI), has been associated with work stress 11 , 12 and early childhood trauma. 13 In a prospective study of British civil servants, job stress was associated with metabolic syndrome (a group of risk factors that includes abdominal obesity, elevated blood pressure, and atherogenic dyslipidemia) 8 and general and visceral obesity. 12 Second, social disadvantage, such as experiences with racial discrimination, may produce stress. 14 Self-reported discrimination appears to be related to several stress-related and obesity-related outcomes, including high blood pressure, 15 depression and anxiety, 16 sleep problems, 17 and coronary calcification. 18 Individuals may also use alcohol to cope with discrimination, 19 – 21 and alcohol can contribute to obesity. 22 Hence, discrimination may directly produce weight gain by activating the stress system and by influencing behavior change. Discrimination also may act indirectly by hindering socioeconomic advancement 23 , 24 and by segregating individuals into communities with fewer healthy food options 25 , 26 and fewer safe places for physical activity. 27 , 28 Consistent with these observations, several studies have suggested that discrimination is associated with weight gain and metabolic problems. Tull et al. found that reports of internalized racism were associated with greater obesity among women in Barbados. 29 Similarly, Chambers et al. found associations between internalized racism and insulin resistance among girls in Barbados. 30 Butler et al. found associations between internalized racism and greater waist circumference and higher fasting glucose among Dominica women. 31 We tested the first hypothesis that reports of discrimination are associated with higher BMI and the risk of obesity and build on previous research in 3 primary ways. First, overweight people may encounter weight discrimination, 32 and associations between racial discrimination and weight might therefore be confounded by weight discrimination. To reduce the chance of spurious findings, we controlled for weight discrimination and other factors. Second, we examined whether findings from Black populations generalize to Asian Americans. Among Asian Americans, discrimination is associated with outcomes related to obesity, including cardiovascular conditions, 33 , 34 depression, 35 – 37 and substance use, 19 but no study has directly examined whether discrimination is associated with BMI and obesity in this population. Third, we tested the main effects of discrimination and investigated whether discrimination is moderated by time spent in the United States. US-born Asians appear to have higher rates of obesity than their foreign-born counterparts, but the rates of obesity among the foreign born increase with years in the United States. 38 – 40 Additionally, immigrants often report less racial discrimination than do nonimmigrants, but reports of discrimination increase with years spent in the United States, perhaps because immigrants are more likely to encounter and recognize discrimination over time. 41 – 43 A recent study found that among African and Latino immigrants, the association between racial discrimination and mental health strengthened with increasing time in the United States. 44 These observations motivate the second hypothesis that time spent in the United States will interact with the association between racial discrimination, such that the association between racial discrimination and BMI among immigrant Asians will strengthen with increasing time spent in the United States.
