Cumulative social disadvantage, denoted by a higher burden of social determinants of health (SDOH), is associated with a higher likelihood of obesity, independently of clinical and demographic factors, according to a new study published in Obesity, the flagship journal of the Obesity Society (TOS). The population-based study is the first to examine this hypothesized association in a nationally representative sample of adults in the United States.
"In general, contemporary models of cardiovascular disease care do not provide opportunities to holistically assess the social burden of patients. In turn, this compromises the quality of care and worsens health inequalities," he said. Khurram Nasir, MD, MPH, MSc, of the Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center in Texas. Nasir is the corresponding author of the study.
Nasir added that "our results urge healthcare providers and policymakers to develop new care delivery models that allow for greater assessment of SDOH to inform patient care, and to prioritize socially vulnerable populations in cardiovascular prevention programs to achieve the greatest population health benefits. Strong political will and partnerships are needed between health systems and community stakeholders to identify and address unfavorable SDOH, and alleviate the burden of obesity in underserved communities."
The researchers explain that limited empirical data has suggested correlations between individual SDOHs, such as education, income, neighborhood and food environment, and obesity. However, the link between SDOH and obesity has not been examined from the perspective of cumulative social disadvantage.
Data from nearly 165,000 adults ages 18 and older were used from the 2013-2017 National Health Survey, a cross-sectional household interview questionnaire conducted annually by the National Center for Health Statistics under the auspices of the Centers for Disease Control and Prevention. Disease Prevention.
- Overweight was defined as a body mass index (BMI) greater than 25 and less than 30, while obesity was defined as a BMI greater than or equal to 30 .
- Obesity was further classified into three classes (obesity class 1 and 2, BMI of 30 kg /m2 greater than 40) and obesity class 3 (BMI equal to or greater than 40) to further examine the association of SDOH and different obesity levels.
To operationalize the SDOH framework, the researchers adapted a model from the Kaiser Family Foundation. Individual SDOHs were grouped into six domains, including economic stability; the neighborhood, the physical environment and social cohesion; the community and social context; feeding; education and the health care system.
A total of 38 SDOHs were added to create a cumulative SDOH score, which was divided into four quartiles to denote SDOH loading levels. The prevalence of overweight and obesity was studied in SDOH quartiles in the total population and by age, sex, and race/ethnicity. Multinomial logistic regression models were used to analyze the association between SDOH quartiles and overweight/obesity, adjusting for relevant covariates.
The results showed that there was a gradual increase in the prevalence of obesity with increasing SDOH burden. In nearly all quartiles, rates of overweight and obesity were higher for non-Hispanic black, middle-aged adults compared with their white counterparts, and additional differences were observed by sex.
In the fully adjusted models, the fourth quartile of SDOH was associated with a 15%, 50%, and 70% higher relative prevalence of overweight, obesity class 1 and 2, and obesity class 3, respectively, relative to the quartile 1 from SDOH.
When social determinants of health are poor, there is an increased risk of overweight and obesity.
The study authors note that future studies should evaluate the relationship between SDOH and obesity with longitudinal study designs. New research must also create data-matching platforms that allow self-reported data to be cross-referenced with medical data. Future studies should also include modeling the cumulative impact of multiple SDOHs considering additional methodological approaches such as machine learning algorithms.
"It is crucial that we address the social determinants of health if we are to begin treating the complex multifactorial disease that is obesity. When the social determinants of health are poor, there is an increased risk of overweight and obesity. Therefore, this study supports our need to address equity and access to SDOH to improve overweight and obesity in the United States and around the world," said Fatima Cody Stanford, MD, MPH, MPA, MBA, FTOS, a physician-scientist. of obesity medicine at Massachusetts General Hospital and Harvard Medical School in Boston, Mass. She is TOS’s advisor for advocacy, public affairs, and regulation. Stanford has not participated in the research.
