Guest Post: Racism and Health Disparities in Black Americans

Today’s guest post comes from Sean Wharton, my friend and colleague from Toronto, well known to all of us working in obesity medicine.

Since the George Floyd incident in the United States, the entire world has taken greater account of instances of racism and discrimination in all walks of life.  Medicine is no different and it is therefore no surprise that much of medicine is steeped in racism.  Many people refer to this as the social determinants of health, but the structure and underlying reasons for those determinants, in many countries, is racism.  

In America, the remnant of slavery also lives on in the social determinants that drive the obesity epidemics in African Americans.  African American women have an incidence of obesity of 57%, compared to white women at 40%. This is 42% higher! 

This is a staggering difference. What accounts for this? 

We now have a greater understanding that most disparities in health, including hypertension, diabetes and obesity, are due to racial and ethnic inequities, many of which are a legacy of their past history.  

For obesity in African Americans, we can start by looking at the nutrition during slavery.  A slave’s diet was primarily made up of inexpensive foods that were high in sugar and fat, designed to provide fuel that would be burned off during the day. 

As reported historically slave rations could include:

10 quarts rice or peas

1 bushel sweet potatoes

2-3 mullet or mackerel salt fish

1 pint mollasses

2 pounds pork

Thus, African Americans became accustomed to this diet and continue to have a palate for such as evidenced by the menu in many Southern African American restaurants and homes.   

Today food choices for African American follow a similar pattern as in the times of slavery.  Foods – high starch, fat, sodium, cholesterol, and caloric content, and are inexpensive and often low-quality nature of the ingredients such as salted pork and cornmeal. 

This gives us some explanations regarding the disparity in the incidence of obesity between the races, and now we deal with the fact that there is are difference in success of obesity treatment between the races. Again this is likely due to the very same social determinants.  

Our own research has documented that women of colour lost less weight at weight management clinic, but when adjusted for the number of visits, the weight loss was the same.  

It was clear that the system was not built for women of colour to access the care. There was no biological difference, just a difference in access.

There is a lot of discussion regarding whether the reason for health disparities is biological or due to societal differences between races.  There is now considerable research that points to the fact that race is a social construct and determinants of health are based on racism and discrimination and not biology.  

Interestingly, as a recent example, the equation for adjustment in eGFR for renal failure, for Black people, has been removed by most labs as it has no scientific validity and does nothing apart from fueling racism.  Remember also, the check box for the adjustment for renal function was Black or White, so what box would Barack Obama, or Beyonce check?

My hope is that the social determinants that define this dramatic differences in rates of obesity and success of obesity treatment will improve as we work to break down the walls of racism around the world.

Sean Wharton,
Toronto, Canada

About Sean Wharton:

Dr. Wharton has a doctorate in Pharmacy and Medicine from the University of Toronto and is the medical director of the Wharton Medical Clinic, a community based internal medicine weight management and diabetes clinic. He is an adjunct professor at McMaster University in Hamilton and York University in Toronto. He also academic staff at Women’s College Hospital, and clinical staff the Hamilton Health Sciences. Dr. Wharton’s research focuses on bariatric medicine and type 2 diabetes. He is the co-lead authour of the Canadian Obesity Guidelines. Apart from his interest in obesity medicine, Dr. Wharton is enthusiastically involved in activism to achieve health equity in Canada. In 2000, he founded the BMSA (Black Medical Students Association) at the University of Toronto, now recognized as a leading mentorship organization across Canada.