An Intersectionality Approach to Interrelations among Body Mass Index, Sex, Ethnic Identity, and Discrimination among African Americans

Abstract

African Americans are disproportionately impacted by obesity and also face widespread discrimination due to the United StatesÕ history of enslavement, colonization, and oppression. However, little research has examined how greater body size relates to discrimination among African Americans. Employing an intersectionality approach, the current study examined potential interactive relations of body mass index (BMI), sex, and ethnic identity to discrimination using data from 1,123 socioeconomically diverse African American participants (mean age = 48.54 years, 54% female, 60% living below poverty) in the Healthy Aging in Neighborhoods of Diversity across the Life Span epidemiological cohort study. BMI was computed from measures height and weight; ethnic identity was assessed by the Multigroup Ethnic Identity Measure-Revised; discrimination was assessed by the Everyday Discrimination Scale, The Experiences of Discrimination Ð Index Racial and Gender, Lifetime discrimination burden and Discrimination across multiple social statuses; and biological sex was recorded during medical examination. Using a model construction approach, multivariable regression analyses were conducted to examine independent and interactive relation of BMI, sex, and ethnic identity to multiple forms of discrimination. Further analyses examined whether poverty status moderated these associations. Lastly, sensitivity analyses were conducted to determine if significant findings withstood statistical adjustment for depressive symptomatology. Contrary to our hypotheses, results revealed no significant main effects of BMI; two-way interactions of BMI*sex; three-way interactions of BMI*sex*ethnic identity; or four-way interactions of BMI*sex*ethnic identity*poverty status to any of our discrimination outcomes. Unexpected findings included a significant two-way interaction of BMI*ethnic identity to Discrimination across social statuses, such that at higher levels of ethnic identity, lower BMI was associated with greater discrimination and significant two-way interactions of sex*ethnic identity to Experiences of Discrimination Ð Gender and Experiences of Discrimination Ð Racial, such that lower levels of ethnic identity were associated with greater discrimination for African American men rather than women. Lastly, significant main effects of poverty status indicated that living below the poverty line was associated with greater Discrimination across social statuses and Lifetime discrimination. All significant models withstood adjustment for depression. The lack of confirmation of our hypotheses underscores the limitations of generalizing prior research mostly from White participant studies to African American samples and suggests the potential importance of including alternative culturally appropriate variables (i.e., colorism, shapeliness, body size ideals) in future explicit examinations of weight-related discrimination. Our ancillary finding that low levels of ethnic identity were associated with higher discrimination (across social statuses) in African American men but not women, suggests an unexpected sex difference such that higher ethnic identity may be protective in men. The association of high levels of ethnic identity with greater racial and gender discrimination at lower BMI, irrespective of sex, may reflect negative connotations of lower body weight. These may include lower body weight being connotated as a physical manifestation of poverty, substance use, and/or HIV/AIDS, all of which may contribute to the endorsement of larger body size ideals among African Americans. Examination of additional social categories such as gender identity, sexual orientation, ableism, etc. may be critical in future investigations that examine the role of intersectionality in the experience of weight-related discrimination among African Americans.