The Social Determinants of Obesity.

Abstract

Obesity has become a major social and public health concern in the United States. The risk for obesity is not evenly distributed across racial/ethnic and socioeconomic groups and we know little about how obesity risk differs according to experiences in important life settings or how experiences accumulate over the life course to influence adult obesity. This dissertation begins by documenting how social disparities in body mass index (BMI) trajectories have changed in the U.S. population during a time of rapid growth in obesity rates. Drawing on intersectionality theory, I examine the multiple and interactive effects of inequality and find increasing racial and socioeconomic disparities in BMI trajectories over time, particularly among the youngest adults, such that black women with medium to high education and low to medium income levels experienced substantially larger increases in BMI over time, while white men with high education or high income levels experienced the least growth. I then investigate the relationship between early-life socioeconomic position (SEP) and adult BMI trajectories and determine which theoretical models of life course processes best explain how early-life SEP comes to influence adult BMI. I find enduring effects of early-life SEP that are heavily mediated by adult characteristics and some evidence that racial/ethnic inequality in BMI is anchored in experiences in early-life, though life course SEP did not fully account for black/white differences in BMI trajectories. I also find that socioeconomic disadvantage accumulates over the life course and that early-life disadvantage in combination with adult disadvantage results in significantly higher BMI. In the third analytic chapter, I examine differences in BMI by different types of relationship change over time and different levels of relationship quality (i.e., stress and social support). I find that people who are continuously in a relationship have higher BMI than those who remain single and that entering a relationship is associated with a subsequent increase in BMI while exiting a relationship is associated with a decrease in BMI. I also find that BMI increases more for those individuals who are in stressful relationships.