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Outcomes Research

Where You Live Might Influence Your Weight

Houston Methodist researchers reveal a connection between socioeconomic deprivation and body mass index.

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For decades, where a person lives has been known to affect health outcomes. Studies have found the lack of green spaces, living in a food desert – more than one mile in an urban area from a full-service grocery store—surrounded by fast-food businesses, convenience stores and other social determinants of health and social deprivations are strongly associated with disease, including hypertension, cardiovascular disease, obesity and diabetes. Obesity, which can lead to hypertension, cardiovascular disease and diabetes, is a disease that is preventable in some cases, and can be linked to environmental factors.
In a recently published study, Houston Methodist researchers noted that morbid obesity accounts for approximately 20% of total healthcare costs but existing literature written about the disease fails to focus on morbid obesity, despite marked differences in disease burden and healthcare costs. The study examined the relationship between available measures of social determinants of health in health systems, such as Area Deprivation Index (ADI) and morbid obesity in the Houston Methodist patient population.
Nwabunie Nwana, PhD, MPH
The authors reviewed ADI, a validated measure of socioeconomic deprivation, and morbid obesity. Using a cross-section of adult patients, researchers calculated Body Mass Index (BMI) to examine the association between morbid obesity and ADI. Using geospatial mapping, they discovered that areas with higher ADI were more likely to include patients with morbid obesity. In other words, patients who lived in neighborhoods that were more impoverished had higher odds of being morbidly obese.
Patients, who lived in neighborhoods where socioeconomic disadvantages influence an abundance of low-cost, high-calorie foods and little opportunity for outdoor activities, appear to be on a causal pathway to the influence of obesity compared to their counterparts in more affluent neighborhoods.
“We know that the living environment, such as low-income regions, lack access to proper grocery stores. Instead, there are only convenience stores and gas stations. Impoverished environments usually don’t have amenities that promote healthy living and healthy eating,” said Nwabunie Nwana, PhD, MPH, and author of study. “We wanted to utilize variables, look at the ADI and BMI matrix, and see if there was a trend where patients who live in poorer neighborhoods were more likely to be morbidly obese. We wanted to see what the association is between ADI and socioeconomic classes.”
The study included 751,174 adult patients with an average age of 52. The study found the strongest association between ADI and morbid obesity was greater among Hispanic patients, followed by white and black patients. Females were more likely to be morbidly obese, and patients between 18-39 and 40-64 were more strongly associated with ADI and morbid obesity.
Once we know where these patients, clinically, we can perform work on the front end at the doctor's office, but will it be sustainable? Have we shifted the burden to the clinician as opposed to policies that the government should be improving in these areas?
Nwabunie Nwana, PhD, MPH
Outcomes, Quality & Health Care Performance Research
The data also confirmed there was a higher prevalence of patients with a higher BMI as ADI increased in the total population, and across age, sex and race/ethnicity subgroups. The authors also noted that while the use of ADI in health outcomes is becoming more common, the understanding of how neighborhood deprivation relates to body weight is still elusive in the literature. This study clearly describes the characteristics and prevalence of all BMI categories in relation to ADI and focuses on an understudied population — patients with morbid obesity. The evidence obtained in this study shows a relationship between BMI and ADI.
“The findings are very informative for food policy makers to begin the discourse on how we can tailor resources to enrich these underserved neighborhoods, such as adding amenities and infrastructure that will allow these patients to adopt a healthier lifestyle that would inherently benefit their BMI status,” said Nwana.
Nwana sees this information being incorporated into a two-fold intervention involving both physicians and policymakers.
“Clinically, we understand that this social determinant is affecting our patients’ health and how to connect them to community resources or even social workers in the hospital system to help them access healthier foods,” she said. “But beyond that intervention, from a policy standpoint, something needs to be done in the communities to really improve the living conditions. Through this twofold intervention, I believe we would really see positive results.”
Nwana, N., Taha, M. B., Javed, Z., Gullapelli, R., Nicolas, J. C., Jones, S. L., Acquah, I., Khan, S., Satish, P., Mahajan, S., Cainzos-Achirica, M., & Nasir, K. (2023). Neighborhood deprivation and morbid obesity: Insights from the Houston Methodist Cardiovascular Disease Health System Learning Registry. Preventive Medicine Reports, 31, [102100].
Erin Graham
November 2023
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