Study Results Link Social Determinants of Health to Increased Rates of Obesity

Limited empirical data from new study suggests correlations between obesity and individual SDOH, such as education level, food environment, income, and neighborhood.

Cumulative social disadvantage, as denoted by higher social determinants of health burden (SDOH), is associated with higher likelihood of obesity independent of clinical demographic factors, according to the results of a new study published in Obesity.

The population-based study is the first to examine this hypothesized association in a nationally representative sample of adults in the United States.

“Our findings call on health care providers and policymakers to develop novel care delivery models that allow for greater assessment of SDOH to inform patient care and prioritize socially vulnerable populations in cardiovascular prevention programs for greatest population health benefits,” Khurram Nasir, MD, MPH, MSc, from the division of cardiovascular prevention and wellness at the Houston Methodist DeBakey Heart and Vascular Center in Texas, said in a statement. “Strong political will and partnerships between health systems and community stakeholders are needed to identify and address unfavorable SDOH and alleviate the burden of obesity in underserved communities.”.

Investigators said that limited empirical data suggest correlations between obesity and individual SDOH, such as education level, food environment, income, and neighborhood.

However, the SDOH-obesity link has not been examined from an upstream cumulative social disadvantage standpoint.

Investigators collected data from nearly 165,000 adults who were used in the National Health Interview Survey between 2013 and 2017.

The survey is a cross-sectional household interview questionnaire conducted annually by the National Center for Health Statistics under the auspices of the CDC.

Overweight, in this study, was defined as a body mass index between 25 and 30, while obesity was defined as a BMI of 30 or above.

Additionally, obesity was further categorized into 3 classes: obesity class 1 and 2, 30 kg/m2 BMI greater than 40, and obesity class 3 was BMI equal to or greater than 40.

The classes were used to further examine the association of SDOH and different levels of obesity.

To operationalize the SDOH framework, investigators adapted a model by the Kaiser Family Foundation. Individual SDOH were grouped into 6 domains: community and social context;economic stability; education; food; health care system; and neighborhood, physical environment, and social cohesion.

A total of 38 SDOH were aggregated to create a cumulative SDOH score, which was divided into 4 quartiles to denote level of SDOH burden.

The prevalence of being obese or overweight were studied across SDOH quartiles in the total population and by age, ethnicity/race, and sex. Multinomial logistic regression models were used to analyze the association between SDOH quartiles and being obese or overweight, adjusting for relevant covariates.

The results showed that there was a graded increase in obesity prevalence with increasing SDOH burden. At nearly each quartile studied, rates of being obese and overweight were higher for middle-aged and non-Hispanic Black adults compared with their white counterparts. Additional differences were observed by sex.

In fully adjusted models, quartile 4 of SDOH was associated with about 15%, 50%, and 70% higher relative prevalence of overweight in obesity class 1 and 2, and obesity class 3, respectively. This was relative to quartile 1 of SDOH.

Futures studies are needed to assess the SDOH-obesity link with longitudinal study designs, investigators said.

New research also needs to build platforms for data crosstalk to allow cross-referencing self-reported and medically ascertained data.

Additionally, other future studies should include modeling the cumulative impact of multiple SDOH considering additional methodological approaches, such as machine-learning algorithms.


Social determinants of health associated with increased rates of obesity. EurekAlert. News release. January 27, 2022. Accessed February 1, 2022.