Health Equity| Volume 33, ISSUE 2, P153-159, March 2023

Racism-Related Experiences and Adiposity: Findings From the Black Women's Experiences Living With Lupus (BeWELL) Study

Published:October 29, 2022DOI:



      Studies suggest that higher rates of excess adiposity in Black women may in part be driven by experiences of racism. Racial microaggressions, which include unintentional and subtle slights and insults, and responses to racism such as racism-related vigilance, may contribute to adiposity in this population. This study examined these understudied racism-related facets as well as interpersonal racial discrimination in relation to adiposity in a cohort of Black women with systemic lupus erythematosus.


      Data are from the Black Women's Experiences Living with Lupus (BeWELL) Study (2015–2017; n = 432). Linear regression was used to examine adiposity measures (body mass index [BMI], percent body fat, and waist-to-hip ratio), measured during a physical examination, in relation to self-reported measures of racial microaggressions, racism-related vigilance, and interpersonal racial discrimination.


      Compared with infrequent microaggressions, very frequent experiences of microaggressions were associated with 2.9 kg/m2 higher BMI (95% confidence [CI], 0.63–5.21) and 2.6% higher body fat (95% CI, 0.32–4.80) after adjusting for covariates. Racism-related vigilance, measured continuously, was positively associated with BMI (b = 0.84; 95% CI–0.08, 1.61) and percent body fat (b = 0.89; 95% CI, 0.14–1.64). Very frequent experiences of everyday discrimination were associated with a higher BMI (b = 2.70; 95% CI, 0.58–4.83) and waist-to-hip ratio (b = 0.32; 95% CI, 0.09–0.55) compared with less frequent everyday discrimination.


      Our results suggest that various dimensions of racism are associated with excess adiposity. Efforts to address obesity among Black women with systemic lupus erythematosus should consider these multiple aspects to decrease racial inequities in adiposity.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Angel R.
        • Burton L.
        • Chase-Lansdale P.
        • Cherlin A.
        • Moffitt R.
        Welfare, Children, and Families: A Three-City Study.
        Inter-University Consortium for Political and Social Research, Ann Arbor, MI2012
        • Beatty Moody D.L.
        • Brown C.
        • Matthews K.A.
        • Bromberger J.T.
        Everyday discrimination prospectively predicts inflammation across 7-years in racially diverse midlife women: Study of women’s health across the nation.
        Journal of Social Issues. 2014; 70: 298-314
        • Bernardo C. de O.
        • Bastos J.L.
        • González-Chica D.A.
        • Peres M.A.
        • Paradies Y.C.
        Interpersonal discrimination and markers of adiposity in longitudinal studies: A systematic review.
        Obesity Reviews. 2017; 18: 1040-1049
        • Boggs D.A.
        • Rosenberg L.
        • Cozier Y.C.
        • Wise L.A.
        • Coogan P.F.
        • Ruiz-Narvaez E.A.
        • Palmer J.R.
        General and abdominal obesity and risk of death among black women.
        New England Journal of Medicine. 2011; 365: 901-908
        • Bower K.M.
        • Thorpe R.J.
        • Yenokyan G.
        • McGinty E.E.E.
        • Dubay L.
        • Gaskin D.J.
        Racial residential segregation and disparities in obesity among women.
        Journal of Urban Health. 2015; 92: 843-852
        • Cao Q.
        • Yu S.
        • Xiong W.
        • Li Y.
        • Li H.
        • Li J.
        • Li F.
        Waist-hip ratio as a predictor of myocardial infarction risk.
        Medicine. 2018; 97: e11639
        • Centers for Disease Control and Prevention (CDC)
        Media statement from CDC Director Rochelle P. Walensky, MD, MPH, on racism and halth [Press Release].
        • Chae D.H.
        • Martz C.D.
        • Fuller-Rowell T.E.
        • Spears E.C.
        • Smith T.T.G.
        • Hunter E.A.
        • Lim S.S.
        Racial discrimination, disease activity, and organ damage: The Black Women’s Experiences Living with Lupus (BeWELL) Study.
        American Journal of Epidemiology. 2019; 188: 1434-1443
        • Clark R.
        • Benkert R.A.
        • Flack J.M.
        Large arterial elasticity varies as a function of gender and racism-related vigilance in Black youth.
        Journal of Adolescent Health. 2006; 39: 562-569
        • Cozier Y.C.
        • Wise L.A.
        • Palmer J.R.
        • Rosenberg L.
        Perceived racism in relation to weight change in the Black Women’s Health Study.
        Annals of Epidemiology. 2009; 19: 379-387
        • Cozier Y.C.
        • Yu J.
        • Coogan P.F.
        • Bethea T.N.
        • Rosenberg L.
        • Palmer J.R.
        Racism, segregation, and risk of obesity in the black women’s health study.
        American Journal of Epidemiology. 2014; 179: 875-883
        • Drenkard C.
        • Bao G.
        • Dennis G.
        • Kan H.J.
        • Jhingran P.M.
        • Molta C.T.
        • Lim S.S.
        Burden of systemic lupus erythematosus on employment and work productivity: Data from a large cohort in the southeastern United States.
        Arthritis Care and Research. 2014; 66: 878-887
        • Eudy A.M.
        • Vines A.I.
        • Dooley M.A.
        • Cooper G.S.
        • Parks C.G.
        Elevated C-reactive protein and self-reported disease activity in systemic lupus erythematosus.
        Lupus. 2014; 23: 1460-1467
        • Flegal K.M.
        • Kit B.K.
        • Orpana H.
        Association of all-cause mortality with overweight and obesity using standard body mass index categories.
        Journal of the American Medical Association. 2013; 309: 71-82
        • Hales C.M.
        • Carroll M.D.
        • Fryar C.D.
        • Ogden C.L.
        Prevalence of obesity and severe obesity among adults, 2017–2018.
        NCHS Data Brief. 2020; 360: 1-7
        • Hall J.M.
        • Fields B.
        “It’s killing us!” Narratives of Black adults about microaggression experiences and related health stress.
        Global Qualitative Nursing Research. 2015; 2 (233339361559156)
        • Hicken M.T.
        • Lee H.
        • Hing A.K.
        The weight of racism: Vigilance and racial inequalities in weight-related measures.
        Social Science and Medicine. 2018; 199: 157-166
        • Hunter E.A.
        • Spears E.C.
        • Martz C.D.
        • Chung K.
        • Fuller-Rowell T.E.
        • Lim S.S.
        • Chae D.H.
        Racism-related stress and psychological distress: Black Women’s Experiences Living with Lupus study.
        Journal of Health Psychology. 2020; 26: 2374-2389
        • Karlson E.W.
        • Daltroy L.H.
        • Rivest C.
        • Ramsey-Goldman R.
        • Wright E.A.
        • Partridge A.J.
        • Fortin P.R.
        Validation of a Systemic Lupus Activity Questionnaire (SLAQ) for population studies.
        Lupus. 2003; 12: 280-286
        • Katz P.
        • Yazdany J.
        • Julian L.
        • Trupin L.
        • Margaretten M.
        • Yelin E.
        • Criswell L.A.
        Impact of obesity on functioning among women with systemic lupus erythematosus.
        Arthritis Care and Research. 2011; 63: 1357-1364
        • Kershaw K.N.
        • Albrecht S.S.
        • Carnethon M.R.
        Racial and ethnic residential segregation, the neighborhood socioeconomic environment, and obesity among blacks and Mexican Americans.
        American Journal of Epidemiology. 2013; 177: 299-309
        • Krishnan E.
        • Hubert H.B.
        Ethnicity and mortality from systemic lupus erythematosus in the US.
        Annals of the Rheumatic Diseases. 2006; 65: 1500-1505
        • Krishnan S.
        • Rosenberg L.
        • Djoussé L.
        • Cupples L.A.
        • Palmer J.R.
        Overall and central obesity and risk of type 2 diabetes in U.S. Black women.
        Obesity. 2007; 15: 1860-1866
        • Lee A.K.
        • Corneille M.A.
        • Hall N.M.
        • Yancu C.N.
        • Myers M.
        The stressors of being young and Black: Cardiovascular health and Black young adults.
        Psychology and Health. 2016; 31: 578-591
        • Lee H.
        • Hicken M.T.
        Death by a thousand cuts: The health implications of Black respectability politics.
        Souls. 2016; 18: 421-445
        • Lewis J.A.
        • Mendenhall R.
        • Harwood S.A.
        • Browne Huntt M.
        “Ain’t I a Woman?”: Perceived gendered racial microaggressions experienced by Black women.
        Counseling Psychologist. 2016; 44: 758-780
        • Lewis T.T.
        • Cogburn C.D.
        • Williams D.R.
        Self-reported experiences of discrimination and health: Scientific advances, ongoing controversies, and emerging issues.
        Annual Review of Clinical Psychology. 2015; 11: 407-440
        • Lim S.S.
        • Bayakly A.R.
        • Helmick C.G.
        • Gordon C.
        • Easley K.A.
        • Drenkard C.
        The incidence and prevalence of systemic lupus erythematosus, 2002-2004: The Georgia Lupus Registry.
        Arthritis and Rheumatology. 2014; 66: 357-368
        • Lim S.S.
        • Drenkard C.
        Epidemiology of systemic lupus erythematosus: Capturing the butterfly.
        Current Rheumatology Reports. 2008; 10: 265-272
        • Manns-James L.
        • Anthony M.K.
        • Neal-Barnett A.
        Racial discrimination, racial identity, and obesity in collegiate African American Women.
        Journal of Racial and Ethnic Health Disparities. 2020; 8: 1217-1231
        • Martz C.D.
        • Allen A.M.
        • Fuller-Rowell T.E.
        • Spears E.C.
        • Hunter E.A.
        • Lim S.S.
        • Chae D.H.
        Vicarious racism stress and disease activity: The Black Women’s Experiences Living with Lupus (BeWELL) Study.
        Journal of Racial and Ethnic Health Disparities. 2019; 6: 1044-1051
        • Moody A.T.
        • Lewis J.A.
        Gendered racial microaggressions and traumatic stress symptoms among Black women.
        Psychology of Women Quarterly. 2019; 43: 201-214
        • Nadal K.L.
        • Erazo T.
        • King R.
        Challenging definitions of psychological trauma: Connecting racial microaggressions and traumatic stress.
        Journal for Social Action in Counseling and Psychology. 2019; 11: 2-16
        • Nadal K.L.
        • Griffin K.E.
        • Wong Y.
        • Hamit S.
        • Rasmus M.
        The impact of racial microaggressions on mental health: Counseling implications for clients of color.
        Journal of Counseling and Development. 2014; 92: 57-66
        • National Center for Health Statistics
        Multiple imputation of family income and personal earnings in the National Health Interview Survey: Methods and examples.
        Author, Hyatesville, MD2015
        • O’Keefe V.M.
        • Wingate L.R.
        • Cole A.B.
        • Hollingsworth D.W.
        • Tucker R.P.
        Seemingly harmless racial communications are not so harmless: Racial microaggressions lead to suicidal ideation by way of depression symptoms.
        Suicide and Life-Threatening Behavior. 2015; 45: 567-576
        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • Flegal K.M.
        Prevalence of childhood and adult obesity in the United States, 2011-2012.
        JAMA. 2014; 311: 806-814
        • Patterson S.L.
        • Schmajuk G.
        • Jafri K.
        • Yazdany J.
        • Katz P.
        Obesity is independently associated with worse patient-reported outcomes in women with systemic lupus erythematosus.
        Arthritis Care and Research. 2019; 71: 126-133
        • Plantinga L.
        • Lim S.S.
        • Patzer R.
        • McClellan W.
        • Kramer M.
        • Klein M.
        • Drenkard C.
        Incidence of end-stage renal disease among newly diagnosed systemic lupus erythematosus patients: The Georgia Lupus Registry.
        Arthritis Care and Research. 2016; 68: 357-365
        • Pool L.R.
        • Carnethon M.R.
        • Goff D.C.
        • Gordon-Larsen P.
        • Robinson W.R.
        • Kershaw K.N.
        Longitudinal associations of neighborhood-level racial residential segregation with obesity among Blacks.
        Epidemiology. 2018; 29: 207-214
        • Powell L.R.
        • Jesdale W.M.
        • Lemon S.C.
        On edge: The impact of race-related vigilance on obesity status in African-Americans.
        Obesity Science & Practice. 2016; 2: 136-143
        • Puhl R.M.
        • Andreyeva T.
        • Brownell K.D.
        Perceptions of weight discrimination: Prevalence and comparison to race and gender discrimination in America.
        International Journal of Obesity. 2008; 32: 992-1000
        • Rhew E.Y.
        • Manzi S.M.
        • Dyer A.R.
        • Kao A.H.
        • Danchenko N.
        • Barinas-Mitchell E.
        • Ramsey-Goldman R.
        Differences in subclinical cardiovascular disease between African American and Caucasian women with systemic lupus erythematosus.
        Translational Research. 2009; 153: 51-59
        • Shin C.N.
        • Soltero E.
        • Mama S.K.
        • Sunseri C.
        • Lee R.E.
        Association of discrimination and stress with cardiometabolic risk factors in ethnic minority women.
        Clinical Nursing Research. 2017; 26: 694-712
        • Su D.L.
        • Lu Z.M.
        • Shen M.N.
        • Li X.
        • Sun L.Y.
        Roles of pro- and anti-inflammatory cytokines in the pathogenesis of SLE.
        Journal of Biomedicine and Biotechnology. 2012; 2012: 347141
        • Sue D.W.
        • Capodilupo C.M.
        • Holder A.M.B.
        Racial microaggressions in the life experience of Black Americans.
        Professional Psychology: Research and Practice. 2008; 39: 329-336
        • Sue D.W.
        • Capodilupo C.M.
        • Torino G.C.
        • Bucceri J.M.
        • Holder A.M.B.
        • Nadal K.L.
        • Esquilin M.
        Racial microaggressions in everyday life: Implications for clinical practice.
        American Psychologist. 2007; 62: 271-286
        • Teh P.
        • Zakhary B.
        • Sandhu V.K.
        The impact of obesity on SLE disease activity: Findings from the Southern California Lupus Registry (SCOLR).
        Clinical Rheumatology. 2019; 38: 597-600
        • Williams D.R.
        • Lawrence J.A.
        • Davis B.A.
        • Vu C.
        Understanding how discrimination can affect health.
        Health Services Research. 2019; 54: 1374-1388
        • Williams D.R.
        • Mohammed S.A.
        Racism and health I: Pathways and scientific evidence.
        American Behavioral Scientist. 2013; 57: 1152-1173
        • Williams D.R.
        • Yu Y.
        • Jackson J.S.
        • Anderson N.B.
        Racial differences in physical and mental health: Socioeconomic status, stress and discrimination.
        Journal of Health Psychology. 1997; 2: 335-351
        • Yazdany J.
        • Trupin L.
        • Gansky S.A.
        • Dall’era M.
        • Yelin E.H.
        • Criswell L.A.
        • Katz P.P.
        Brief Index of Lupus damage: A patient-reported measure of damage in systemic lupus erythematosus.
        Arthritis Care and Research. 2011; 63: 1170-1177
        • Yelin E.
        • Yazdany J.
        • Trupin L.
        Relationship between poverty and mortality in systemic lupus erythematosus.
        Arthritis Care and Research. 2018; 70: 1101-1106


      Nicole D. Fields, PhD, MPH, received her PhD in Epidemiology from the University of Massachusetts Amherst. She is a postdoctoral fellow at Rollins School of Public Health at Emory University. Her research examines social determinants and cardiometabolic disorders in marginalized populations.


      Nicole A. VanKim, PhD, MPH, is an Assistant Professor in the Department of Epidemiology at the University of Massachusetts Amherst. Her research focuses on sexual orientation- and gender-based disparities in weight-related health behaviors and outcomes.


      Brian W. Whitcomb, PhD, is Professor of Epidemiology at the University of Massachusetts Amherst. His research focuses on environmental/molecular influences of reproductive health, and epidemiologic methods for causal inference from biomarker data.


      Elizabeth Bertone-Johnson, ScD, is Professor of Epidemiology and Chair of the Department of Health Promotion and Policy at the University of Massachusetts Amherst. She conducts research in women's mental and reproductive health.


      Airín D. Martínez, PhD, is an Assistant Professor in the Department of Health Promotion and Policy at the University of Massachusetts Amherst. Her interdisciplinary research uses mixed methods to examine how structural and institutional racism produce cardiometabolic risk primarily in Latinx persons.


      David H. Chae, ScD, is an Associate Professor, Director of the Society, Health, and Racial Equity (SHARE) Lab, and Associate Dean for Research at Tulane University, School of Public Health and Tropical Medicine. His research focuses on social determinants and embodiment of racism.