Racial and ethnic minorities experience disproportionately poorer health outcomes for almost all chronic diseases, especially heart disease, with obesity (abnormal or excessive fat) being a prominent trigger for these negative health outcomes.¹ A body mass index (BMI) over 25 is considered overweight, and over 30 is obese.²

Obesity increases morbidity and mortality in the Black community, and its related complications are major drivers of rising healthcare costs, diminished health-related quality of life, and the recent decline in U.S. life expectancy, with the greatest effect seen in Black communities.³

Clinical obesity has been directly linked to cardiovascular disease because it increases your risk of dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. All of these conditions alone are major independent risk factors for heart disease, which can lead to heart attack, amputation, and stroke. 

This article will cover how obesity increases heart disease risk in Black people.

BMI is a dated, flawed measure. It does not take into account factors such as body composition, ethnicity, sex, race, and age. Even though it is a biased measure, BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.

Race and Obesity

Four in 10 Americans, totaling about 100 million, are obese according to the Centers for Disease Control and Prevention (CDC). Among African-American adults, nearly half—48%—are clinically obese compared to 32.6% of White people.⁴

The Black community persistently experiences food insecurity at higher rates than the White community and faces added social, economic, and environmental challenges. Years of systemic oppression have resulted in obesity rates that are higher than they’ve ever been in the Black community.

Black People and Obesity

According to the CDC and National Institutes of Health (NIH), more than 75% of the Black community is considered overweight or obese, with Black women experiencing even higher rates of obesity.⁵

As a result, 42% of the Black community has hypertension, and Black people are 30% more likely to die from heart disease than White people.⁶

Why Obesity Is a Risk Factor for Heart Disease

Black people who have obesity, compared to those with a healthy weight, are at increased risk for many serious diseases and health conditions that can increase the risk of heart disease, including:⁷

• High blood pressure (hypertension)
• High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (dyslipidemia)
• Type 2 diabetes
• Sleep disorders

How Does Obesity Increase Your Heart Disease Risk?

When you're obese, the body requires more blood to supply oxygen and nutrients, which causes an increase in blood pressure. An increase in blood pressure increases your risk of heart disease.⁷

Underlying Cause of Obesity Disparities

Obesity is a complex health condition resulting from a combination of behavioral, environmental, and genetic factors.

Many low-income Black communities have higher rates of unemployment and therefore, by proxy have:⁸

• Higher rates of physical inactivity
• Sedentary lifestyle
• Poor diet

To make matters worse, many Black people who live in urban environments that have a dearth of healthy food options—called food deserts—are targets of junk food marketing by fast-food companies.⁸

Risk Factors in Black People

There are several risk factors associated with obesity.

Risk factors can be alterable—that is, you can change them—such as your eating habits or exercise routine, or inalterable—unchanging—like your family history and genetics.

The following is a list of risk factors that are not specific to Black people but must certainly be considered by members of this community:¹⁰

• Lack of physical activity
• Unhealthy eating behaviors
• Lack of sleep
• High amounts of stress
• Sedentary lifestyle
• Lack of exercise
• Childhood inactivity (childhood obesity is at a crisis level in the United States, with Black communities having some of the highest rates in the country)
• Low socioeconomic status
• Living in an unsafe and impoverished neighborhood
• Living in a food desert (particularly an area with few grocery stores or healthy food options and a high number of fast-food restaurants)
• Exposure to chemicals known as obesogens can change hormones and increase fatty tissue in the body
• Family history and genetics. Research shows that obesity can run in families via a complex set of genes passed down from parents to their children, but the number of genes and the mechanism by which their DNA is associated with obesity have not been elucidated. 

Biological Sex and Obesity

Your biological sex also affects your obesity risk. In the United States, Black or Latinx people who are born female are more likely to be obese than Black or Latinx people who are born male.

Women are also more likely to have polycystic ovary syndrome (PCOS), an endocrine disorder that results in a hormonal imbalance that can affect fertility and lead to weight gain.⁵

A study found that Black people who identified as having a low family income, little to no education, or under-/unemployed were more likely to be obese. Receipt of public assistance was also strongly associated with obesity in Caribbean-Black men and women. Conversely, those who reported higher levels of income, education, occupation, or living in a residence within a neighborhood with a supermarket had lower rates of obesity.¹¹

Discussing Your Weight With a Healthcare Provider

Your weight should be a topic of discussion with your healthcare provider since it is an important indicator of overall health.

Finding a Trustworthy Healthcare Provider

Discussing your weight with a healthcare provider may be difficult for you for a myriad of reasons. Therefore, it is imperative that you seek out an empathic, equitable, and unbiased healthcare provider who will take the time and attention needed to address this issue, understanding that it may take some time to figure out a plan that works best for you.

Many Black people report that they are more likely to feel comfortable with Black healthcare providers and more likely to adhere to certain preventive measures delivered by Black healthcare providers.¹²

While Black healthcare providers are more likely to practice in underserved communities, often concentrated in urban areas, more rural areas may have few, if any.

As of 2024, 5.2% of physicians identified as Black despite Black Americans making up 14.1% of the U.S. population.¹² Fortunately, there are initiatives in place to increase this number, and websites like Blackdoctor.org and FindABlackDoctor.com have created search engines that help you find Black healthcare providers more easily. 

Prejudice in Health Care

Implicit bias—a type of prejudice in which racial stereotypes are formed without conscious intention—is often experienced by Black people, unbeknownst to the non-Black healthcare provider, which compromises care.

Black healthcare providers are more likely to provide culturally-specific care—listening to their patients' concerns and empathizing with their plights.¹³

For many Black people, finding a trustworthy healthcare provider is often centered around finding a Black healthcare provider. That alone raises the chances of getting the quality of care you need. A history of biased and substandard care from White healthcare providers is one reason why Black people are more trusting of Black healthcare providers.¹⁴

Questions to Ask

Knowing what questions to ask is a major factor in choosing the right healthcare provider. This helps set expectations, which ensures you will receive quality care.

Some questions you may want to ask your healthcare provider include:

• How much experience do you have in nutrition science and weight loss management?
• How do you approach weight-loss management?
• Do you work with a lot of people who experience obesity? What percentage is Black?
• What are my risk factors as a Black person who struggles with their weight?
• Is there anything I can do today to make sure I do not become obese or make my situation better?
• How do you ensure that all your patients receive culturally competent and culturally specific care?
• Do you meet after hours? Do you have an emergency contact number?
• I’m unsure if I am ready to make drastic changes today. How frequently do you meet with patients? How long are the visits?
• What are all my treatment options? 

An Integrative Treatment Approach

Understanding your risk factors for obesity is important in determining how you will either prevent or treat it.

The following are the components of an integrative approach that address the many factors that contribute to obesity risk.

Medication

Using medication to treat a medical condition—even deadly ones like obesity—is sometimes seen as taboo in the Black community, but research shows that using medication as prescribed by your healthcare provider to help manage your underlying health conditions is a great way to promote healing. 

There are a host of medications that can help you lose weight or curb weight gain. They usually work one of three ways:¹⁵

• You feel less hungry
• You feel full sooner
• Your body has a harder time absorbing fat from the foods you eat

Some common Food and Drug Administration (FDA)-approved medications prescribed to treat obesity include:¹⁵

• Xenical (orlistat)
• Qsymia (phentermine-topiramate)
• Contrave (naltrexone-bupropion)
• Saxenda (liraglutide)
• Wegovy (semaglutide)
• Imcivree (setmelanotide)
• Zepbound (tirzepatide)

Losing Weight At a Healthy Pace

The goal isn’t to lose all the weight as quickly as possible. Losing weight in a healthy way starts with meeting small achievable goals. Even modest weight loss of 5 to 10% can make a dramatic impact on your health, helping to improve blood sugar, blood pressure, and triglyceride levels.

Medication treatment is most effective when combined with lifestyle modifications and is best when used to meet new weight loss goals after first trying traditional lifestyle measures. Studies show that adding prescription weight management medications to your current weight loss plan can help you lose 10% or more of your starting weight, although results vary by medication and by person.¹⁶

Therapy 

You do not have to fight obesity alone, but some Black people might feel like they do. Stigma—and the forces that create the stigma—sometimes make it difficult for individuals to reach out to a trained health professional for help.

The Danger of Normalizing Obesity

Some people in the Black community have normalized obesity, justifying an unhealthy weight and lifestyle in the name of body positivity. While there is no place for fat-shaming, there is no place, either, for obesity-normalizing, because obesity is a risk factor for many chronic medical conditions.

Your healthcare provider may suggest behavioral therapy if you are struggling with your weight.

Research has shown that intensive behavioral therapy—a form of talk therapy—can help you lose weight and keep it off by helping you to re-imagine your eating and exercise habits.¹⁷

While therapy has been shown to be an effective weight management tool, it is no substitute for making lifestyle changes. 

Lifestyle 

Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction.

The following healthy habits may prevent obesity or lead to lifesaving weight loss, protecting your heart in the process:

• Regular exercise
• Eating a heart-healthy diet
• Never smoking and limiting alcohol
• Getting quality sleep

Stress Management 

High levels of stress are associated with poor health habits like late-night snacking, lack of exercise, a sedentary lifestyle, and smoking.

Limiting stress has immeasurable value in preventing obesity. 

Ways you can manage stress include:

• Taking breaks at work
• Talking to supportive friends
• Eating healthy
• Going for a run after work or school

The goal isn’t to avoid stress at all costs—that’s nearly impossible to do—but to find ways to address stressful situations in a healthy way and limit the amount of negative stress that you experience. Even more, working with a healthcare provider and/or a therapist can help you figure out the best treatment plan to meet your specific goals. 

Group Exercise

Group exercise sessions are a proven method to prevent obesity. Not only are you getting a vigorous workout, but often people form strong support groups.

Group exercise classes may include:

• Circuits
• Aquatic fitness
• Walking programs
• Low-impact workouts
• Stability ball workouts
• Indoor cycling
• Small-group training

Group exercise programs are even more effective when they're done with friends.

The reasoning behind the effectiveness of group workouts over individual workouts is that communal meetings keep people accountable, increasing commitment to a fitness routine. Also, people give each other a boost or a competitive edge. One study found that people were able to hold a plan for 27% longer when working out with a partner.¹⁸ Lastly, group workouts help you to diversify your workouts, making them less likely to become mundane and unenjoyable. 

Surgery

Prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery.⁷

Resources

The following national resources can be accessed by anyone who is seeking help managing their weight. The resources below provide Black-specific treatment and can connect you with Black providers:

• National Council on Aging’s (NCOA) 
• The Obesity Action Coalition (OAC) 
• STOP Obesity Alliance
• Obesity Care Advocacy Network (OCAN)
• African American Collaborative Obesity Research Network

There are many other local resources that can also be accessed from places like churches and community health centers.

Of note, OCAN’s initiative, the Obesity Care Now campaign, is leading the fight to modernize outdated policies that stigmatize obesity as a choice, rather than a complex chronic disease.

This network of health organizations is calling on Congress and the Biden administration to follow the science and address health inequities by providing evidence-based treatment options for the tens of millions of Americans who lack access to comprehensive obesity care.

Summary

Racial and ethnic minorities experience disproportionately poorer health outcomes for almost all chronic diseases, especially heart disease, with obesity being a major driver.

Obesity increases morbidity and mortality in the Black community, and its related complications are major drivers of rising healthcare costs, diminished health-related quality of life, and the recent decline in U.S. life expectancy, with a great effect seen in Black communities. 

A Word From Verywell 

The issue with being overweight is not simply aesthetics in terms of body shape and size. Obesity is a deadly condition that can put your health in serious jeopardy. Diabetes, high blood pressure, sleep apnea, kidney disease, and the development of certain types of cancer are just some of the medical obesity-related conditions that are disproportionately impacting the Black community. Even more, these conditions are curbing life expectancy for the first time in decades, leading society to confront the reality that people today may not live as long as their parents. 

If you are struggling with your weight, therapy and stress management are useful tools to curb obesity, but they are no substitute for making lifestyle changes. Preventing obesity, by making lifestyle decisions such as getting appropriate amounts of exercise and choosing foods that support your weight loss goals, is the most effective way to meet your long-term weight loss goals. 

Frequently Asked Questions

What’s the link between race and clinical obesity in America?

Black and Latinx populations have higher rates of obesity compared to White Americans, largely due to systemic inequalities that make it difficult for these groups to achieve their best health.¹ Obesity is admittedly complex and no one-size-fits-all approach will work for Black America, but the visual of the overweight older Black adult is far too common, and it rests on all members of society to support anti-obesity missions that aim to create a better life for the community.

What does being overweight do to the heart?

Being overweight puts you at a higher risk of developing conditions like high blood pressure or diabetes that can lead to heart disease. Obesity can also cause your heart to work hard. Obese individuals require more blood to supply oxygen and nutrients to their bodies which causes an increase in blood pressure. Over time this can lead to heart failure.¹⁰

SOURCES

1. Carnethon MR, Pu J, Howard G, et al. Cardiovascular health in African Americans: a scientific statement from the American Heart Association. Circulation. 2017;136(21). doi:10.1161/CIR.0000000000000534
2. WHO. Obesity.
3. Turkson‐Ocran RN, Nmezi NA, Botchway MO, et al. Comparison of cardiovascular disease risk factors among African immigrants and African Americans: an analysis of the 2010 to 2016 national health interview surveys. JAHA. 2020;9(5). doi:10.1161/JAHA.119.013220
4. Centers for Disease Control and Prevention. Adult obesity facts.
5. The Office of Minority Health. Obesity and African Americans.
6. The Office of Minority Health. Heart disease and African Americans.
7. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143(21). doi:10.1161/CIR.0000000000000973
8. Hilmers A, Hilmers DC, Dave J. Neighborhood disparities in access to healthy foods and their effects on environmental justice. Am J Public Health. 2012;102(9):1644-1654. doi:10.2105/AJPH.2012.300865
9. Dubowitz T, Dastidar MG, Troxel WM, et al. Food insecurity in a low-income, predominantly African American cohort following the COVID-19 pandemic. Am J Public Health. 2021;111(3):494-497. doi:10.2105/AJPH.2020.306041
10. National Institutes of Health. Overweight and obesity.
11. Barrington DS, James SA, Williams DR. Socioeconomic Correlates of Obesity in African-American and Caribbean-Black Men and Women. J Racial Ethn Health Disparities. 2021;8(2):422-432. doi:10.1007/s40615-020-00798-4
12. Association of American Medical Colleges. Diversity in medicine: facts and figures 2024.
13. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 2017;18(1):19. doi:10.1186/s12910-017-0179-8
14. Alsan M, Garrick O, Graziani G. Does diversity matter for health? Experimental evidence from Oakland. American Economic Review. 2019;109(12):4071-4111.
15. NIH. National Institute of Diabetes and Digestive and Kidney Diseases. Prescription medications to treat overweight & obesity.
16. Yanovski SZ, Yanovski JA. Progress in pharmacotherapy for obesity. JAMA. 2021;326(2):129. doi:10.1001/jama.2021.9486
17. Castelnuovo G, Pietrabissa G, Manzoni GM, et al. Cognitive behavioral therapy to aid weight loss in obese patients: current perspectives. Psychol Res Behav Manag. 2017;10:165-173. doi:10.2147/PRBM.S113278
18. Andersson MA, Christakis NA. Desire for weight loss, weight-related social contact, and body mass outcomes: social contact and desire for weight loss. Obesity. 2016;24(7):1434-1437. doi:10.1002/oby.21512

Chances are, if you have put on a few pounds, the cause is deeper than eating too much junk food or skipping one too many workouts. Chronic, low-grade inflammation that swells in the body is to blame for this gain. And the relationship is cyclical. Weight and inflammation go hand in hand, and working to maintain a healthy weight through diet, exercise, sleep, and stress management can help tame inflammatory markers as well.

Inflammation, however, comes in two varieties: acute and chronic. Most of us are accustomed to acute inflammation, such as after sustaining an injury. This temporary response doesn't serve as a catalyst for serious health conditions but actually protects the body.

Chronic inflammation manifests as a slow burn in the body. "Inflammation is designed so once your body needs some healing, inflammation rushes in, but it's only supposed to be short-term. Chronic inflammation is more subtle, and it's caused by irritation in the body," says Carolyn Williams, Ph.D., R.D., author of Meals That Heal. "And that may be environmental things, that may be food-related things, that may be stress, that may be lack of sleep. Just about any kind of irritation to the body can trigger subtle inflammation." Williams compares chronic inflammation to a fire in the body that will continue to grow without intervention. Research suggests that reducing chronic, low-grade inflammation may even be as crucial a component as diet and activity, Williams says. And the relationship goes both ways. "Among people who are overweight or obese, immune cells start to infiltrate that fatty tissue. That in itself is thought to be part of what drives that chronic inflammation," says Caroline Childs, a lecturer in nutritional sciences at the University of Southampton in the U.K. "So people who are overweight or obese may be more likely to be experiencing chronic inflammation. Whether that is causing them to gain weight or a result of having gained weight is a bit hard to unpick." A 2018 study in the journal Clinical Nutrition, for example, found that weight loss in people categorized as having obesity or being overweight "is a determinant factor for reducing the level of pro-inflammatory markers."

Leptin is one significant influence in this cyclical relationship between weight and inflammation. High levels of chronic inflammation can detrimentally increase leptin in the body. A hormone released from the body's fat cells, leptin communicates with the hypothalamus to regulate food intake and energy use. Since leptin comes from fat cells, it is directly related to body fat. Sometimes referred to as the "satiety hormone," leptin inhibits hunger and regulates the body's energy balance, which keeps you from feeling hungry when your body doesn't need any energy. Someone who has been categorized as having obesity, however, will have too much leptin in their blood, which can cause an aversion to the hormone in what is known as leptin resistance. This, in turn, makes the body want to keep eating. "So your body isn't getting proper feedback about appetite and when to stop eating and when you're satisfied," Williams says. Levels of leptin that result from weight loss can also increase appetite and cause more food cravings, which can make further weight loss more difficult. Excess leptin in individuals categorized as having obesity is considered a contributor to low-grade, chronic inflammation. This can lead to higher susceptibility to chronic conditions, such as cardiovascular disease, type 2 diabetes, and autoimmune diseases, such as rheumatoid arthritis. Leptin joins with weight and inflammation to form a damaging cycle.

Inflammation and weight gain also work together in influencing the body's insulin response. A 2018 study in the Journal of Clinical Investigation found that insulin resistance promotes body fat inflammation in mice. The researchers stated that there is a "chicken and egg" relationship between insulin resistance and inflammation in that having "obesity induces insulin resistance . . . which in turn promotes inflammation." This can increase the symptoms and severity of type 2 diabetes. "The problem is that they both fuel one another. Weight gain causes more insulin resistance, insulin resistance causes more weight gain, and then inflammation is at the root of all of them. It's almost like they're just cyclical and build on one another," Williams says.

Sudden or unexplained weight gain, however, might be caused by inflammation in the thyroid, a butterfly-shaped, hormone-secreting gland located at the front of the neck that influences metabolism, growth, development, and body temperature. When the thyroid gland becomes inflamed and produces too few hormones, this leads to hypothyroidism, and metabolism slows, causing sudden weight gain. "Your thyroid is going to control a lot of those hormones that affect your metabolism, so any time you have changes in your weight and changes in inflammation, they both alter your hormone fluctuations and the proper balance that all of those are supposed to be in," Williams says.

When it comes to losing weight and taming inflammation, your diet is a crucial factor. "An anti-inflammatory eating approach really benefits everyone, but it should definitely be a component of the way you eat if you're trying to lose weight," Williams says. So how can you ready your plate to fight back against inflammation? Add some color. This includes dark, leafy greens, such as spinach and kale, and vibrant fruits, such as tomatoes, berries, and oranges. Additionally, consider swapping red-meat proteins with lean picks, such as chicken and fatty fish, particularly salmon. "Oily fish or omega-3s are the best-understood anti-inflammatory foods," Childs says. "If, as individuals, we can aim toward eating oily fish once or twice a week, that would be beneficial." Not to fret if you're a vegetarian; Childs recommends algae as a plant-based source of these healthy omega-3s. To implement healthful carbohydrates, try using whole-grain bread for your sandwiches or whole-grain pasta with a low-sugar sauce.

Recent research highlights these anti-inflammatory foods as key factors in healthy weight management. A recent study in the European Journal of Nutrition, for example, examined the effect of a legume-based, low-calorie diet on inflammation in participants categorized as having overweight or obesity. The researchers found that consuming four servings of legumes per week reduced inflammatory markers and, therefore, improved metabolism in the subjects. Additionally, a 2014 review in the Journal of Agricultural and Food Chemistry discussed that eating whole fruits and whole fruit products has been shown to mitigate inflammatory markers in some studies. These foods also fall in line with the popularized Mediterranean diet, which emphasizes fruits, vegetables, whole grains, beans, legumes, herbs, and spices. It also highlights plant-based and lean proteins.

Childs acknowledges, however, that some healthy picks, such as salmon and kale, might not be financially accessible to everyone and recommends more affordable options, such as carrots, peas, and apples, to achieve the same anti-inflammatory benefits. All these whole foods have similar anti-inflammatory effects. "Focus on getting your calories from real foods," Williams emphasizes, also pointing toward low- and moderate-carb diets that target excess weight and inflammation. These foods and eating patterns can also help balance insulin and glucose levels.

And controlling weight and inflammation isn't just a matter of what you eat; other lifestyle changes have the same close relationship as food to weight loss. "What we're realizing is we tend to think weight is just related to food, but weight loss and inflammation, both are whole-body approaches," Williams says. Williams points to psychological aspects, such as sleep, stress, and exercise, as influences for weight control. Lack of shut-eye is one of the most common factors; the Centers for Disease Control and Prevention estimates that 35% of adults don't get enough sleep—at least 7 hours per night.

Though a revamped plate and lifestyle changes can decrease harmful inflammation in the body, you still need small amounts of acute inflammation, such as when you sprain your ankle. The goal is to avoid getting too much of a good thing. "A little bit in the right place is a good thing. We don't want to turn it off completely," says Childs. "I think the challenge is finding the right balance.