Mental Health, Obesity, and Racial Disparities
Last year for Mental Health Awareness Month we discussed the intersections of mental health, obesity, and the COVID-19 pandemic. Then, we were focused on the ways lockdowns were affecting mental health. Now, many are dealing with reentry anxiety, as pandemic restrictions are removed and vaccinated individuals are allowed to socialize indoors and outdoors without masks.
As we approach the end of pandemic lockdowns, it is becoming clear that the pandemic has affected the mental and physical health of many, and that not all populations have been affected equally. Data from the Children’s Hospital of Philadelphia suggest that childhood obesity rates have risen during the pandemic, especially for Black and Hispanic youth, widening pre-pandemic disparities. For adults, racial disparities exist both for obesity prevalence and obesity care. Disparities in health care, housing, employment, access to healthful affordable food and opportunities for physical activity caused by centuries of discrimination have contributed to poor health in racial and ethnic minority communities and these have been exacerbated during the COVID-19 pandemic.
For many of us, the pandemic has been a time of extreme stress. Health anxiety, social isolation, financial insecurity, and uncertainty about the future have added to the everyday stress that many of us face. For members of populations most vulnerable to severe COVID-19 illness, like Black or Hispanic Americans and those with obesity, this time has been especially stressful. Experiencing multiple stressful life events has been associated with higher waist circumference, which can indicate that an individual is at risk for obesity-related diseases. Long-term cortisol levels, which can be the result of chronic stress, are also related to abdominal obesity. Those who take medication for mental illness may be at risk for obesity as well. Many psychiatric medications can cause weight gain, including mood stabilizers, anti-depressants, and anti-psychotics.
For some of us, the everyday stressors of the pandemic have been worsened by racism and discrimination. Daily experiences of racism can put Black Americans at risk for poor mental health and many lack access to psychological care. In addition to stress from the pandemic, Black Americans have dealt with the trauma associated with police violence; reported rates of anxiety and depression in the Black community increased dramatically following the release of the video of George Floyd’s death. The Asian American and Pacific Islander (AAPI) community has also suffered during the pandemic, with coronavirus-related racism taking a mental health toll on many.
Weight bias has also taken its toll on mental health during the pandemic. In healthcare, both racism and weight bias can prevent patients from receiving the care they need. Recently, a podcast on systemic racism from the Journal of the American Medical Association (JAMA) made waves when it questioned whether racism actually exists in healthcare. Unfortunately, we see that it does, even in obesity care. Body mass index (BMI), often used to diagnose obesity, is an imperfect indicator that does not measure body composition or health. The American Heart Association recommends that providers use waist circumference in addition to BMI, as well as gauge cardiovascular disease risk for individual patients.
This Mental Health Awareness Month we need to commit to being anti-racist and combatting weight bias. For those who are struggling with mental health, the Substance Abuse and Mental Health Services Administration (SAMHSA) is offering a national helpline. The National Alliance on Mental Illness (NAMI) also provides many resources for those who are affected by mental illness.