Decomposing Racial Disparities in Obesity Prevalence

Variations in Retail Food Environment
  • Chelsea R. Singleton
    Address correspondence to: Chelsea R. Singleton, PhD, MPH, Institute for Health Research and Policy, University of Illinois at Chicago, Westside Research Office Building 441, 1747 West Roosevelt Road, Chicago IL 60608
    Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
    Search for articles by this author
  • Olivia Affuso
    Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama

    Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, Alabama
    Search for articles by this author
  • Bisakha Sen
    Department of Healthcare Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama

    Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, Alabama
    Search for articles by this author
Published:October 21, 2015DOI:


      Racial disparities in obesity exist at the individual and community levels. Retail food environment has been hypothesized to be associated with racial disparities in obesity prevalence. This study aimed to quantify how much food environment measures explain racial disparities in obesity at the county level.


      Data from 2009 to 2010 on 3,135 U.S. counties were extracted from the U.S. Department of Agriculture Food Environment Atlas and the Behavioral Risk Factor Surveillance System and analyzed in 2013. Oaxaca–Blinder decomposition was used to quantify the portion of the gap in adult obesity prevalence observed between counties with a high and low proportion of African-American residents is explained by food environment measures (e.g., proximity to grocery stores, per capita fast-food restaurants). Counties were considered to have a high African-American population if the percentage of African-American residents was >13.1%, which represents the 2010 U.S. Census national estimate of percentage African-American citizens.


      There were 665 counties (21%) classified as a high African-American county. The total gap in mean adult obesity prevalence between high and low African-American counties was found to be 3.35 percentage points (32.98% vs 29.63%). Retail food environment measures explained 13.81% of the gap in mean age-adjusted adult obesity prevalence.


      Retail food environment explains a proportion of the gap in adult obesity prevalence observed between counties with a high proportion of African-American residents and counties with a low proportion of African-American residents.
      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 American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Fryar CD, Carroll MD, Ogden CL. Prevalence of overweight, obesity, and extreme obesity among adults: United States, trends 1960-1962 through 2009−2010. Published 2012. Accessed on August 15, 2014

        • Kenney M.
        • Wang J.
        • Iannotti R.
        Residency and racial/ethnic differences in weight status and lifestyle behaviors among U.S. youth.
        J Rural Health. 2014; 30: 89-100
        • Jackson C.L.
        • Szklo M.
        • Yeh H.C.
        • et al.
        Black-white disparities in overweight and obesity trends by educational attainment in the United States, 1997-2008.
        J Obes. 2013; 2013: 140743
        • Sharma S.
        • Malarcher A.
        • Giles W.
        • Myers G.
        Racial, ethnic and socioeconomic disparities in the clustering of cardiovascular disease risk factors.
        Ethn Disp. 2004; 14: 43-48
        • Wang Y.
        • Beydoun M.A.
        The obesity epidemic in the United States—gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis.
        Epidemiol Rev. 2007; 29: 6-28
        • Flegal K.M.
        • Carroll M.D.
        • Kit B.K.
        • Ogden C.L.
        Prevalence of obesity and trends in the distribution of body mass index among U.S. adults, 1999−2010.
        JAMA. 2012; 307: 491-497
        • Myers C.A.
        • Slack T.
        • Martin C.K.
        • Broyles S.T.
        • Heymsfied S.B.
        Regional disparities in obesity prevalence in the United States: a spatial regime analysis.
        Obesity (Silver Spring). 2015; 23: 481-487
        • Singh G.
        • Kogan M.
        • Van Dyck P.
        A multilevel analysis of state and regional disparities in childhood and adolescent obesity in the United States.
        J Community Health. 2008; 33: 90-102
        • Kumanyika S.K.
        Environmental influences on childhood obesity: ethnic and cultural influences in context.
        Physiol Behav. 2008; 94: 61-70
        • Zick C.
        • Smith K.
        • Fan J.
        • Brown B.
        • Yamada I.
        • Kowaleski-Jones L.
        Running to the store? The relationship between neighborhood environments and the risk of obesity.
        Soc Sci Med. 2009; 69: 1493-1500
        • Larson N.
        • Story M.
        • Nelson M.
        Neighborhood Environments: Disparities in Access to Healthy Foods in the U.S.
        Am J Prev Med. 2009; 36: 74-81
        • Ford P.B.
        • Dzeweltowski D.A.
        Disparities in obesity prevalence due to variation in the retail food environment: three testable hypotheses.
        Nutr Rev. 2008; 66: 216-228
        • Franco M.
        • Diez Roux A.
        • Glass T.
        • Caballero B.
        • Brancati F.
        Neighborhood characteristics and availability of healthy foods in Baltimore.
        Am J Prev Med. 2008; 35: 561-567
        • Baker E.
        • Schootman M.
        • Barnidge E.
        • Kelly C.
        The role of race and poverty in access to food that enable individuals to adhere to dietary guidelines.
        Prev Chronic Dis. 2006; 3: A76
        • Block J.
        • Scribner R.
        • DeSalvo K.
        Fast food, race/ethnicity, and income.
        Am J Prev Med. 2004; 27: 211-217
        • Galvez M.
        • Morland K.
        • Raines C.
        • et al.
        Race and food store availability in an inner-city neighborhood.
        Public Health Nutr. 2007; 11: 624-631
        • Neckerman K.
        • Bader M.
        • Richards C.
        • et al.
        Disparities in the food environments of New York City Public Schools.
        Am J Prev Med. 2010; 39: 195-202
        • Powell L.M.
        • Chaloupka F.J.
        • Bao Y.
        The availability of fast-food and full-service restaurants in the United States: associations with neighborhood characteristics.
        Am J Prev Med. 2007; 33: S240-S245
        • Powell L.M.
        • Slater S.
        • Mirtcheva D.
        • Bao Y.
        • Chaloupka F.
        Food store availability and neighborhood characteristics in the United States.
        Prev Med. 2006; 44: 189-195
        • Sharkey J.
        • Horel S.
        Neighborhood socioeconomic deprivation and minority composition are associated with better potential spatial access to the ground-truthed food environment in a large rural area.
        J Nutr. 2008; 138: 620-627
        • Richardson A.
        • Boone-Heinonen J.
        • Popkin B.
        • Gorden-Larsen P.
        Are neighbourhood food resources distributed inequitably by income and race in the USA? Epidemiological findings across the urban spectrum.
        BMJ Open. 2012; 2: e000698
        • Morland K.
        • Filomena S.
        Disparities in the availability of fruits and vegetables between racially segregated urban neighborhoods.
        Public Health Nutr. 2007; 10: 1481-1489
        • Morland K.
        • Wing S.
        • Diez Roux A.
        • Poole C.
        Neighborhood characteristics associated with the location of food stores and food service places.
        Am J Prev Med. 2002; 22: 23-29
        • Bodor J.N.
        • Rice J.C.
        • Farley T.A.
        • Swalm C.M.
        • Rose D.
        Disparities in food access: does aggregate availability of key foods from other stores offset the relative lack of supermarkets in African-American neighborhoods?.
        Prev Med. 2010; 51: 63-67
        • Drewnowski A.
        • Aggarwal A.
        • Hurvitz P.
        • Monsivais
        • Moudon A.
        Obesity and supermarket access: proximity or price?.
        Am J Public Health. 2012; 102: e74-e80
        • Michimi A.
        • Wimberly M.C.
        Associations of supermarket accessibility with obesity and fruit and vegetable consumption in the conterminous United States.
        Int J Health Geogr. 2010; 9: 49
        • Jilcott S.
        • Keyserling T.
        • Crawford T.
        • Mcguirt J.
        • Ammerman A.
        Examining associations among obesity and per capita farmers’ markets, grocery stores/supermarkets, and supercenters in U.S. counties.
        J Am Diet Assoc. 2011; 111: 567-572
        • Ahern M.
        • Brown C.
        • Dukas S.
        A national study of the association between food environments and county-level health outcomes.
        J Rural Health. 2011; 27: 367-379
        • Jilcott S.
        • Lui H.
        • Moore J.
        • Bethel J.
        • Wilson J.
        • Ammerman A.
        Commute times, food retail gaps, and body mass index in North Carolina counties.
        Prev Chronic Dis. 2010; 7: A107
        • Oka M.
        • Link C.
        • Kawachi I.
        Area-based variations in obesity are more than a function of the food and physical activity environment: area-based variations in obesity.
        J Urban Health. 2013; 90: 442-463
        • Sen B.
        Using the Oaxaca-Blinder decomposition as an empirical tool to analyze racial disparities in obesity.
        Obesity. 2014; 22: 1750-1755
        • Powell L.
        • Wada R.
        • Krauss R.
        • Wang Y.
        Ethnic disparities in adolescent body mass index in the United States: the role of parental socioeconomic status and economic contextual factors.
        Soc Sci Med. 2012; 75: 467-476
        • Chou S.
        • Grossman M.
        • Saffer H.
        An economic analysis of adult obesity: results from the Behavioral Risk Factor Surveillance System.
        J Health Econ. 2004; 23: 565-587
      2. U.S. Department of Agriculture Economic Research Service. Food Environment Atlas. USDA 2013. Accessed March 6, 2013.

        • Glanz K.
        • Hoelscher D.
        Increasing fruit and vegetable intake by changing environments, policy and pricing: restaurant-based research, strategies, and recommendations.
        Prev Med. 2004; 2: S88-S93
        • Story M.
        • Kaphingst K.
        • Robinson-O’Brien R.
        • Glanz K.
        Creating healthy food and eating environments: policy and environmental approaches.
        Annu Rev Public Health. 2008; 29: 253-272
        • Caspi C.E.
        • Kawachi I.
        • Subramanian S.V.
        • Adamkiewicz G.
        • Sorensen G.
        The relationship between diet and perceived and objected access to supermarkets among low-income housing residents.
        Soc Sci Med. 2012; 75: 125-1262
        • Jack D.
        • Neckerman K.
        • Schwartz-Soicher O.
        • et al.
        Socio-economic status, neighborhood food environments and consumption of fruits and vegetables in New York City.
        Public Health Nutr. 2013; 16: 1197-1205
        • Jones-Smith J.C.
        • Karter A.J.
        • Kelly M.
        • et al.
        Obesity and the food environment: income and ethnicity differences among people with diabetes.
        Diabetes Care. 2013; 36: 2697-2705