COVID-19 infection is significantly more dangerous for certain groups including older adults, immunocompromised people, and people with obesity.

As a person’s Body Mass Index (BMI) – a measure based on a person’s weight relative to their height – increases, their chance of severe COVID-19 infection rises sharply, too.

Loneke Blackman Carr, assistant professor of nutritional sciences in the College of Agriculture, Health and Natural Resources, saw an opportunity to shed light on the connections between race and obesity and the ramifications they have for health in the context of the COVID-19 pandemic.

“It made everybody vulnerable, especially if your health was not in tip-top shape,” Blackman Carr says. “We have to address that on a national level for everybody, because it is a public health threat. But it is even more threatening for those communities that experience obesity disparities.”

Obesity disproportionally affects Black communities. This is largely due to structural factors, such as the increased likelihood that Black individuals will live in areas where healthy food is scarce and unhealthy fast food is abundant.

This work ties in with Blackman Carr research expertise, which focuses on health disparities in obesity treatment and prevention. In particular, Blackman Carr studies the impact for Black women, who have the highest rate of obesity of any group in the U.S. Obesity among Black women is 60%, compared to 40% of the general adult population.

“Given my area of work, it was very clear there was a connection between obesity and COVID-19,” Blackman Carr says. “So, it seemed like there was also an opportunity to shine a light on the need for obesity treatment that reaches those who need it the most.”

A Need to Broaden the Field of Scholarship

In a recently published paper in the Journal of Racial and Ethnic Health Disparities, Blackman Carr and her colleagues Caryn Bell at Tulane University, Candice Alick at North Carolina Central University, and Keisha Bentley-Edwards at Duke University crafted a series of recommendations for behavioral weight loss interventions to address the unmet needs of Black people with obesity.

Behavioral weight loss involves modifying diet and physical activity levels to combat obesity, as opposed to pharmacological interventions, combined with psychological behavior change theory.

One recommendation the group makes is to “broaden the research lens” to focus on Black people’s experiences with these interventions by increasing the number of Black scholars working in this field.

“Research questions are generated by people and scientists who have a certain perspective,” Blackman Carr says. “When we broaden the field of who’s doing the research and who’s doing the asking, then we also generate more, potentially more novel, questions.”

The paper also emphasizes the importance of enhancing recruitment and retention of Black men and women in behavioral weight loss intervention studies. Currently, most participants in these studies are white, middle- or upper-class women.

When Black men participate in these studies, they tend to have results comparable to white men in the same study. Yet, Black women tend to have worse outcomes than white women.

The first step in developing interventions that address these disparities is having studies with enough Black participants to make significant conclusions.

The researchers recommend using qualitative methods, like interviews and focus groups, to better understand Black participants’ lived experiences.

Combining Policy with Behavioral Changes

Blackman Carr has found many Black women take on the “superwoman role.” Black women often serve as the caregiver not only for their children, but their entire extended family and community network. Constantly caring for others can have negative impacts on what Black women eat and how much physical activity they can perform.

“Being in constant service to others in this multiple caregiver role is a prized position because it’s been necessary for the thriving and survival of Black women and our families,” Blackman Carr says. “But it can also be a barrier for some when it gets in the way of actually setting aside time for yourself to engage in the behavioral weight loss intervention.”

The paper also discusses the importance of engaging with policies and programs that can support research.

National poverty alleviating programs like the Supplemental Nutritional Assistance Program (SNAP) already support healthy food choices. Combining extension education with behavioral weight loss interventions can create a more holistic approach for Black communities.

“It really would look like a marriage of these two areas of behavior change but also knowledge and skill building,” Blackman Carr says.

Blackman Carr’s future research will work to identify what elements of behavioral weight loss interventions do work for Black women and develop others to create more informed and effective interventions for this population.

Fundamentally, Blackman Carr says, the conversations the article raises work toward addressing systemic racism.

“Racism is structural,” Blackman Carr says. “Our neighborhoods are not the same…it is that lived experience in the place people inhabit day-to-day that does shape our health and that definitely has been impacted by race in the U.S., and so we can’t be afraid to talk about it because that’s how we get to positive solutions that ultimately lead to a healthier America.”

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