Gough Courtney Margaret, Carroll Alyssa
University of La Verne, USA.
SSM Popul Health. 2022 Nov 23;20:101297. doi: 10.1016/j.ssmph.2022.101297. eCollection 2022 Dec.
The increasing prevalence of overweight and obesity in the United States, and disparities by race, ethnicity, and gender, have caused concern among public health practitioners, health care providers, and others, in part because overweight and obesity may be linked to chronic health problems and weight stigma. Researchers have traditionally relied upon body mass index (BMI) as a measure of overweight and obesity, despite its limitations. In this study we apply an intersectional framework and use data from the 2011-2018 waves of the nationally representative National Health and Nutrition Examination Survey (NHANES) to study sex differences in the risk of overweight and obesity among Mexican Americans, triangulating three measures that proxy for overweight and obesity: BMI, high waist circumference, and high percent body fat. We assess heterogeneity across nativity, education, income by parenthood status, food security, time in the United States (for immigrants), and receipt of SNAP/WIC benefits (for the low-income sample). Results from logistic regression models indicate choice of cutoff values and measure are critical to determining whether sex disparities exist. We find no evidence of disparities in BMI but evidence of greater risk for females using traditional cutoff values for high waist circumference and high percent body fat. Adjusted cutoff values provide differing results. Minimal heterogeneity is seen. Results reinforce the importance of considering sex disparities and emphasize the importance of critically examining measures that proxy for overweight and obesity risk, given the high stakes surrounding weight stigma.
美国超重和肥胖现象日益普遍，且存在种族、族裔和性别差异，这引起了公共卫生从业者、医疗服务提供者及其他人士的关注，部分原因在于超重和肥胖可能与慢性健康问题及体重耻辱感有关。传统上，研究人员一直依赖身体质量指数（BMI）作为超重和肥胖的衡量标准，尽管它存在局限性。在本研究中，我们应用交叉性框架，并使用具有全国代表性的2011 - 2018年国家健康与营养检查调查（NHANES）的数据，来研究墨西哥裔美国人中超重和肥胖风险的性别差异，使用三种代表超重和肥胖的指标进行三角测量：BMI、高腰围和高体脂百分比。我们评估了在出生地、教育程度、按父母身份划分的收入、食品安全、在美国的居住时间（针对移民）以及领取补充营养援助计划/妇女、婴儿和儿童专项补充营养计划福利（针对低收入样本）方面的异质性。逻辑回归模型的结果表明，临界值和测量指标的选择对于确定性别差异是否存在至关重要。我们没有发现BMI存在差异的证据，但有证据表明，对于高腰围和高体脂百分比使用传统临界值时，女性面临更大风险。调整后的临界值给出了不同的结果。观察到的异质性最小。研究结果强化了考虑性别差异的重要性，并强调鉴于体重耻辱感相关的重大风险，批判性地审视代表超重和肥胖风险的测量指标的重要性。
