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Race, Obesity, and Birth Outcomes: Unraveling a Complex Association to Improve Maternal-Child Health


Snowden, Jonathan M.; Robinson, Whitney R.; Marshall, Nicole E.; & Boone-Heinonen, Janne (2016). Race, Obesity, and Birth Outcomes: Unraveling a Complex Association to Improve Maternal-Child Health. Obesity, 24(12), 2447. PMCID: PMC5557633


The obesity epidemic and racial disparities in birth outcomes are among the most pressing and persistent population health challenges in the United States. A study by Lemon et al. in this issue of Obesity considers the convergence of these two issues: how racial disparities in maternal obesity contribute to persistent racial disparities in stillbirth and infant death [1]. The authors use an innovative analytical technique to address the complex interpretation of race as an exposure in epidemiologic research, as well as racial differences in how maternal obesity predicts perinatal complications [2, 3]. They use causal diagrams to elucidate their research question and employ an inverse probability weighted estimator, and they are appropriately cautious to avoid claims of causality. Notably, they consider race a marker of disparity rather than a cause, per se, thereby remaining agnostic in debates in epidemiology about whether race and obesity may be considered causes [4-7]. The study estimates that approximately 10% of the black/white racial disparity in stillbirth and infant death is attributable to the higher prevalence of obesity in African-American women [1]. The study raises three important questions for future obesity research. The first is the extent to which maternal obesity is modifiable and therefore a promising target for intervention. The general lack of effective, sustained, nonsurgical obesity treatments raises doubts about the effectiveness of targeting maternal obesity to reduce black/white perinatal inequalities, leading us to consider which levers we would intervene on during this life stage. The translation of research findings into feasible interventions is critically important to inform practical and effective solutions.


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Snowden, Jonathan M.
Robinson, Whitney R.
Marshall, Nicole E.
Boone-Heinonen, Janne