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. Author manuscript; available in PMC: 2020 Dec 1.
Published in final edited form as: J Natl Med Assoc. 2019 Sep 20;111(6):642–647. doi: 10.1016/j.jnma.2019.08.005

Masculinity ideology and racism as indicators of obesity risk among Black men

Anna K Lee 1, Maya A Corneille 2, Dwayne T Brandon 3
PMCID: PMC6983976  NIHMSID: NIHMS1543337  PMID: 31548000

Abstract

Background

Racial inequities in health continue to persist and one major controllable and preventable risk factor is obesity. This study examined whether psychosocial factors such as masculinity ideology and frequency of experiences with racism may be significantly associated with Black men’s obesity risk.

Method

Participants were 125 Black men aged 20-39 years old (M=23.0, SD=3.43). They completed surveys to measure masculinity ideology and experiences with racism. In addition, body mass index, waist-to-hip ratio and systolic and diastolic blood pressure readings were collected. Results showed low negative correlations between experiences with racism and masculinity ideology.

Results

Results showed significant correlations between experiences with racism and masculinity ideology. There were significant interaction effects between masculinity ideology and experiences with racism for body mass index scores, waist-to-hip ratio and blood pressure.

Conclusion

Findings indicated that experiences with racism and masculinity ideology interact to impact obesity risk and prevention.

Keywords: racism, obesity, masculinity, inequity

1. INTRODUCTION

There has been a sharp rise in the prevalence of obesity in the U.S. over the past five decades.1,2 Obesity is a major risk factor for chronic conditions including increased risk for diabetes, prostate cancer, cardiovascular diseases, kidney failure, and metabolic syndrome.3-7 In the United States, racial health inequities exacerbate the prevalence of obesity among Black citizens.8,9 Obesity disproportionately impacts Black people, with 38.8% of Black men affected by obesity.4 Black men experience elevated rates of risk factors for diabetes including obesity and as a result Black men may be facing an epidemic of diabetes by the year 2050.10 Obesity and type-2 diabetes are two major public health concerns that disproportionately affect Black Americans.11-13 Understanding factors that impact obesity, a controllable risk factor for diabetes, may lead to the development of interventions that reduce its prevalence. Risk for obesity among Black men may be influenced by cultural psychosocial determinants of health such as; racism and masculinity ideology.

Masculinity ideology refers to the importance men associate with adhering to cultural beliefs regarding male behavioral standards.14-16 Research has found significant negative associations between endorsing “traditional” masculinity ideologies and scheduling routine health visits and dietary practices. 15,17 Whereas, other research has found a significant positive association between Black men endorsing “nontraditional” masculinity and personal wellness.18,19 Similar to the experience of other acute and chronic stressors, experiencing individual racism (e.g. discrimination, racial slurs) can lead to negative health outcomes 9,20-22 and increased vulnerability to illness and disease.23 It has been argued that for Black men everyday racism is particularly problematic because it operates in various social contexts.24 Evidence indicates that factors such as perceived racism and discrimination are also associated with the increased adoption of health risk behaviors (e.g. obesity, high blood pressure, and substance use), decreased enactment of health enhancing behaviors (e.g. seeking social support, engaging in active coping styles, and group identification), delays or failure to seek treatment for less severe conditions and poorer mental health outcomes.25-28 This study examined the extent to which experiences with racism and masculinity ideology would be associated obesity risk.

2. MATERIALS AND METHOD

Participants were recruited through flyers; word of mouth and classroom appeals. Flyers were shared via research assistants and participants’ social media pages. Research has shown that direct appeals that demystify the research process are effective in recruiting Black participants.29 Also, this method enabled us to recruit a wider sample encompassing young men across campus. Participants arrived at the research laboratory and were seated at a private desktop computer to complete the surveys using Qualtrics, an online survey system. After reading the informed consent and agreeing to participate by clicking the ‘Next’ button on the computer screen, participants completed the following: a demographic questionnaire (DQ), the Multicultural Masculinity Ideology Scale (MMIS), the Schedule of Racist Events (SRE), the centrality subscale of the Multidimensional Inventory of Black Identity (MIBI), and the Africultural Coping Systems Inventory (ACSI). After the last question, the participants read a debriefing screen reminding them of the purpose of the study and offering them contact information for the investigator and review board. Participants’ weight, height, waist circumference, hip circumference, body fat and diastolic and systolic blood pressure were recorded on an Anthropometric Measures Worksheet (AMW). Participants’ health information was shared with them. They were thanked for their time and were given a $30 Walmart gift card as compensation. Monetary incentives are routinely used to motivate individuals to participate in research studies.

3. THEORY

To better understand the extent to which masculinity ideology and experiences with racism influence obesity risk and prevention, we framed this study using the biopsychosocial model. The biopsychosocial model suggests that health outcomes are best explained when biological, psychological and social determinants are considered.30 Clark et al. (1999) developed a similar conceptual model as it relates to examining the ways in which individual racism impacts health outcomes. Clark et al.’s model asserts that the perception of an environmental stimulus as racist, results in exaggerated psychological and physiological stress that is influenced by constitutional factors, sociodemographic factors, psychological and behavioral factors, and coping responses.31 In the current study, we suggest that social constructs such as experiences with racism and masculinity ideology influence obesity risk indicators (i.e., body mass index, waist-to-hip ratio, blood sugar, cholesterol and blood pressure). Factors such as racial identity and use of Africultural coping strategies may affect this relationship and therefore served as covariates in our data analyses.

4. RESULTS & DISCUSSION

Data was analyzed using the IBM Statistical Package of the Social Sciences. To investigate the extent to which masculinity ideology and number of experiences with racism were associated with indicators of obesity a univariate analysis of covariance was conducted for each health indicator (i.e., BMI, waist-to-hip ratio, blood pressure). Independent variables were scores on the subscales of the masculinity and racism measures. There were 125 participants aged 20-39 years old (M=23.0, SD=3.43). An overview of the participants’ indicators of obesity are reported including BMI, WHR, body fat, systolic and diastolic blood pressure (see Table A.1).

Results revealed a significant interaction between the achievement subscale of the masculinity measure and lifetime experiences with racism (F(1,26) = 6.25, p<.02). Participants who reported lower lifetime experiences with racism and scored high on the achievement subscale had systolic blood pressures higher (M=132.39, SD= 13.40) than those who scored low on the achievement subscale (M=129.82, SD=19.98). Findings from the study indicated that among young adult college student Black men, experiences with racism and masculinity ideology can interact to impact obesity risk and thereby prevention. Specific findings indicated that in this sample, more frequent experiences with racism were associated with higher diastolic blood pressure even after controlling for racial centrality and Africultural coping. The finding that frequency of experiences with racism was associated with higher blood pressure is consistent with several studies that have found an association with racism and blood pressure in both community samples 32 and blood pressure reactivity in laboratory samples.33,34

Results revealed a significant interaction effect between hypermasculinity and yearly experience with racism F(1,57) = 4.17, p≤.05. An examination of the means revealed that for those low on hypermasculinity but high on experiences with racism within the last year had a slightly higher BMI (M=27.66, SD=7.46) than those who reported lower numbers of experiences within the last year (M=26.15, SD=5.38). Among this sample, 61.3% were in the acceptable range for WHR. Results revealed a significant interaction between the masculinity achievement subscale and lifetime experiences with racism F(1,50) = 6.19, p<.02. There was a significant interaction between yearly and lifetime experiences with racism F(1,50) = 5.99, p<.02. Participants who scored high on lifetime experiences with racism and yearly experiences with racism had higher WHR (M=.90, SD=.08) than those who scored low on experiences with racism within the last year (M=.87, SD=.08). Results revealed a significant main effect for experiences with racism (F(1,26) = 4.34, p≤.05) on diastolic blood pressure. An examination of the means revealed that participants who scored high on racial stress had higher diastolic blood pressure readings (M=79.68, SD=11.50) than those that scored low (M=76.03, SD=10.41) (see Table A.2).

The current study extends previous research by examining the interaction of racism and masculinity ideology. Men who scored low on the hypermasculinity subscale but high on frequency of experiences with racism during the last year had slightly higher BMIs than those with fewer experiences with racism. Moreover, results indicated that participants who reported less lifetime experiences with racism and scored high on the masculinity achievement subscale had higher systolic blood pressure than participants who scored low on the achievement subscale. These findings suggest that racism may shape the adoption of masculinity ideologies and the resulting health outcomes in Black college student men. Previous research suggests that hypermasculine constructions of masculinity can be dangerous and self-destructive to health outcomes.35 However, our findings suggest that even among participants who scored low on hypermasculinity but had more experiences with racism there was an association with higher BMI scores.

4.1. Limitations

Generalizability of findings are limited to a college student population. The MMIS was used because of its focus on culture, the sensitivity and sexual responsibility subscales, however, since this study was conducted more appropriate scales for this population were developed such as the Black Men Experiences Scales 36 or the Masculinity Inventory Scale.37 Another limitation was that blood pressure was only collected once after the survey was completed. In future studies, at least two blood pressure reading should be collected to establishing a resting blood pressure.38 Moreover, the study focused on the frequency of experiences and stress associated with racism but did not distinguish between various types of racism such as structural, institutional, cultural, or individual racism to determine which types of racism impacted obesity risk. Structural racism describes the practices, processes, and ideologies that produce differential access to power and life opportunities along racial and ethnic lines.39-42 More specifically, structural racism refers to racial discrimination that is perpetuated through systems including housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice.42 Additionally, additional and more robust indicators of obesity risk were needed.

5. IMPLICATIONS

These findings suggest that structural interventions that promote masculinity ideologies that support well-being and reduce the prevalence of racism and the resulting stress associated with it may provide an effective pathway for obesity prevention among Black American college men. Researchers have documented structural inequalities that impact obesity risk and prevention including decreased access to safe and walkable areas, decreased access to healthy food options among Black Americans, and decreased access to employment opportunities to afford healthy foods 43-45. For example, individuals who reside in safe and walkable areas and have easy access to healthy foods are less likely to be obese 41,43,46. As seen in our results, overall the participants in this sample rejected hypermasculinity and scored high in achievement. In general, American conceptualizations of masculinity tend to emphasize avoidance of displaying vulnerability, avoidance of help seeking, and avoidance of expressing painful emotions such as sadness, hurt, and alienation 47. However, Black male college students who view expressing emotion as not appropriately masculine may be particularly adversely affected by racial stress, and be more likely to experience increased blood pressure and weight gain. This study provides an important contribution of examining the ways that masculinity ideology and frequency of experiences with racism interacts to impact obesity risk for college-aged Black men. Replication of this study with a non-student population is needed to expand generalizability of the findings. Future studies may consider using a Black masculinity scale designed specifically for studying the ways in which Black men construct masculinity to develop interventions focused on obesity prevention. Additional research is needed that considers the context of Black men’s masculinity ideology and racial socialization within the broader ecological context of racism and structural inequality.

Acknowledgments

This research was supported by a grant from Hampton University's Minority Male Health Initiative; Subaward # HU-15-0005, National Institutes of Health, Grant No. U54MD00862

Appendix

Table A.1.

Metabolic Syndrome and Blood Pressure

Variables N Min Max Mean SD Acceptable/Unacceptable %
BMI 121 17.00 47.00 27.73 6.51 Underweight = 2.4% (<18.5)
Healthy = 36.0% (18.5 to 24.9)
Overweight = 27.2% (25 to 29.9)
Obese = 31.2% (>30.0)
WHR 113 0.75 1.18 .90 .08 Excellent = 29.6% (<0.85)
Good = 20.8% (0.85-0.89)
Average = 16.8% (0.90-0.95)
At Risk = 17.6% (>0.95)
Body fat 106 5.00 38.00 18.27 7.86 Essential Fat = 2.4% (2-5%)
Athletes = 26.4% (6-13%)
Fitness = 12.8% (14-18%)
Average = 24.8% (19-24%)
Obese = 18.4% (>25%)
Systolic 70 99 199 130.53 17.60 Normal range = 16% (<120)
Prehypertensive range = 25.6% (120-139)
Hypertensive range = 14.4% (>140)
Diastolic 70 53 114 77.64 10.98 Normal range = 30.4% (<80)
Prehypertensive range = 18.4% (80-89)
Hypertensive range = 7.2% (>90)
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Table A.2.

ANCOVA Results

F p High Low
Main Effect
Diastolic Blood Pressure
 -   Racism 4.34 .05 79.68 76.03
Interaction Effects
BMI
 -   Hypermasculinity * Racism 4.17 .05 27.66 26.15
WHR
 -   Yearly Racism*Lifetime Racism 5.99 .02 0.90 0.87
Systolic Blood Pressure
 -   Achievement*Racism 6.25 .02 132.39 129.82
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Footnotes

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Contributor Information

Anna K. Lee, North Carolina A&T State University

Maya A. Corneille, North Carolina A&T State University

Dwayne T. Brandon, North Carolina Central University

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