Exploring Associative Pathways and Gender Effects of Racial and Weight Discrimination with Sleep Quality, Physical Activity, and Dietary Behavior in Adults with Higher Body Mass Index and Elevated Cardiovascular Disease Risk



Racial disparities in obesity and cardiovascular disease can partly be attributed discrimination. Racial discrimination (RD) and weight discrimination (WD) have been linked to higher psychological distress, lower sleep quality, less physical activity, and unhealthy diet, which can negatively impact weight. Better understanding the processes by which discrimination influences weight-loss factors would help create strategies for mitigating obesity disparities.


This is a cross-sectional study of 745 primary care patients with a BMI ≥ 25 kg/m2 (43.1% Female, Mage=51 years) who were enrolled in a weight-loss trial. To investigate the direct and indirect (via psychological distress) pathways by which RD and WD may be associated with sleep quality, physical activity, and diet, and to explore gender as a moderator, we used Ordinary Least Square regression with bootstrapping. Validated surveys included EOD, PROMIS-29, LDBQ, REAP-S, IPAQ-SF.


We found that RD and WD were indirectly associated with lower sleep quality via psychological distress (WD: indirect=2.11, CI[1.218;3.092]; RD: indirect=0.93, CI[0.057;0.134]). Further, we found that for men, RD and WD were indirectly associated with less physical activity via psychological distress (WD: moderated mediation=491.67, CI[75.565;1040.877]; RD: moderated mediation=22.60, CI[0.080;51.828]). Finally, we found that RD and WD were directly associated with unhealthy diet (WD: direct=0.195, CI[0.076;0.314]; RD: direct=0.007; CI[0.001;0.012]).


Weight-loss factors were associated with both racial and weight discrimination through different pathways depending on gender and type of outcome. Lower sleep quality was associated with discrimination via psychological distress for both gender groups. Lower physical activity was also linked to discrimination via psychological distress, however for men only. Associations between unhealthy diet and discrimination were direct and could not be explained by increases in psychological distress. Although more research is needed, our findings suggest that interventions to address discrimination and its psychological impacts could mitigate obesity disparities and improve cardiovascular health.

The full study is available in Circulation.