Obesity in African-Americans: The role of physiology

The disproportionate obesity in African American (AA) women has a physiologic basis and can be explained by the interactive effects of insulin secretion, insulin clearance, insulin sensitivity and the glycaemic load of the diet. This review will present data supporting a physiologic basis for obesity propensity in obesity-prone AA women that resides in their unique metabolic/endocrine phenotype: high beta-cell responsiveness, low hepatic insulin extraction and relatively high insulin sensitivity, which together result in a high exposure of tissues and organs to insulin. When combined with a high-glycaemic (HG) diet (that stimulates insulin secretion), this underlying propensity to obesity becomes manifest, as ingested calories are diverted from energy production to storage. Our data indicate that both weight loss and weight loss maintenance are optimized with low-glycaemic (LG) vs HG diet in AA. Whether greater obesity in AA is mechanistically related to their greater prevalence of type 2 diabetes is debatable. This review provides data indicating that obesity is not strongly related to insulin resistance in AA. Rather, insulin resistance in AA is associated with relatively low adipose tissue in the leg, consistent with a genetic predisposition to impaired lipid storage. Greater bioenergetic efficiency has been reported in AA and, via resultant oxidative damage, could plausibly contribute to insulin resistance. In summary, it is proposed here that a subset of AA women are predisposed to obesity due to a specific metabolic/endocrine phenotype. However, greater diabetes risk in AA has an independent aetiology based on impaired lipid storage and mitochondrial efficiency/oxidative stress.

Keywords: African American; carbohydrate; diet; glycaemic load; insulin; insulin sensitivity; obesity.

© 2020 The Association for the Publication of the Journal of Internal Medicine.

Comment in

Nguemeni Tiako MJ, Stanford FC. Nguemeni Tiako MJ, et al. J Intern Med. 2020 Sep;288(3):363-364. doi: 10.1111/joim.13132. Epub 2020 Jul 10. J Intern Med. 2020. PMID: 32648266 Free PMC article. No abstract available.

Gower BA, Adele Fowler L, Fernandez JR. Gower BA, et al. J Intern Med. 2020 Sep;288(3):365-367. doi: 10.1111/joim.13131. Epub 2020 Jul 13. J Intern Med. 2020. PMID: 32657497 No abstract available.

Gower BA, Adele Fowler L, Fernandez JR. Gower BA, et al. J Intern Med. 2020 Sep;288(3):371-372. doi: 10.1111/joim.13152. Epub 2020 Aug 3. J Intern Med. 2020. PMID: 32744390 No abstract available.

Tsai J, Cerdeña JP, Khazanchi R, Lindo E, Marcelin JR, Rajagopalan A, Sandoval RS, Westby A, Gravlee CC. Tsai J, et al. J Intern Med. 2020 Sep;288(3):368-370. doi: 10.1111/joim.13153. J Intern Med. 2020. PMID: 32808368 No abstract available.

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References

    1. Davis KK, Tate DF, Lang W et al. Racial differences in weight loss among adults in a behavioral weight loss intervention: role of diet and physical activity. J Phys Act Health 2015; 12: 1558-66.
    1. Fitzgibbon ML, Tussing-Humphreys LM, Porter JS, Martin IK, Odoms-Young A, Sharp LK. Weight loss and African-American women: a systematic review of the behavioural weight loss intervention literature. Obesity Rev 2012; 13: 193-213.
    1. Tussing-Humphreys LM, Fitzgibbon ML, Kong A, Odoms-Young A. Weight loss maintenance in African American women: a systematic review of the behavioral lifestyle intervention literature. J Obes 2013; 2013: 437369.
    1. DeLany JP, Jakicic JM, Lowery JB, Hames KC, Kelley DE, Goodpaster BH. African American women exhibit similar adherence to intervention but lose less weight due to lower energy requirements. Int J Obesity 2005; 2014: 1147-52.
    1. Hollis JF, Gullion CM, Stevens VJ et al. Weight loss during the intensive intervention phase of the weight-loss maintenance trial. Am J Prevent Med 2008; 35: 118-26.