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Obesity and Systemic Racism: A Teaching Guide for a New Paper

By Daniel Aaron

Introduction

Is obesity a manifestation of systemic racism? This past week, a paper I co-authored on this question was published in the Journal of Internal Medicine.

In the paper, Dr. Fatima Cody Stanford and I present an argument that obesity’s disproportionate harms to Black, Indigenous, and People of Color (BIPOC) are attributable to systemic racism. We provide a ten-point strategy for studying and solving the core issues.

For health law, public health, and medical academics interested in teaching the article, I have created this guide, which includes follow-up questions you might consider posing to students to stir further thought and discussion.

[Note: The article is currently behind a paywall, but those with access can read the article here, and some of the article can be read in the images on Twitter here. Please contact the author at daaron@jd20.law.harvard.edu if you are having trouble accessing the article.]

Questions for Discussion

  • To start, do you have an intuitive sense of what causes obesity? Does your conception concord with the article’s?
  • The authors contend that “[t]he popular discourse on obesity and race has at times been counterproductive for the health of BIPOC.” Why? What’s another area where you see problematic discourse in the media, and is there anything in common?
  • Several recent articles in the press have suggested that obesity is a distraction, especially for BIPOC. One article contends obesity is not a significant cause of racial health disparities and instead labels and stigmatizes Black people. Another article critiques obesity as a concept: “Focusing on weight—or health behaviors—puts the burden on the individual, deflecting attention from the more pernicious problem: systemic injustice.” How would the authors respond to these arguments? What is your view?
  • The authors state that “[o]besity is its own disease with a recognized complex pathophysiology.” But they also seem to suggest obesity is a social determinant of health and is likely tied to systemic racism. Do they view obesity more in terms of biological or social factors, or a combination of the two, or something else?
  • In a landmark article in 1989, Professor Kimberlé Crenshaw coined the term intersectionality to describe multiple overlapping axes of subordination. She argued that efforts to achieve racial and sex equality have been unduly compartmentalized, a frame that “reinforces the status quo” and undermines collective action. She has called for greater attention to those who are the most marginalized due to intersectional identities, particularly Black women. Is there any applicability of this theory to BIPOC with obesity?
  • The final recommendation of the paper is “Foreground the lived experiences of BIPOC living with obesity, and form cross-connections with social movements.” Are you aware of organizing surrounding obesity among BIPOC? What are the barriers and opportunities?

Daniel Aaron

Dr. Daniel Aaron grew up just outside of Boston. He graduated from Brown University and studied law and medicine between Harvard and Boston University. Dr. Aaron hopes to alleviate health injustice by studying the role of law and policy in creating and perpetuating disease. His research foci include food and drug law, obesity, opioids and related tort litigation, tobacco products, the intersections with racial health inequities, and constitutional health law. His research has been covered by the New York Times, CNN, Time Magazine, and others. Today, he is a Heyman Fellow at Harvard Law School, an attorney at the U.S. Food and Drug Administration, and a member of The Justice Initiative, a collaboration between Harvard Law School and Howard University School of Law aimed at building a community of lawyers and law students around racial justice. Publications: Tobacco Reborn: The Rise of E-Cigarettes and Regulatory Approaches, 25 LEWIS & CLARK L. REV. ___ (forthcoming 2021). Is Obesity a Manifestation of Systemic Racism? A Ten-Point Strategy for Study and Intervention, J. INTERNAL MEDICINE (2021). Ten years post-GAO assessment, FDA remains uninformed of potentially harmful GRAS substances in foods., CRITICAL REVS. OF FOOD SCIENCE & NUTRITION (2020). Constitutional Cohesion and the Right to Public Health, 53 MICHIGAN J. LAW REFORM 173 (2019). Sponsorship of national health organizations by two soda companies, 52 AM. J. PREVENTIVE MEDICINE 20 (2017). The Landscape of Genetic Variation in Dilated Cardiomyopathy as Surveyed by Clinical DNA Sequencing, 16 GENETICS IN MEDICINE 601 (2014). Nature Publishing Group.

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