Racial and Ethnic Disparities in Obesity and Contributing Behavioral Factors: Diet, Physical Activity, Length of Walk, and Sleep Duration

<h2>Abstract</h2> Introduction: The prevalence of obesity varies by racial and ethnic group in the United States, with non-Hispanic Black and Hispanic adults having higher rates than non-Hispanic White and Asian adults. Unhealthy diet, sedentary lifestyle, and short sleep duration are associated with greater likelihoods of obesity. Methods: Using the 2022 National Health Interview Survey Public Use Sample Adult File, the study constructed measurements of obesity, diet, physical activities, walk, sleep duration. Multivariable logistic regressions were performed for each racial/ethnic group to assess associations between behavioral factors and the likelihood of obesity, adjusting for demographic and socioeconomic characteristics. Results: Obesity prevalence was the highest in non-Hispanic AIAN (44.0%; 95% CI, 38.2%–50.1%), followed by 42.7% (95% CI, 40.5%-44.9%) in non-Hispanic Black adults. Compared to other groups, non-Hispanic Asian adults reported the highest fruit and vegetable intake. Non-Hispanic American Indian and Alaska Native (AIAN) adults had diets low in fruits and vegetables and high in sugar sweetened beverages. One out of four adults who are non-Hispanic Whites or other/multiple races met the recommendations for strength building and aerobic activities. More than half of Hispanics failed to meet either physical activity criterion. More than one third of non-Hispanic AIANs, Blacks, other/multiple races reported short sleep duration. Adjusted odds of obesity were 1.359 (95% CI, 1.167–1.581) higher for Hispanics, 1.338 (95% CI, 1.240–1.445) higher for non-Hispanic Whites, and 1.285 (95% CI, 1.087–1.519) higher for non-Hispanic Blacks with less than 7 hours of sleep than their counterparts of the same race/ethnicity with adequate sleep. Conclusions: Although there is a strong association between obesity and behavioral factors, the effects vary substantially across racial/ethnic groups, adjusting for demographic and socioeconomic characteristics. Policies and programs addressing obesity should consider the heterogeneous effects of behavioral factors on obesity among racial/ethnic groups.