Over the past few decades, obesity has become a persistent and widespread public health problem, especially within the United States. Obesity is defined as a chronic illness marked by an excessive build-up of body fat that has harmful effects on general health. One of the most popular methods for evaluating this illness is body mass index (BMI), which takes into account a person’s height and weight. The obesity epidemic reached national attention in 2001 when the U.S Surgeon General issued a call to action to address and reduce the rate of overweight and obesity in the US population (US Department of Health & Human Services; Public Health Service; Office of Surgeon General, 2001). Following this important statement, extensive preventive measures have been widely put into place. However, drawing upon data from the National Health Statistics Reports covering the period from 2017 to March 2021, it is revealed that the prevalence of obesity in adults aged 20 and older is a remarkable 41.9%, with 9.2% of the population suffering from severe obesity (Bryan et al., 2021, p. 6). This finding highlights the concerning fact that a large portion of the adult population in the United States is experiencing the detrimental effects of obesity.

Black American adults are disproportionately affected by obesity, who are a significant portion of the population affected by this condition. Notably, 49.9% of non-Hispanic black adults have obesity, surpassing the rates among Hispanic adults (45.6%), non-Hispanic white adults (41.4%), and non-Hispanic Asian adults (16.1%), as reported by the National Health Statistics (Bryan et al., 2021, p. 6). Regional variations are also noticeable in the prevalence of obesity among American adults. The Midwest (35.8%) and the South (35.6%) exhibit the highestprevalence rates, followed by the Northeast (30.5%) and the West (29.5%), according to statistics provided by the Centers for Disease Control and Prevention (CDC, 2023).

Risk Factors

Obesity is correlated with a massive increase in mortality rates. Individuals characterized as obese exhibit an increased risk of premature death from all causes ranging between 50 to 100 percent, when compared to their counterparts possessing a BMI within the range of 20 to 25.1 (US Department of Health & Human Services; Public Health Service; Office of Surgeon General, 2001, p. 8). In a general context, the overall life expectancy diminishes by 5-10 years among people classified as obese (Fruh, 2017, p. S4). Moreover, the harmful effects extend beyond just mortality – a plethora of morbidities are associated with the illness as well. These include, but are not limited to, type 2 diabetes, stroke, hypertension, cancer, depression, anxiety, sleep apnea, breathing difficulties, gallbladder disease, heart disease, heightened surgical risk, infertility in women, and various other health complications (Fruh, 2017, p. S6) (US Department of Health & Human Services; Public Health Service; Office of Surgeon General, 2001, p. 9). Not only can gaining an immense amount of excess weight increase the risk of disease, but even a small gain in weight can have a negative impact on general health. For example, weight gain between 11 and 18 pounds increases a person’s risk of type 2 diabetes by twice as much as it does for individuals who do not gain weight. Meanwhile, the risk of type 2 diabetes increases by four for those who gain 44 pounds or more (US Department of Health & Human Services; Public Health Service; Office of Surgeon General, 2001, p. 8).

Social Determinants

To fully understand obesity, you must look at everything that shapes the disease at every level, which can be thought of as the social determinants of health (SDH). It is important to

acknowledge that obesity is an illness that is not merely a consequence of genetic predisposition, rather, it's a disease that is immensely intertwined with social determinants. Social determinants encompass the many conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks (Social Determinants of Health - Healthy People 2030 | Health.Gov, n.d.). Socioeconomic status, social environment, and physical environment are three basic domains in which social determinants related to obesity can be categorized. These social determinants are made up of elements like occupation, income, social interactions, education, and other comparable factors combined together. Research on the socioeconomic determinants of obesity was conducted using data from the National Health Interview Survey on adult U.S. participants between 2013 and 2017. The study found that people who struggled with overweight and obesity were more likely to be middle-aged, be male, belong to a racial/ethnic minority group, have low income and education, live in the South and Midwest, have poor cardiovascular risk factor profile, and lack health insurance, relative to their counterparts who were not obese (Javed et al., 2022, p. 493).

The consequences of obesity have become more well known, especially in the wake of the Surgeon General's 2001 call to action. However, there are many obstacles in the way of treating or managing this illness, especially in populations that are more susceptible. This results from the fact that many social determinants that impact healthy behaviors may be outside the reach or control for those who are disadvantaged (Bryan et al., 2021, p. 220). For example, economic instability has been linked to decreased availability of nutritious foods, lower spending on healthy food items, and the adoption of harmful behavioral patterns, like poor eating habits, all of which increase the risk of obesity (Javed et al., 2022, p. 497).

Community of Interest

In a recent specialized article from the New England Journal of Medicine, the publication highlighted a concerning projection: by 2023, nearly one in every two adults will have obesity, with nearly one in every four adults having severe obesity. This will disproportionately impact non-Hispanic black adults to an extreme level, raising the possibility that severe obesity could become the most common Body Mass Index (BMI) category in this population (Ward et al., 2019, p. 2440). The significance of this discovery intensifies as we cross into 2024; a mere 6 years away from 2030. Furthermore, non-hispanic black adults living in the Midwest and Southern regions of the US will feel the brunt of this projection the hardest, given they have the highest prevalence of obesity currently. For instance, North Carolina has an overall obesity rate of 34.1%; however, non-Hispanic black adults in this region surpass this statistic with an obesity rate of 45.8%, a higher percentage than their racial counterparts (DNPAO Data, Trends and Maps: Explore by Location | CDC, n.d.)

Intervention

Black Southern American culture has a rich and expansive heritage, rooted deeply in the historical context of African-American slavery. One of the most distinct aspects of Southern Black culture, setting it apart from other regional cultures, is its culinary tradition. “Soul food”' is

a traditional ethnic cuisine that is popular with southern Black Americans. This dish is typically comprised of foods like cornbread, fried chicken, collard greens, macaroni and cheese, sweet potatoes/yams, and pork. Supplementary to these staples are sides like black eyed peas, fried fish, hushpuppies, and pecan pie. Soul food has been a crucial cuisine to southern Black Americans for decades. However, recent debate has raised questions about the nutritional implications of soul food consumption. In 2018, a study was conducted to investigate hypertension disparities between Black and White Americans by subjecting participants to Southern/soul food diets. The findings of this study highlighted that soul food often contains elevated levels of fried foods, organ meats, processed meats, eggs and egg-based dishes, added fats, high-fat dairy products, sugar-sweetened beverages, and bread. The consumption of these elements was associated with an increased risk of incident stroke, coronary heart disease, end-stage renal disease, chronic kidney disease, sepsis, cancer mortality, and cognitive decline (Howard et al., 2018). It is reasonable to state that obesity serves as a potential risk factor linked to soul food, given the interconnectedness of diseases such as stroke and cancer with obesity.

Soul food is a potential contributing factor to obesity among Black American adults in North Carolina. In light of this observation, community education about the potential adverse effects of soul food could be an important intervention for this demographic. An example of an effective community education initiative is the Stanford Three Community Study, conducted between 1972 and 1975. This study aimed to assess the impact of a mass media cardiovascular health education program on dietary behaviors across three distinct California communities. The mass media education initiative encompassed multiple platforms such as radio, television, newspapers, and billboards, with pamphlets and cookbooks being directly delivered via mail. Results from the study showed substantial enhancements in dietary behaviors within the treatment towns, including reductions in cholesterol and saturated fat intake, as well as positive alterations in relative weight and plasma cholesterol levels (Fortmann et al., 1981). A notable strength of this intervention was its cost-effectiveness. This same approach can be applied to Black American communities in North Carolina, whereby mass media tools, similar to those employed in the Stanford study, could effectively spread education on the nutritional aspects of soul food. Such efforts may shift this demographic towards healthier dietary options. The efficacy of this intervention could even be further heightened by tailoring the language used in mass media to language used among Black North Carolinians. For example, employing African American Vernacular English (AAVE) in radio broadcasts, with a Black American presenter talking about the effects of soul food consumption, may resonate better with Black listeners. This specific approach has the potential to create a greater inclination among the black community to understand and heed advice from a familiar and relatable source within their own community.

While mass media education has proven to have successful results in reducing obesity, a limitation might lie in the potential reluctance to change dietary habits. Interventions requiring deviation or alteration of a cultural tradition in any aspect may encounter resistance. A study conducted in 2009 sought to assess the beliefs, barriers, and self-efficacy of African Americans living in eastern North Carolina concerning healthy eating practices. The primary objective was to understand their perceptions of nutritious foods, their knowledge pertaining to nutrition, and their behavior when it comes to grocery shopping. The findings of the study revealed that, despite participants acknowledging the advantages of healthy eating and demonstrating high self-efficacy in the consumption and procurement of nutritious foods, they expressed a deep belief in the inadequacy of their intake of healthful foods. The study concluded that cultural beliefs and attitudes have a notable influence on dietary patterns, despite awareness concerning disease prevention or beliefs regarding the healthfulness of specific foods. This influence is particularly pronounced in the southern region of the United States and the eastern part of North Carolina (Pawlak & Colby, 2009). Even in the face of awareness regarding the adverse health effects of certain foods, there appears to be a persistent consumption of unhealthy foods.

Conclusion

In conclusion, the rising prevalence of obesity, particularly among Black American adults in North Carolina, presents a critical public health concern that needs urgent attention. Despite many efforts, obesity rates persist, with projections showing a worsening situation. Social determinants, such as cultural influences like soul food cuisine in the South, play a major role in this public health issue. A targeted intervention through community education, inspired by successful models like the Stanford Three Community Study, can effectively raise awareness about the nutritional implications of soul food. Leveraging culturally sensitive language and media, these campaigns have the potential to instigate positive dietary changes. However, recognizing cultural barriers is crucial, as highlighted by studies on perceptions of healthy eating among African-Americans in eastern North Carolina.

In addressing obesity, a nuanced approach that considers social determinants, cultural influences, and individual beliefs is essential. Tailoring interventions to the unique needs of Black American adults in North Carolina can create sustainable lifestyle changes and contribute to a healthier future. The urgency of this task is highlighted by escalating obesity projections, emphasizing the need for specific and adaptive public health efforts right now.

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