Racial Discrimination and Hypothalamic-Pituitary-Adrenal Axis Dysregulation in Adolescents With Overweight and Obesity: Does Context Matter?

Abstract

OBJECTIVES The role of context, for which a discriminatory event occurs, on cortisol dysregulation is unclear in adolescents at higher risk for chronic disease. The purpose of this study was to perform a cross-sectional analysis examining the association between racial discrimination context (peer, educational, institutional, and cumulative) and diurnal cortisol patterning in adolescents with overweight and obesity. METHODS One-hundred adolescents [13–19 years; 49% non-Hispanic Black; 65% female; Body Mass Index Percentile (BMI%): 93.9 ± 4.14] were included in this analysis. Racial discrimination context was measured using the self-reported Adolescent Discrimination Distress Index. Salivary cortisol, collected across three days at five time points during the day, was used to calculate Δ 0-30 minutes, diurnal slope, and average total diurnal cortisol area under the curve. Sixteen separate multivariable linear regression models were performed to analyze the relationship between racial discrimination and diurnal cortisol patterns. RESULTS Primary findings show that cumulative racial discrimination and peer discrimination were associated with a greater diurnal slope (cumulative: β = 0.010 ± 0.004; p = 0.03; peer: β = 0.023 ± 0.010; p = 0.026). CONCLUSIONS Findings from this study identified cross-sectional associations between racial discrimination experienced among peers and diurnal cortisol patterns in adolescents with overweight/obesity. If our findings were to be confirmed in longitudinal analyses, evidence-based programs should be considered to buffer the effects of discrimination on adolescent health and more importantly, policymakers should work to eliminate discrimination exposure.