Obesity and Structural Barriers: A County-Level Oaxaca–Blinder Decomposition of Inequality, Social Vulnerability, Healthy Food Access, and Minimum Wage Policies

Abstract

This study examines structural determinants of county-level variations in obesity prevalence across the United States, assessing the extent to which factors such as income inequality, access to healthy foods, health-related behaviors, social vulnerability, and minimum wage policies contribute to these differences. We utilized County Health Rankings Data for obesity prevalence (body mass index of ≥30 kg/m2) in the U.S. and combined it with the American Community Survey to include the Gini coefficient (GC) and demographic information. The analysis comprised 3129 counties from 2015 to 2019. We applied Oaxaca–Blinder decomposition (OBD) to analyze the impact of income inequality, racial composition, health behaviors, access to healthy foods, and social vulnerability in states with and without minimum wage policies. Overall, 31.7% of the population was living with obesity, with higher rates in states lacking minimum wage policies (MWPs) (35% vs. 31% in counties with MWP equal or higher than $9.0, p < 0.001). The OBD results indicated that reducing income inequality and improving access to healthy food would serve as protective factors in lowering obesity prevalence. Notably, having more racially minoritized populations, lower physical activity, and higher social vulnerability served as predictor factors for a higher prevalence of obesity. OBD predicted 88.7% of the variation in obesity prevalence, but a 0.19 percentage point difference in counties with MWP could not be explained by the model. Policymakers should consider increasing minimum wages and addressing racial composition, access to healthy food, and social vulnerabilities to reduce obesity prevalence effectively.