10 Notes: Race, Gender, Weight, and Healthcare Experiences

Healthcare experiences vary widely. Variances in the quality of care based on gender, race, and weight status have been reported, but a deep understanding of what’s driving these variations is a challenge. Rebecca Puhl, Kimberly Gudzune, and others have published good studies of the effects that stigmatizing experiences in healthcare have upon patients with obesity.

This week in Obesity, Susan Persky and colleagues dig a little deeper into the relationship between weight, race, gender, and healthcare experiences.These data both offer deeper insight and prompt further questions. Note that the data comes from a sample of 1,036 young, healthy, ethnically diverse, insured adults. Here are ten observations from the data Persky has analyzed.

  1. Women with excess weight use less preventive care. This observation is consistent with prior findings in the weight bias literature.
  2. Men with excess weight use more primary care. Note that this sample was screened to be relatively healthy at baseline. The higher burden of illness might be explained by acute illness and injury associated with excess weight. Even so, men’s use of primary care is lower than women’s, consistent with prior literature.
  3. Men use little preventive care, regardless of weight. Low preventive care utilization by men is well-documented and unaffected by weight status.
  4. African-American women use more preventive care. Note here that the study population consists of insured patients who saw their primary care doctor at least once in the prior year. So factors related to health insurance status that affect a broader population of African-American women are excluded from this analysis.
  5. Women with excess weight report no more negative healthcare experiences. This is an interesting finding that may reflect the nature of this study’s sample. Since the sample includes only women who have seen their primary care doctor in the past year, it may be that women with excess weight who have been alienated from primary care by weight bias are under-represented in this sample.
  6. Women with negative healthcare experiences use less primary care. Regardless of weight status, women in this sample who have negative experiences (low trust, poor interpersonal treatment) make fewer primary care vists, regardless of their weight status.
  7. Men with excess weight report less trust and more negative interpersonal treatment. Seeing this pattern in men but not women is noteworthy. Perhaps men have fewer exposures to weight bias and thus negative healthcare interactions have greater impact.
  8. African-American women but not men report more negative healthcare experiences. The surprise here is that African-American men did not report more negative healthcare experiences, which may be a reflection of this insured, healthy study population.
  9. African-American women with healthy weights report less trust in their providers. This observation merits further study to understand how excess weight could mitigate the lower levels of trust that African-American women typlically place in healthcare providers.
  10. Providers are less likely to discuss weight with Aftican-American women. Some good and some bad might be found in this observation. Providers who are less likely to criticize a woman’s excess weight might engender more trust. But avoiding the health implcations of excess weight is not a satisfactory solution.

No doubt, the relationships between race, gender, weight, and healthcare experiences are complicated. These observations point to some truths that require further work for a full understanding.

Food for thought.

Click here to read the study in Obesity.

The Patient, oil painting by Felix Vallotton / WikiPaintings

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