OW2018: Poverty, Stress, and Access to Obesity Care

The last few days at ObesityWeek brought us some fascinating insights relating to poverty, stress, and access to obesity care. Presentations here remind us that obesity has a complex relationship with social status. Food security plays a role. Veterans live with a higher risk. And yet, access to effective care is nothing short of bizarre at times.

Social Status and Food Insecurity

Terry Huang chaired an oral session Wednesday that explored drivers of social inequalities in obesity. For example, Luis Maldonado presented data documenting a relationship between food insecurity and cardiometabolic risk. Rather clearly, he and his colleagues showed that the risk for bad outcomes is higher in Hispanic and Latino children if they’re not sure they can get enough to eat.

Along the same line, Michelle Cardell and colleagues presented data on the relationship between social status and food insecurity. Simultaneously, they published their full analysis in Obesity. Based on their work, food insecurity seems like it might be quite an important driver of social status. Perhaps more than income alone.

Bizarre Patterns of Access to Care

On top of the stressors of poverty and food security, we have some bizarre patterns of access to care. For example, veterans live with a high prevalence of obesity. But their access to either behavioral or surgical treatment varies tremendously, according to data presented by Matthew Maciejewski at ObesityWeek on Wednesday. Depending on where they live, a veteran might be 20 times less likely to get the care they need. Maciejewski and colleagues also published their full findings in Obesity this week.

But perhaps most disturbing are some of the bizarre coverage criteria that Nichole Jannah et al found in their study. It was selected for presentation in the prestigious Obesity journal symposium. For example, she noted that some states require a submission of full-body photographs with prior authorization requests for bariatric surgery coverage. What the heck is that about? Evidence of medical need? Hardly.

All of this, taken together, can be quite disturbing. Or maybe it just points to opportunities to get to work and improve an unfortunate pattern. We’ll go with the latter view.

Click here for more on the Jannah study and here for more on social and economic status.

Allegory of Poverty, painting by Adriaen van de Venne / Allen Memorial Art Museum

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November 16, 2018