Glaring Disparities in Obesity Effects, Care, and Policy

Glaring Disparities in Obesity Effects, Care, and Policy

Disparities are everywhere you look in healthcare. But they’re especially glaring if you take a moment to look at effects, healthcare, and policies related to obesity. Speaking at the Harvard Blackburn Obesity Course in Boston yesterday, Fatima Cody Stanford explained:

Excess weight in racial and ethnic minorities is not just a cultural phenomenon. Research points to genetic and hormonal differences as significant contributors. We must invest in understanding these factors so that we can address them.

Dismissed as Cultural

Because obesity is already stigmatized, it’s easy to dismiss racial and ethnic disparities in this disease as a function of culture and behavior. The public and most healthcare professionals already think of obesity as a simple behavioral problem. But of course that’s wrong.

Regardless of the facts, both providers and researchers look right past important racial and ethnic differences in obesity. Most clinical obesity research enrolls mostly white non-Hispanic females. Where we have data, the clinical response to obesity treatment is often different for racial and ethnic minorities. For example, the response to bariatric surgery is less favorable. Wanda Admiral and colleagues found 8.4 percent less weight loss for African Americans in their meta-analysis of bariatric surgery outcomes.

Physiology Plays a Role

One thing is clear, though. These difference are not merely due to cultural differences. Certainly, life stressors play a role. But the role they play is physiological as much as it is psychological. Genetic differences play a role. And so do differences in the physiology of weight regulation.

Patient-Centered Obesity Care

It’s almost impossible to miss. The impact of obesity on racial and ethnic minorities is greater. Prevalence is higher. Complications are more common. And yet, obesity care seems tailored to the needs of white, non-Hispanic women. Suggesting that this fact only reflects treatment-seeking patterns is simply wrong. It should be obvious that people are less likely to seek care that’s not adapted to their needs.

However, the good news is that genuinely patient-centered care can be very beneficial. Build it, make it accessible, and they will come. That’s a lot smarter than cleaning up the mess that results from the complications of untreated obesity.

Click here for Stanford’s slides. You can find further background here, here, here, and here.

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June 22, 2019