Black Lives Matter

Racism Baked into Health and Obesity Care

We are in a moment when life and death and race and ethnicity are forcing conversations that White people politely avoid. It’s uncomfortable. But the brutal deaths of Black people at the hands of police have become impossible to ignore. And in the COVID-19 pandemic, Black and Latino people are dying in numbers that make the health effects of systemic racism plainly obvious. Racism is built into healthcare systems. It’s so pervasive that people ordinarily look right past it – even though it shows up in health outcomes. The racism baked into obesity care is even more obvious. But only if you open your eyes to it.

Research and Care for White Women

Take, for instance, studies of obesity treatment. The dominant demographic group in these trials is White women. Thus we have a bit of a chicken and egg puzzle. Do we have treatments tailored to the needs of White women because those are the subject who enroll? Or is the nature of the treatments under consideration less relevant to Black and Latino subjects in the first place? Either way, the result is plain. Obesity treatment meets the needs of White women better than it meets the needs of Black and Latino people.

This disparity shows up in clinical outcomes. Angel Bird, Alexander Toth, and Fatima Cody Stanford recently described this unacceptable fact:

Higher prevalence and reduced treatment response to lifestyle, behavior, pharmacotherapy, and surgery are observed in racial and ethnic minorities.

Inviting People to “Be Like Us”

For too long, strategies to address obesity have been precisely the opposite of patient centered. Bias toward people with obesity is common – even among professionals in obesity. When you add racial bias onto weight bias, disparities in health are unsurprising.

Even with good intentions, efforts to address disparities that come from a culture of White privilege can fail miserably. In a recent interview, Suzanne Plihcik described a multicultural school that was failing to recruit and retain a diverse staff and student body. They offered a long litany of all the things they were doing to appeal to people of color. But they failed to examine their own culture, as she describes:

Our very wise director, Deena Hayes-Greene, said to them at the end of this litany, “So what did you do for White people?” And their jaw dropped.

Because you see the culture that was keeping them from attracting and retaining students and faculty of color was the one culture they had not examined, it’s White culture. It’s our way of being in the world, our set of values. And the invitation they issued is very much like the invitation we as White people have issued since the Civil Rights Act, which is, come be like us. Don’t bring your ways of being, don’t bring your ways of knowing, come be like us.

Unsurprising Disparities

When you consider how intensely personal matters of health and obesity are, the disparities in obesity and obesity care are unsurprising. Trust and respect are essential in healthcare. They’re even more essential in obesity care. To say the least, systemic racism undermines trust for Black and Latino patients. Racism makes disparities in obesity inevitable.

We need to reset our thinking. Professor Jamy Ard, Director of Weight Management at Wake Forest, recently explained:

Our conversations on obesity prevention have an inherent assumption of some level of control or agency. A lot of Black people don’t have this agency – we operate in a space where fate and external actors seem to drive our outcomes rather than individual choices. While the events of recent weeks highlight this, we all know it’s always been this way. If you feel your individual choices can be easily overridden or nullified by someone else, you lose faith that your choices will matter. So when everyone in your family has obesity and diabetes, you have no expectation that it will be different for you.

Racism thus systematically produces health disparities – especially in obesity. We must each ask ourselves, what are we actually doing to oppose racism? It is not enough to tell ourselves we have “not a racist bone in our body.”

Click here for the full interview with Suzanne Plihcik and here for the review by Bird, Toth, and Stanford. For more on systemic racism in healthcare, click here.

Black Lives Matter Plaza, photograph © Victoria Pickering / flickr

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June 22, 2020