La La Land Castle

Disparities in Obesity: The View from an Ivory Tower

This week from the New England Journal of Medicine, a perspective on COVID-19, disparities, nutrition, and obesity popped up. Great! But then we read it. Social determinants of health . . . a healthy diet . . . food deserts . . . minority groups face hurdles. The authors piled on familiar phrases. In sum, it was a decent inventory of presumptions about the roots of disparities in obesity.

Toward the end, these authors finally mentioned racism. But they made no mention of weight bias whatsoever.

All About Us Without Us

This is an important subject. In fact, it’s so important that a complete perspective is imperative. If even one of the authors were Black, the subject of racism would surely emerge more prominently.

It’s both appalling and unsurprising – a homogeneous collection of authors offering opinions about diversity.

A Problem in Academic Medicine

Perhaps this perspective serves an important purpose – to illustrate a problem highlighted in NEJM just a week earlier. Sandra Grubbs wrote:

My pending exodus from academic medicine after 15 years is prompted by my belief that the institutional and systemic racism so obvious to me would never be fully acknowledged, much less addressed. This belief was formed after several experiences that left me – a Black woman – feeling stifled, unheard, unvalidated, unsupported, and concerned for my health.

A recent study in PLoS One found that representation of Blacks and Hispanics in academic medicine is shrinking. Not good.

Presumptions About “Those People”

Thus we have much speculation and presumption. Scholars opine about social, economic, and cultural factors affecting racial and ethnic minorities, perhaps without direct, relevant experiences. But the subject is urgent because of COVID-19. The disparate burden of obesity is contributing to deadly, disparate outcomes.

Academic medicine must do better. NEJM should be leading the way. The journal should publish more diverse perspectives. Directly relevant life experiences matter.

Click here and here for the two perspectives from NEJM. For further perspective on diversity in healthcare, click here.

La La Land Castle, illustration © Sandra Strait / flickr

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July 17, 2020