Street Portrait 2017

Disparities in Obesity Care: The Will and the Way

A powerful new study in the New England Journal of Medicine tell us it’s possible. Health coaches can deliver effective obesity care in mostly Black and underserved populations. In this randomized study, patients achieved and maintained a healthier weight status after two years. But without the intervention of health coaches, the control group did not. So disparities in obesity care do not exist for the lack of a way to do better.

The question, then, is simple. Do we have the will to deliver better access to obesity care?

A Cluster Randomized Study

This study is powerful because it is so well designed and executed. Researchers randomly assigned a total of 18 clinics to deliver either standard care or intensive behavioral therapy. Health coaches embedded in the clinics delivered the lifestyle program. In total, 803 patients living with obesity received treatment in this study. The clinics were primary clinics in both urban and rural communities of Louisiana. Two thirds of patients were Black.

Randomizing a study between clinics requires special care. This design is called a cluster randomization. When researchers are not careful with this design, they can wind up with meaningless results. But Peter Katzmarzyk et al did just the opposite, consulting with experts on this technique.

After two years, patients in the clinics with health coaches achieved and maintained a five percent lower body weight. That’s enough to significantly improve cardiometabolic health. However, patients in the control group experienced almost no change. Their weight on average was only 0.48 percent lower.

The bottom line is simple, as Tom Wadden and Adam Tsai explain:

This well-conducted trial clearly shows that socioeconomically disadvantaged persons can lose clinically meaningful amounts of weight when provided with intensive behavioral therapy in primary care settings.

Their comments appear in an editorial alongside this study.


We’ve long noted that willpower is a favorite old trope employed to blame patients who do not cure themselves of obesity. Certainly, when it comes to obesity, we do see a lack of will. That deficit comes not from patients. Rather it lies in our health systems that deny patients the access to effective care.

Access to effective obesity care is especially poor for Black and low-income patients. So the huge disparities we see in obesity are not surprising. Overall obesity prevalence is 42 percent. But for Black women it is 57 percent.

We can address the disparities in obesity care if we will. Or we can continue to exhaust our healthcare budgets by paying for the complications of untreated obesity. Can we muster the will to do better?

Click here for the study and here for the editorial.

Street Portrait 2017, photograph © Johnny Silvercloud / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


September 4, 2020

2 Responses to “Disparities in Obesity Care: The Will and the Way”

  1. September 04, 2020 at 8:21 am, Mary-Jo said:

    Thanks for sharing this study. It made me think of something I read recently, “Medical care is so much more than medicine — it’s about letting people know they matter.” Wade Davis, Professor Davis, a noted anthropologist, talks about how concerning it is for people in the USA and other countries who don’t get access to care because they can’t afford it And how it creates even more disparities in opportunity, in health, in quality of life. When people are given some quality time and attention, good education, great support, enough follow-up to feel good that what they learned is mastered in practical terms, for longer-lasting, do-able, sustained practice with tools to handle blips, well, it has to be better in so many ways than leaving people with obesity to fend for themselves, rudderless, feeling uncared for, that they don’t matter unless they just get strong and eat less and move more!

  2. September 04, 2020 at 1:18 pm, John DiTraglia said:

    ok stipulated. But this and other studies agree that the first thing you have to get your pt to understand is that this is expensive and a big time and effort commitment forever for a potential benefit of 5% wt loss and the included metabolic and life preserving benefits.