OW2021: The Equity Problem in Obesity and Healthcare

We have an equity problem – in healthcare generally and in obesity specifically. Diversity, equity, and inclusion have been a key theme running through ObesityWeek® and thus, there’s plenty of content on this subject to absorb from the meeting. We’re just barely beginning to take it all in.

But in a nutshell, serious obesity care has long served mainly white women. Access to care for obesity – generally poor for everyone – is even less for racial and ethnic minorities. Add to that healthcare systems with racism embedded, and it’s little wonder that outcomes for Black and Hispanic persons related to obesity are consistently worse.

Barriers to Bariatric Care

Tuesday, Justin Brown chaired a symposium devoted to the barriers and disparities in bariatric and metabolic surgery. Crystal Johnson-Mann explained how the barriers to obtaining bariatric surgery are even higher for minorities. On top of that, patient and provider perceptions magnify these disparities.

Karen Coleman described the disparities in outcomes by race that are evident for the persons who gain access to care. Black persons tend to lose a bit less weight after bariatric surgery. In addition, they have a slightly higher risk of serious complications. Now it’s worth noting that disparities in healthcare likely account for disparities in bariatric surgery risks. Coleman explained:

“It’s not that Black patients are riskier. It’s that our healthcare system is so racist at its core that it is putting some of our patients at a disadvantage.

“Black patients often come with health conditions that have been untreated for much longer than white patients. Of course this leads to metabolic systems that have been stressed for much longer.”

Monique Hassan explained the origin of these disparities in systemic racism and opportunities to address it on multiple levels. But representation matters greatly, she said.


Representation is necessary. But is it happening in professional organizations that focus on obesity and nutrition? A new paper published simultaneously in AJCN and Obesity suggests this needs work. Two of three major organizations in this field do not even track it. The limited available tracking data points to considerable under representation. Black, Latinx, and Native American persons are significantly under represented among obesity medicine physicians, too. And finally, only one of the three major organizations can report any diversity in presidential leadership for the last decade.

The program at ObesityWeek is full of content on this subject. In particular, key lectures by Monica Baskin and Zinzi Baily demand your attention. Giving it your attention, though, is not enough. Purposeful action is necessary for any of this to change. The equity problem in obesity and healthcare is too great and to costly to accept without acting.

Click here for more on racism as a root cause of health inequities.

Baby, woodcut by MC Escher / WikiArt

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November 5, 2021

2 Responses to “OW2021: The Equity Problem in Obesity and Healthcare”

  1. November 05, 2021 at 9:34 am, Allen Browne said:


    You left out inequities by age. Children with obesity and their families need a voice. Obesity is a disease for children, too. Ignoring the disease in children until they are adults leads to:

    1) More time with disease and time to develop worse disease and complications

    2) More time with bias and stigma

    3) Worse response for metabolic comorbidities when treatment is finally started.

    4) Worse response to economic problems such as becoming a productive, less expensive citizen. I.e. how long should society have to pay more and get less.

    5) Allowing them to get farther from the 95th %tile. We now have safe means to lose 20-30 % TBW, but this means if you are too far from a healthy body composition we cannot get you back to health. This means more and more comorbidities, more and more costs, and less and less productivity

    It doesn’t make sense.


    • November 05, 2021 at 11:59 am, Ted said:

      You’re right, Allen.