Study: What Does Race Have to Do With Obesity Counseling?

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Nobody has to be convinced that obesity is a problem — doctors have made it clear that excess weight leads to a host of health risks, and even raises the chance of early death compared to normal-weighted individuals. Given the poorer health — and occasional social discrimination — faced by many obese people, a team lead by Sara Bleich at Johns Hopkins Bloomberg School of Public Health decided to see if racial disparities in providing care exacerbated existing challenges faced by obese patients during regular doctors’ visits.

Overall, only 30% of obese Americans actually receive a diagnosis of obesity from their primary physician and only a third are advised by their doctor to improve their nutrition, exercise or lose weight.  But Bleich and team assumed that racial concordance — when a doctor and patient are of the same race — would improve these odds, based on other recent research that has shown a connection between racial congruity and improved care. They were shocked to find that obesity related counseling was poor across the board, and even worse for black patients than white ones, regardless of their doctors’ racial identities. (More on The Complicated Link Between Wealth and Obesity)

Using data from the National Ambulatory Medical Care Surveys (NAMCS) between 2005—2007, the team looked at 2,231 visits of black and white obese patients to their black and white primary care doctors. The researchers looked at race concordance and the incidence of doctor-initiated discussions on three types of weight counseling: nutrition, exercise and weight reduction. Overall, black patients were less likely to receive counseling on weight reduction and exercise than their white counterparts, regardless of the physician’s race. In particular, white doctors were unlikely to counsel black patients on exercise.

“Physicians in general often have negative perceptions of black patients and a lack of sensitivity to the underlying health challenges they face,” said Bleich, who is an assistant professor in the department of Health Policy and Management. “There’s some evidence that many physicians believe that black patients have fewer resources available to them, so they may be less likely to recommend going to a gym or devoting time to exercise because they don’t think that’s within [the patient’s] reach.” (More on Patients Eligible for Weight-Loss Surgery May Double)

That will sound familiar to all obese patients, who are often dismissed by primary care physicians. The authors wrote:

Patient–physician communication and relationship problems may influence obesity care. For example, obese patients are more likely to report trying to lose weight or exercising regularly than nonobese patients, but physicians are less likely to perceive obese patients as engaging in those activities. Groups who are at higher risk for obesity are not more likely to receive exercise, diet, or weight-reduction counseling from their physician.

One reason for the lack of primary care doctor engagement in weight issues may be due to a gap in medical school training combined with a lack of time and resources in clinic. Obesity counseling is essentially behavior modification counseling, which is time-consuming — there’s no uniform way to lose weight, no prescription to write. Each patient may have a different underlying cause that physicians can only glean by spending time in discussion with a patient. GPs may simply not have the time to devote to this complex issue. (More on Study: Obese Workers Cost Employers $73 Billion Per Year)

Given the time constraints for proper weight counseling, Bleich recommends that the care come from a different source within the same office. “The counseling could still be in the context of clinical practice, but rather than getting some referral, there should be an incorporation of nutritionists. That way, the physician can keep a close eye on the issue, but it’s not their responsibility to offer counseling.”

Because obesity is associated with a host of chronic conditions like diabetes, sleep apnea and high blood pressure and costs the United States as much as $270 million dollars in associated health care costs and lost productivity, according to a recent calculation, that’s a suggestion worth considering. The study appears this month in the journal Obesity.

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