From the Obesity Medicine Association


 

While obesity can affect anyone, African-American women have the highest rates. According to recent CDC data, four out of five Black women are overweight or have obesity. These alarming statistics are partially due to the striking disparities in obesity reduction behaviors and obesity interventions for Black women.

Physicians take an oath to “first do no harm.” Failing to address obesity with updated resources is harmful. Yet, according to the NIH research, “Black patients seeing White physicians had a 46% lower likelihood of receiving [obesity] counseling than White patients seen by White physicians.” The preceding is just one example of bias. Studies show clinicians of all ethnicities can have weight bias toward patients with obesity. As clinicians, it is our responsibility to be aware of our biases and educate ourselves on the complexity of obesity. Such knowledge empowers us to address the factors that uniquely impact each person with obesity, including the role of bias and health disparities.

 

The Impact of Culture & Society on Obesity

The latest scientific evidence shows that obesity is a complex disease influenced by many biopsychosocial factors that disrupt the body’s metabolism. Traditionally, factors like psychological stress, sleep hygiene, socioeconomic status, psychological trauma, and racial discrimination have been underappreciated in diagnosing and treating obesity. Each uniquely impacts Black women and obesity, as do cultural expectations and beauty standards. Cultural beauty aesthetics, such as high-maintenance hairstyles and preference for a “curvy figure” can influence obesity rates as much as the pressure to be thin from healthcare and mainstream media.

 

Racial Discrimination, Psychological Stress & Obesity 

Racial discrimination and psychological stress both contribute to obesity. On the individual level, racial discrimination causes psychological stress, which becomes physiological stress. On the molecular level, physiological stress disrupts several essential weight regulatory hormones—such as cortisol, insulin, leptin, and ghrelin—which can lead to obesity.

Systemic racism and racial discrimination also impact obesity on the public health level. These harmful factors affect every aspect of obesity, from individual to systemic influences, such as policy and neighborhood planning. Studies show that Black women disproportionately experience racism and weight bias. Considering the known associations of racism and obesity, this may contribute to the high rates of obesity in Black women.

 

How Healthcare Professionals Can Be More Inclusive 

The first step to more inclusive care is to be aware of biases. Unfortunately, physicians aren’t exempt from bias. Many of the statistics we hear repeatedly influence our preconceptions, such as “Black women have the highest rates of obesity.”

Without contextualizing the contributing factors to high rates of obesity in Black women, one may subconsciously internalize the statistics as “Black women want to have obesity” or “Black women aren’t interested in addressing obesity.” These statements are examples of implicit racial and weight bias, which directly impact the quality of obesity care if left unaddressed. Therefore, it’s essential that clinicians be aware of their misconceptions. To be more inclusive,

  1. Identify your biases. Take an implicit bias test, such as the Harvard Implicit Association Test, which helps highlight your covert biases.
  2. Individualize weight assessment: BMI & waist circumference may need to be adjusted.  Clinicians need to be aware of and appropriately use BMI charts adjusted for age, race, ethnicity, sex, and obesity-related conditions.
  3. Use data as just the start of the discussion. To effectively treat obesity, go beyond the numbers and tailor a comprehensive plan to the individual. Uniquely address individual lifestyle factors, such as home environment, support systems, psychological stress and other pertinent factors.
  4. Incorporate medications, bariatric procedures, or bariatric surgery as indicated. Lifestyle modifications may not be enough to effectively address obesity in some individuals. Obesity treatments are underutilized and can be life changing. Considering the staggering statistics, more Black women with obesity may benefit from medication, bariatric procedures, and bariatric surgery.

 

Obesity Care Requires Support 

Obesity is a complex disease that requires a team-based approach for the most effective intervention. Studies also show that Black women with obesity benefit from supportive programs.

A spectrum of resources is available for primary care physicians to help manage obesity, including obesity specialists, nutritionists, fitness experts, and community-based programs to help coordinate obesity care. Clinicians can access trained obesity medicine specialists through the Obesity Medicine Association’s clinician locator and the American Board of Obesity Medicine’s clinician locator.

To explore best practices for enhancing the treatment of obesity in African-American women, join the upcoming spring conference of the Obesity Medicine Association (OMA), where I will be presenting the session “Obesity & Black Women: What Are We Missing?” Learn more about OMA or become a member at www.obesitymedicine.org/join.