Obesity Counseling: Is Race a Factor?

Most people know that the US is struggling to contain a surging epidemic of obesity, and that the problem is most acute among African-Americans. Whereas about 27% of all adult Americans are obese (defined as having a body mass index of 30 or more), fully 37% of African-American adults are obese, and that number jumps to an appalling 42% among African-American women.

Over the years, public health officials have provided evidence that socioeconomic and cultural factors drive this racial disparity. Now, a new study suggests there is another reason as well: obese African-Americans receive less obesity-related counseling than their white counterparts, and it matters not whether the physicians they see are African-American or white.

To reach these conclusions, Sara Bleich and colleagues from the Johns Hopkins School of Public Health used clinical encounter data from the 2005–2007 National Ambulatory Medical Care Surveys (NAMCS). The sample included 2,231 visits involving African-American and white obese people who were at least 20 years old and who visited family practitioners and internists that were either African-American or white. Asian and Hispanic patients and physicians were excluded from the study because their numbers were too small to permit hypothesis testing.

For each encounter in the study, the scientists determined whether the patient received guidance on weight reduction, diet and nutrition, or exercise from his or her physician.

It turned out that African-American patients received weight-loss counseling about half as often as white patients did, regardless of whether the physician was African-American or white. Worse yet, African-Americans were only about one-third as likely as their white counterparts to receive advice about exercise from their physicians—once again, regardless of the physicians’ race.

Bleich’s group presented 3 hypotheses to explain their findings. First, physicians may tend not to believe that African-Americans will heed their advice. Second, African-American physicians may curtail such counseling in attempt to be “culturally sensitive” to their African-American patients. Third physicians may not have the resources or proper training to counsel patients about these issues, no matter what their race might be.

“Future work,” the scientists wrote, “should examine similarities and differences in the contribution of patient, clinician, and health system factors to low levels of weight-related counseling among patients of different ethnic groups.”