Healthcare disparities in weight management.
Today I wanted to briefly touch on a topic that was brought up by a member of A Community Wellness Clinic’s Facebook page. She had asked if we could discuss health disparities related to people of color in the United States. I think this is a really great topic considering kind of what we’re dealing with today regarding the Black Lives Matter movement. To be clear A Community Wellness Clinic supports a Black Lives Matter movement because we understand the health disparities typically are tilted towards our patients of color.
I wanted to talk a little bit about the rate of weight issues in the United States and who it affects the most. When we look at the data from the centers for disease control or the CDC, we’re going to see that there’s a higher percentage of black and brown people who have an increased body mass index. Body mass index is basically just a height versus weight calculation that is supposed to give us a good understanding of your risk factors due to your body weight for things like diabetes heart disease etc. It’s not the best number for determining risk factors, but it is a great starting point and a good general screening tool for our primary care providers. So when we say that people of color have a higher BMI, this means they tend to have higher body weights, which also means they have higher incidence of the over 40 different chronic illnesses that problems with weight management can cause. And when I talk about the rate of weight issues in America, I am talking about people with a BMI over 30. That doesn’t include that portion of the patient population that I specialize in, which is those who are may be a little bit overweight but not at the point where they’re in the high risk “obese” category.
The CDC broke down the data a little bit further so we can see a little bit more about who weight actually affects. Issues with weight are the highest in among middle-aged adults aged 40 to 59 years at 44.8%. Non-Hispanic blacks (49.6%) had the highest rates of weight issues, followed by Hispanics (44.8%), and whites (42.2%). Asians (17.4%) tend to have a lower rate of weight issues overall, but they do have a lower threshold for reaching a “risky weight”. We typically diagnose Asians with weight issues at a BMI of 24, rather than the 25 we use for all other ethnicities. This is because Asian population tends to have a smaller body frame and that carries less fat typically, but they also have less risk of hypertension or diabetes due to their genetic makeup.
Fortunately, what we are seeing in the newest healthcare guidelines is that there is more of a emphasis placed on your genetic makeup. I think this is really important because we should be doing medicine that’s geared towards the person not towards a generalized population. In the past many of of our guidelines have been geared towards white men and now researchers are finally starting to look at how ethnicity can play a part in spectrum of the chronic illness that affect population.
Data shows a glaring disparity between people of color and their white counterparts. There are multiple studies that show that if you are on the lower end of the socioeconomic scale, you much more at risk to be overweight. This pattern was observed among non-Hispanic white, non-Hispanic Asian, and Hispanic women. However, for black women, there was NO DIFFERENCE in obesity prevalence by income.
Just think about that….for a black woman it doesn’t matter how much money you make or how much education you have, you will still be struggle with your weight.
Let’s compare this to the fact that only 1% of patients who are actually a candidate for weight loss medication receive this treatment. So essentially, in the healthcare field we are condemning people of color, especially if you’re a black woman, to a life where you struggle not only weight, but you will have a much higher risk of having chronic illnesses like diabetes heart attacks or strokes all because we’re not seeing established racism in our practice.
I’m going to give you another example. When I worked in a big box clinic I asked our medical director if we could replace Band-Aids from the typical white person Band-Aid (you know that flashy color that assumes everyone has white skin color) to a clear Band-Aid. Although our medical director thought this was a great idea, when it was brought up to administration they came back with a “no we can’t do that because it’s too expensive”.
So…..our healthcare administrators are willing to spend lots of time and money on forms that identify health disparities, but we’re not willing to spend the extra few cents to ensure that our people of color feel comfortable with our healthcare community?
Although, I’m extremely proud of being a nurse, I am extremely disappointed that the healthcare system still plays into the color blindness of the United States general population. So the next time you go to your doctors office and you get a flesh colored white person Band-Aid, maybe you could nicely ask them to get any other type of Band-Aid. This may seem like a small step, but really that is part of what it will take for us to stand up for your colored brothers and sisters.
#blm
reference for data: https://www.cdc.gov/obesity/data/adult.html
