Over the past twenty years, there has been a dramatic increase in obesity in the United States. Studies have shown that blacks are disproportionately impacted by obesity — 44 percent of black adults are obese compared to 33 percent of white adults.
A new study from the Bloomberg School of Public Health examined the role of patient-physician communication in the observed racial disparity and found that black patients were less likely to receive exercise and weight-reduction counseling when they visit the doctor.
Obesity, defined as a BMI greater than or equal to 30, also constitutes a major risk factor for cardiovascular disease, certain types of cancer and type II diabetes. Obesity is estimated to cost 147 billion dollars annually and is associated with annual medical costs which are 42 percent higher than among healthy weight individuals.
Increasing evidence shows that the care given for obesity is second-rate for many African American patients. For instance, most obese patients do not receive an obesity diagnosis when they visit their doctor.
Research shows that one of the most important factors that can improve obesity care is patient-physician communication. For instance, one study shows physicians are more likely to believe their patients when they say that they are trying to lose weight or exercise regularly if they are not obese.
Studies from 2003-2006 show that the proportion of obese adults told that they were overweight was significantly lower for blacks than for whites; this may be explained by suboptimal obesity care for blacks.
Increasing attention has been directed towards one factor that may cause poor communication race concordance between patients and clinicians — race concordance.
Previous studies have shown that patients in race-concordant relationships with their physicians, or patients who have doctors who are the same race as they are, receive better quality of care, have longer visits and more participatory decision-making, more timely receipt of treatment, greater use of needed medical services, less delay in seeking care, more preventative care and greater patient satisfaction with their provider and healthcare.
A group of researchers, led by Sara N. Bleich, assistant professor of Health Policy and Management at the Bloomberg School of Public Health, sought to explore these relationships specifically focusing on obesity care.
Using data obtained from the 2005-2007 National Ambulatory Medical Care Surveys (NAMCS), the team analyzed over 22,000 patients over the age of 20 who were seeing physicians in the specialties of general or family practice and general internal medicine.
The results revealed that race concordance did not play a significant role in determining the quality of obesity care among patients.
Overall, the study showed that visits by black patients include less exercise counseling than visits by white patients when they see white doctors and less weight-reduction counseling than white patients when they see black doctors.
“It totally surprised me,” Bleich said in an interview with the Baltimore Sun. “I went in thinking race concordance would matter. Some studies say it has a positive impact; some say it’s negative. But my sense was that it would matter. But what was super-surprising was if you are a black, obese patient, you are less likely in general to get care, and that was really discouraging.”
Besides race concordance, which proved to be insignificant, several reasons were proposed for why black, obese patients might receive less obesity care than white, obese patients.
Some studies suggest that physicians hold more negative perceptions about likelihood of adherence, engagement in risk behaviors, and social resources available to black patients.
On the other hand, the low rates of weight-reduction counseling among black patients seeing black physicians may also reflect black physicians’ efforts to be culturally sensitive to their black patients. Some studies cite that blacks and whites hold different views of body image and perceptions of overweight and obesity statuses.
Physicians also just may not be getting enough training or resources to provide weight-related counseling to their obese patients, regardless of race.
The finding of low rates of weight-related counseling may be a reflection of general physician stigma toward obesity as well as lower physician respect toward patients with a higher BMI.
Furthermore, other factors including the patient’s gender, age and comorbidity risk status as well as characteristics of the clinical encounter such as type of visit, and time spent with the doctor can influence the physician’s decision to give weight-related counseling.
