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Disparities in Treatment Uptake and Outcomes of Patients with Obesity in the USA

  • Obesity Treatment (CM Apovian, Section Editor)
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Abstract

There are clear and persistent disparities in obesity prevalence within the USA. Some of these disparities fall along racial/ethnic lines; however, there are a number of other social and demographic constructs where obesity disparities are present. In addition to differing rates of obesity across groups, there is growing evidence that subgroups of patients both seek out and respond to obesity treatment differently. This review article explores the epidemiology of obesity disparities, as well as the existing evidence around how different groups may respond to behavioral, medical, and surgical therapies, and potential reasons for differential uptake and response, from culture, to access, to physiology. We find that the vast majority of evidence in this area has focused on the observation that African Americans tend to lose less weight in clinical trials compared to non-Hispanic whites and mainly pertains to behavioral interventions. Moving forward, there will be a need for studies that broaden the notion of health disparity beyond just comparing African Americans and non-Hispanic whites. Additionally, a more thorough examination of the potential for disparate outcomes after medical and surgical treatments of obesity is needed, coupled with the careful study of possible physiologic drivers of differential treatment response.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Fujioka K. Safety and tolerability of medications approved for chronic weight management. Obesity (Silver Spring). 2015;23 Suppl 1:S7–11.

    Article  Google Scholar 

  2. Ogden C, Carroll M. Prevalence of overweight, obesity and extreme obesity among adults: United States, trends 1960-1962 through 2007-2008. National Center for Health Statistics; 2010. http://198.246.102.49/nchs/data/hestat/obesity_adult_07_08/obesity_adult_07_08.pdf

  3. Johnson NB, Hayes LD, Brown K, Hoo EC, Ethier KA, Centers for Disease C, et al. CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors—United States, 2005-2013. MMWR Surveill Summ. 2014;63 Suppl 4(3).

  4. Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes (Lond). 2013;37(6):889–91.

    Article  CAS  Google Scholar 

  5. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Wang Y, Beydoun MA. The obesity epidemic in the United States—gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 2007;29:6–28.

    Article  CAS  PubMed  Google Scholar 

  7. Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in adults: United States, 2005-2008. NCHS Data Brief. 2010;50:1–8.

    PubMed  Google Scholar 

  8. Chang VW, Lauderdale DS. Income disparities in body mass index and obesity in the United States, 1971-2002. Arch Intern Med. 2005;165(18):2122–8.

    Article  PubMed  Google Scholar 

  9. Zhang Q, Wang Y. Trends in the association between obesity and socioeconomic status in U.S. adults: 1971 to 2000. Obes Res. 2004;12(10):1622–32.

    Article  PubMed  Google Scholar 

  10. Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics. 2006;117(2):417–24.

    Article  PubMed  Google Scholar 

  11. Befort CA, Nazir N, Perri MG. Prevalence of obesity among adults from rural and urban areas of the United States: findings from NHANES (2005-2008). J Rural Health. 2012;28(4):392–7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Garland-Forshee RY, Fiala SC, Ngo DL, Moseley K. Sexual orientation and sex differences in adult chronic conditions, health risk factors, and protective health practices, Oregon, 2005-2008. Prev Chronic Dis. 2014;11:E136.

    Article  PubMed  PubMed Central  Google Scholar 

  13. DEH M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10(1):52–77.

    Article  Google Scholar 

  14. Wingo BC, Carson TL, Ard J. Differences in weight loss and health outcomes among African Americans and whites in multicentre trials. Obes Rev. 2014;15 Suppl 4:46–61.

    Article  PubMed  Google Scholar 

  15. Morales KH, Kumanyika SK, Fassbender JE, Good J, Localio AR, Wadden TA. Patterns of weight change in black Americans: pooled analysis from three behavioral weight loss trials. Obesity (Silver Spring). 2014;22(12):2632–40.

    PubMed Central  Google Scholar 

  16. West DS, Elaine Prewitt T, Bursac Z, Felix HC. Weight loss of black, white, and Hispanic men and women in the Diabetes Prevention Program. Obesity (Silver Spring). 2008;16(6):1413–20.

    Article  Google Scholar 

  17. Tussing-Humphreys LM, Fitzgibbon ML, Kong A, Odoms-Young A. Weight loss maintenance in African American women: a systematic review of the behavioral lifestyle intervention literature. J Obes. 2013;2013:437369.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bennett GG, Foley P, Levine E, Whiteley J, Askew S, Steinberg DM, et al. Behavioral treatment for weight gain prevention among black women in primary care practice: a randomized clinical trial. JAMA Intern Med. 2013;173(19):1770–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Newton RL, Griffith DM, Kearney WB, Bennett GG. A systematic review of weight loss, physical activity and dietary interventions involving African American men. Obes Rev. 2014;15 Suppl 4:93–106.

    Article  PubMed  Google Scholar 

  20. Poston WS, Reeves RS, Haddock CK, Stormer S, Balasubramanyam A, Satterwhite O, et al. Weight loss in obese Mexican Americans treated for 1-year with orlistat and lifestyle modification. Int J Obes Relat Metab Disord. 2003;27(12):1486–93.

    Article  CAS  PubMed  Google Scholar 

  21. McMahon FG, Fujioka K, Singh BN, Mendel CM, Rowe E, Rolston K, et al. Efficacy and safety of sibutramine in obese white and African American patients with hypertension: a 1-year, double-blind, placebo-controlled, multicenter trial. Arch Intern Med. 2000;160(14):2185–91.

    Article  CAS  PubMed  Google Scholar 

  22. Osei-Assibey G, Adi Y, Kyrou I, Kumar S, Matyka K. Pharmacotherapy for overweight/obesity in ethnic minorities and White Caucasians: a systematic review and meta-analysis. Diabetes Obes Metab. 2011;13(5):385–93.

    Article  CAS  PubMed  Google Scholar 

  23. Coleman KJ, Brookey J. Gender and racial/ethnic background predict weight loss after Roux-en-Y gastric bypass independent of health and lifestyle behaviors. Obes Surg. 2014;24(10):1729–36.

    Article  PubMed  Google Scholar 

  24. Coleman KJ, Huang YC, Hendee F, Watson HL, Casillas RA, Brookey J. Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system. Surg Obes Relat Dis. 2014;10(3):396–403.

    Article  PubMed  Google Scholar 

  25. Buffington CK, Marema RT. Ethnic differences in obesity and surgical weight loss between African-American and Caucasian females. Obes Surg. 2006;16(2):159–65.

    Article  PubMed  Google Scholar 

  26. Nguyen GC, Patel AM. Racial disparities in mortality in patients undergoing bariatric surgery in the USA. Obes Surg. 2013;23(10):1508–14.

    Article  PubMed  Google Scholar 

  27. Osei-Assibey G, Kyrou I, Adi Y, Kumar S, Matyka K. Dietary and lifestyle interventions for weight management in adults from minority ethnic/non-White groups: a systematic review. Obes Rev. 2010;11(11):769–76.

    Article  CAS  PubMed  Google Scholar 

  28. Gudzune KA, Bleich SN, Clark JM. Efficacy of commercial weight-loss programs. Ann Intern Med. 2015;163(5):399.

    Article  PubMed  Google Scholar 

  29. Bennett GG, Warner ET, Glasgow RE, Askew S, Goldman J, Ritzwoller DP, et al. Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Arch Intern Med. 2012;172(7):565–74.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sciamanna CN, Tate DF, Lang W, Wing RR. Who reports receiving advice to lose weight? Results from a multistate survey. Arch Intern Med. 2000;160(15):2334–9.

    Article  CAS  PubMed  Google Scholar 

  31. Dutton GR, Herman KG, Tan F, Goble M, Dancer-Brown M, Van Vessem N, et al. Patient and physician characteristics associated with the provision of weight loss counseling in primary care. Obes Res Clin Pract. 2014;8(2):e123–30.

    Article  PubMed  Google Scholar 

  32. Worni M, Guller U, Maciejewski ML, Curtis LH, Gandhi M, Pietrobon R, et al. Racial differences among patients undergoing laparoscopic gastric bypass surgery: a population-based trend analysis from 2002 to 2008. Obes Surg. 2013;23(2):226–33.

    Article  PubMed  Google Scholar 

  33. Duncan CL, Cummings SR, Hudes ES, Zahnd E, Coates TJ. Quitting smoking: reasons for quitting and predictors of cessation among medical patients. J Gen Intern Med. 1992;7(4):398–404.

    Article  CAS  PubMed  Google Scholar 

  34. Durant NH, Bartman B, Person SD, Collins F, Austin SB. Patient provider communication about the health effects of obesity. Patient Educ Couns. 2009;75(1):53–7.

    Article  PubMed  Google Scholar 

  35. Wong MS, Gudzune KA, Bleich SN. Provider communication quality: influence of patients’ weight and race. Patient Educ Couns. 2015;98(4):492–8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bleich SN, Simon AE, Cooper LA. Impact of patient-doctor race concordance on rates of weight-related counseling in visits by black and white obese individuals. Obesity (Silver Spring). 2012;20(3):562–70.

    Article  Google Scholar 

  37. Safran DG, Taira DA, Rogers WH, Kosinski M, Ware JE, Tarlov AR. Linking primary care performance to outcomes of care. J Fam Pract. 1998;47(3):213–20.

    CAS  PubMed  Google Scholar 

  38. Mostashari F, Riley E, Selwyn PA, Altice FL. Acceptance and adherence with antiretroviral therapy among HIV-infected women in a correctional facility. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18(4):341–8.

    Article  CAS  PubMed  Google Scholar 

  39. Ayanian JZ, Cleary PD, Weissman JS, Epstein AM. The effect of patients’ preferences on racial differences in access to renal transplantation. N Engl J Med. 1999;341(22):1661–9.

    Article  CAS  PubMed  Google Scholar 

  40. Connelly JE, Campbell C. Patients who refuse treatment in medical offices. Arch Intern Med. 1987;147(10):1829–33.

    Article  CAS  PubMed  Google Scholar 

  41. Jih J, Mukherjea A, Vittinghoff E, Nguyen TT, Tsoh JY, Fukuoka Y, et al. Using appropriate body mass index cut points for overweight and obesity among Asian Americans. Prev Med. 2014;65:1–6.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Lebrun LA, Chowdhury J, Sripipatana A, Nair S, Tomoyasu N, Ngo-Metzger Q. Overweight/obesity and weight-related treatment among patients in U.S. federally supported health centers. Obes Res Clin Pract. 2013;7(5):e377–90.

    Article  PubMed  Google Scholar 

  43. Larson NI, Story MT, Nelson MC. Neighborhood environments: disparities in access to healthy foods in the U.S. Am J Prev Med. 2009;36(1):74–81.

    Article  PubMed  Google Scholar 

  44. Boone-Heinonen J, Diez-Roux AV, Goff DC, Loria CM, Kiefe CI, Popkin BM, et al. The neighborhood energy balance equation: does neighborhood food retail environment + physical activity environment = obesity? The CARDIA study. PLoS One. 2013;8(12):e85141.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Lynch CS, Chang JC, Ford AF, Ibrahim SA. Obese African-American women’s perspectives on weight loss and bariatric surgery. J Gen Intern Med. 2007;22(7):908–14.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Golden SH, Brown A, Cauley JA, Chin MH, Gary-Webb TL, Kim C, et al. Health disparities in endocrine disorders: biological, clinical, and nonclinical factors—an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2012;97(9):E1579–639.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Schneider EC, Zaslavsky AM, Epstein AM. Racial disparities in the quality of care for enrollees in Medicare managed care. JAMA. 2002;287(10):1288–94.

    Article  PubMed  Google Scholar 

  48. Dorsey RR, Eberhardt MS, Ogden CL. Racial/ethnic differences in weight perception. Obesity (Silver Spring). 2009;17(4):790–5.

    Article  Google Scholar 

  49. Desmond SM, Price JH, Hallinan C, Smith D. Black and white adolescents’ perceptions of their weight. J Sch Health. 1989;59(8):353–8.

    Article  CAS  PubMed  Google Scholar 

  50. Rand CS, Kuldau JM. Morbid obesity: a comparison between a general population and obesity surgery patients. Int J Obes Relat Metab Disord. 1993;17(11):657–61.

    CAS  PubMed  Google Scholar 

  51. Kahn HS, Williamson DF, Stevens JA. Race and weight change in US women: the roles of socioeconomic and marital status. Am J Public Health. 1991;81(3):319–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Kumanyika SK, Obarzanek E, Stevens VJ, Hebert PR, Whelton PK, Kumanyaka SK. Weight-loss experience of black and white participants in NHLBI-sponsored clinical trials. Am J Clin Nutr. 1991;53(6 Suppl):1631S–8S.

    CAS  PubMed  Google Scholar 

  53. Pérez-Escamilla R. Acculturation, nutrition, and health disparities in Latinos. Am J Clin Nutr. 2011;93(5):1163S–7S.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Rittner B, Kirk AB. Health care and public transportation use by poor and frail elderly people. Soc Work. 1995;40(3):365–73.

    CAS  PubMed  Google Scholar 

  55. Bennett GG, Steinberg DM, Stoute C, Lanpher M, Lane I, Askew S, et al. Electronic health (eHealth) interventions for weight management among racial/ethnic minority adults: a systematic review. Obes Rev. 2014;15 Suppl 4:146–58. This systematic review looks at the evidence for efficacy of electronic health interventions for weight management studied in groups of racial/ethnic minorities.

    Article  CAS  PubMed  Google Scholar 

  56. DeLany JP, Jakicic JM, Lowery JB, Hames KC, Kelley DE, Goodpaster BH. African American women exhibit similar adherence to intervention but lose less weight due to lower energy requirements. Int J Obes (Lond). 2014;38(9):1147–52.

    Article  CAS  Google Scholar 

  57. Jakicic JM, Wing RR. Differences in resting energy expenditure in African-American vs Caucasian overweight females. Int J Obes Relat Metab Disord. 1998;22(3):236–42.

    Article  CAS  PubMed  Google Scholar 

  58. Sharp TA, Bell ML, Grunwald GK, Schmitz KH, Sidney S, Lewis CE, et al. Differences in resting metabolic rate between white and African-American young adults. Obes Res. 2002;10(8):726–32.

    Article  PubMed  Google Scholar 

  59. Weyer C, Snitker S, Bogardus C, Ravussin E. Energy metabolism in African Americans: potential risk factors for obesity. Am J Clin Nutr. 1999;70(1):13–20.

    CAS  PubMed  Google Scholar 

  60. Weinsier RL, Hunter GR, Schutz Y, Zuckerman PA, Darnell BE. Physical activity in free-living, overweight white and black women: divergent responses by race to diet-induced weight loss. Am J Clin Nutr. 2002;76(4):736–42.

    CAS  PubMed  Google Scholar 

  61. Weinsier RL, Hunter GR, Zuckerman PA, Redden DT, Darnell BE, Larson DE, et al. Energy expenditure and free-living physical activity in black and white women: comparison before and after weight loss. Am J Clin Nutr. 2000;71(5):1138–46.

    CAS  PubMed  Google Scholar 

  62. Storlien L, Oakes ND, Kelley DE. Metabolic flexibility. Proc Nutr Soc. 2004;63(2):363–8.

    Article  CAS  PubMed  Google Scholar 

  63. Berk ES, Kovera AJ, Boozer CN, Pi-Sunyer FX, Albu JB. Metabolic inflexibility in substrate use is present in African-American but not Caucasian healthy, premenopausal, nondiabetic women. J Clin Endocrinol Metab. 2006;91(10):4099–106.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Gower BA, Ard JD, Hunter GR, Fernandez J, Ovalle F. Elements of the metabolic syndrome: association with insulin sensitivity and effects of ethnicity. Metab Syndr Relat Disord. 2007;5(1):77–86.

    Article  CAS  PubMed  Google Scholar 

  65. Haffner SM, D’Agostino R, Saad MF, Rewers M, Mykkanen L, Selby J, et al. Increased insulin resistance and insulin secretion in nondiabetic African-Americans and Hispanics compared with non-Hispanic whites. The Insulin Resistance Atherosclerosis Study. Diabetes. 1996;45(6):742–8.

    Article  CAS  PubMed  Google Scholar 

  66. Ellis AC, Alvarez JA, Granger WM, Ovalle F, Gower BA. Ethnic differences in glucose disposal, hepatic insulin sensitivity, and endogenous glucose production among African American and European American women. Metabolism. 2012;61(5):634–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, Ludwig DS. Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial. JAMA. 2007;297(19):2092–102.

    Article  CAS  PubMed  Google Scholar 

  68. Gower BA, Goss AM. A lower-carbohydrate, higher-fat diet reduces abdominal and intermuscular fat and increases insulin sensitivity in adults at risk of type 2 diabetes. J Nutr. 2015;145(1):177S–83S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Pittas AG, Roberts SB. Dietary composition and weight loss: can we individualize dietary prescriptions according to insulin sensitivity or secretion status? Nutr Rev. 2006;64(10 Pt 1):435–48.

    Article  PubMed  Google Scholar 

  70. AbouAssi H, Slentz CA, Mikus CR, Tanner CJ, Bateman LA, Willis LH, et al. The effects of aerobic, resistance, and combination training on insulin sensitivity and secretion in overweight adults from STRRIDE AT/RT: a randomized trial. J Appl Physiol. 2015;118(12):1474–82.

    Article  CAS  PubMed  Google Scholar 

  71. Fernandez JR, Pearson KE, Kell KP, Bohan Brown MM. Genetic admixture and obesity: recent perspectives and future applications. Hum Hered. 2013;75(2-4):98–105. The authors of this paper provide a general introduction to the application of genetic admixture in the study of obesity, highlighting some of the progress and challenges of this technique that moves beyond racial categories.

    Article  PubMed  Google Scholar 

  72. Bress A, Kittles R, Wing C, Hooker Jr SE, King A. Genetic ancestry as an effect modifier of naltrexone in smoking cessation among African Americans: an analysis of a randomized controlled trial. Pharmacogenet Genomics. 2015;25(6):305–12.

    Article  CAS  PubMed  Google Scholar 

  73. Kumanyika SK, Whitt-Glover MC, Haire-Joshu D. What works for obesity prevention and treatment in black Americans? Research directions. Obes Rev. 2014;15 Suppl 4:204–12. This paper is an introduction to a full supplement on various aspects of obesity treatment and prevention in African American populations. This introduction provides a framework to consider the issue and summarizes key directions for future research.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Jamy D. Ard.

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Kristina H. Lewis, Shenelle A. Edwards-Hampton, and Jamy D. Ard declare that they have no conflict of interest.

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Lewis, K.H., Edwards-Hampton, S.A. & Ard, J.D. Disparities in Treatment Uptake and Outcomes of Patients with Obesity in the USA. Curr Obes Rep 5, 282–290 (2016). https://doi.org/10.1007/s13679-016-0211-1

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