Racial Disparities in Obesity Treatment
Purpose of Review
Obesity rates in the USA have reached pandemic levels with one third of the population with obesity in 2015–2016 (39.8% of adults and 18.5% of youth). It is a major public health concern, and it is prudent to understand the factors which contribute. Racial and ethnic disparities are pronounced in both the prevalence and treatment of obesity and must be addressed in the efforts to combat obesity.
Disparities in prevalence of obesity in racial/ethnic minorities are apparent as early as the preschool years and factors including genetics, diet, physical activity, psychological factors, stress, income, and discrimination, among others, must be taken into consideration. A multidisciplinary team optimizes lifestyle and behavioral interventions, pharmacologic therapy, and access to bariatric surgery to develop the most beneficial and equitable treatment plans.
The reviewed studies outline disparities that exist and the impact that race/ethnicity have on disease prevalence and treatment response. Higher prevalence and reduced treatment response to lifestyle, behavior, pharmacotherapy, and surgery, are observed in racial and ethnic minorities. Increased research, diagnosis, and access to treatment in the pediatric and adult populations of racial and ethnic minorities are proposed to combat the burgeoning obesity epidemic and to prevent increasing disparity.
KeywordsObesity Overweight Race Ethnicity Genetics Weight loss medications Bariatric surgery Disparities Socioeconomic status
Compliance with Ethical Standards
Conflicts of Interest
Angel S. Byrd, Alexander T. Toth, and Fatima Cody Stanford declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Hudda MT, Nightingale CM, Donin AS, Owen CG, Rudnicka AR, Wells JCK, et al. Patterns of childhood body mass index (BMI), overweight and obesity in South Asian and black participants in the English National child measurement programme: effect of applying BMI adjustments standardizing for ethnic differences in BMI-body fatness associations.: Int J Obes. (London) 2017. https://doi.org/10.1038/ijo.2017.272.
- 4.•• Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. 2017;(288):1–8. Key findings from the NHANES study that overall prevalence of obesity is higher among non-Hispanic black and Hispanic adults than among non-Hispanic white and non-Hispanic Asian adults. Google Scholar
- 5.• Tauqeer Z, Gomez G, Stanford FC. Obesity in women: Insights for the clinician. J Women's Health (Larchmt). 2017. https://doi.org/10.1089/jwh.2016.6196. Obesity is more prevalent among women than men and requires unique considerations particularly in women of child bearing age.
- 18.• An R. Racial/ethnic disparity in obesity among US youth, 1999–2013. Int J Adolesc Med Health. 2015;29(4). https://doi.org/10.1515/ijamh-2015-0068. Disparities in obesity persist based on racial and ethnic differences and have not improved during the period from 1999–2013.
- 19.• Hawkins SS, Rifas-Shiman SL, Gillman MW, Taveras EM. Racial differences in crossing major growth percentiles in infancy. Arch Dis Child. 2017. https://doi.org/10.1136/archdischild-2016-311238 Suggests that rapid weight gain in infancy is more harmful in black than white children in regards to risk for obesity later on in life.
- 22.•• Hill SE, Bell C, Bowie JV, Kelley E, Furr-Holden D, LaVeist TA, et al. Differences in obesity among men of diverse racial and ethnic background. Am J Mens Health. 2017;11(4):984–9. Confirms that men born outside of the United States of the same racial/ethnic group are less likely to have obesity than those born in the United States and distinguishes Hispanic men of Puerto Rican and Mexican origin or ancestry as having increased obesity prevalence among hispanics. CrossRefPubMedGoogle Scholar
- 28.•• Chen G, Doumatey AP, Zhou J, Lei L, Bentley AR, Tekola-Ayele F, et al. Genome-wide analysis identifies an african-specific variant in SEMA4D associated with body mass index. Obesity (Silver Spring). 2017;25(4):794–800. Highlights a possible genetic explanation for increased observed obesity rates in African Americans based on increased levels of the SEMA4D protein. CrossRefGoogle Scholar
- 35.• Leonard SA, Petito LC, Stephansson O, Hutcheon JA, Bodnar LM, Mujahid MS, et al. Weight gain during pregnancy and the black-white disparity in preterm birth. Ann Epidemiol. 2017;27(5):323–8.e1. Disparities exist between black and white women in gestational weight gain and pre-term birth rates. CrossRefPubMedGoogle Scholar
- 36.• Headen I, Mujahid MS, Cohen AK, Rehkopf DH, Abrams B. Racial/ethnic disparities in inadequate gestational weight gain differ by pre-pregnancy weight. Matern Child Health J. 2015;19(8):1672–86. Disparity between black and white women in gestational weight gain varies based on initial weight. CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Kaczynski AT, Besenyi GM, Stanis SA, Koohsari MJ, Oestman KB, Bergstrom R, et al. Are park proximity and park features related to park use and park-based physical activity among adults? Variations by multiple socio-demographic characteristics. Int J Behav Nutr Phys Act. 2014;11:146.CrossRefPubMedPubMedCentralGoogle Scholar
- 43.• Morgan Hughey S, Kaczynski AT, Child S, Moore JB, Porter D, Hibbert J. Green and lean: is neighborhood park and playground availability associated with youth obesity? Variations by gender, socioeconomic status, and race/ethnicity. Prev Med. 2017;95 Suppl:S101–S8. Disparity in the built environments of groups from different social and economic statuses and racial/ethnic differences in access to resources for physical activity influence obesity prevalence. CrossRefPubMedGoogle Scholar
- 46.Nappo A, Iacoviello L, Fraterman A, Gonzalez-Gil EM, Hadjigeorgiou C, Marild S, et al. High-sensitivity C-reactive protein is a predictive factor of adiposity in children: results of the identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) study. J Am Heart Assoc. 2013;2(3):e000101.CrossRefPubMedPubMedCentralGoogle Scholar
- 49.Paltoglou G, Schoina M, Valsamakis G, Salakos N, Avloniti A, Chatzinikolaou A, et al. Interrelations among the adipocytokines leptin and adiponectin, oxidative stress and aseptic inflammation markers in pre- and early-pubertal normal-weight and obese boys. Endocrine. 2017;55(3):925–33.CrossRefPubMedGoogle Scholar
- 50.• Rodgers RF, Peterson KE, Hunt AT, Spadano-Gasbarro JL, Richmond TK, Greaney ML, et al. Racial/ethnic and weight status disparities in dieting and disordered weight control behaviors among early adolescents. Eat Behav. 2017;26:104–7. Racial/ethnic minority adolescents are at an increased risk for harmful weight control behaviors than other groups. CrossRefPubMedGoogle Scholar
- 56.•• Cozier YC, Yu J, Coogan PF, Bethea TN, Rosenberg L, Palmer JR. Racism, segregation, and risk of obesity in the Black Women’s Health Study. Am J Epidemiol. 2014;179(7):875–83. Provides evidence that racism and experiences of racism contribute to the higher incidence of obesity among African American Women. CrossRefPubMedPubMedCentralGoogle Scholar
- 63.• Ard JD, Carson TL, Shikany JM, Li Y, Hardy CM, Robinson JC, et al. Weight loss and improved metabolic outcomes amongst rural African American women in the Deep South: six-month outcomes from a community-based randomized trial. J Intern Med. 2017;282(1):102–13. Increased access to high-intensity behavioral interventions may be achieved by training lay health staff using community based treatment approaches but these approaches need further research as they do not show improved results compared to traditional approaches. CrossRefPubMedGoogle Scholar
- 74.• Zhang C, Gao F, Luo H, Zhang CT, Zhang R. Differential response in levels of high-density lipoprotein cholesterol to one-year metformin treatment in prediabetic patients by race/ethnicity. Cardiovasc Diabetol. 2015;14:79. Reports differing responses to metformin based on race/ethnicity, and highlights the need to study the effects of different medications in different racial and ethnic groups. CrossRefPubMedPubMedCentralGoogle Scholar
- 77.Nostedt JJ, Switzer NJ, Gill RS, Dang J, Birch DW, de Gara C, et al. The effect of bariatric surgery on the spectrum of fatty liver disease. Can J Gastroenterol Hepatol. 2012;2016:2059245.Google Scholar
- 83.•• Stanford FC, Jones DB, Schneider BE, Blackburn GL, Apovian CM, Hess DT, et al. Patient race and the likelihood of undergoing bariatric surgery among patients seeking surgery. Surg Endosc. 2015;29(9):2794–9. Race/Ethnicity are not associated with decisions to proceed with surgery once the option is available, highlights the need for increased access to surgery as a treatment in racial and ethnic minorities. CrossRefPubMedGoogle Scholar
- 85.• Ng J, Seip R, Stone A, Ruano G, Tishler D, Papasavas P. Ethnic variation in weight loss, but not co-morbidity remission, after laparoscopic gastric banding and Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2015;11(1):94–100. Weight loss surgery was found to produce less weight loss in African American patients than in Whites however no difference in remission of comorbidities was found highlighting the importance of continuing to increase access to bariatric surgery procedures among racial/ethnic minority groups. CrossRefPubMedGoogle Scholar
- 87.•• Istfan N, Anderson WA, Apovian C, Ruth M, Carmine B, Hess D. Racial differences in weight loss, hemoglobin A1C, and blood lipid profiles after Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2016;12(7):1329–36. Found that weight loss surgery resulted in an improvement in hemoglobin A1C levels among African American, Hispanic, and white patients but that 2 years post op African American patients had much higher increases of hemoglobin A1C levels, showing that differences persist among patients based on race and ethnicity in how they respond to weight loss surgery and that more research is needed to understand long-term differences that may have a basis in racial/ethnic group. CrossRefPubMedGoogle Scholar