Objective : Over 70% of the adult US population is either overweight or obese, a condition that increases the risk of multiple complications. Despite these risks, very few studies have evaluated patients’ experiences and expectations for weight management with their primary care providers (PCP). We have previously shown that patients with higher BMI are more likely to avoid health care visits, feel judged by their PCP, and are less likely to want to discuss their weight in clinic visits. However, no studies have addressed the influence of economic stability and education (key social determinants of health that contribute to widespread health inequities) on these factors. Therefore, the primary aim of this study was to assess the impact of these factors on healthcare provider weight management advice and patient’s perception of this advice.
Methods : Through the Learning Health System Network (LHSNet), a total of 19,964 surveys were mailed to patients identified as overweight/obese at 5 health care systems across 11 states. Multivariable logistic regression controlling for age, BMI, ethnicity/race, and gender was used to evaluate factors associated with negative patient-health care provider interactions. Of the 2799 surveys, 305(10.9%) were excluded due to incomplete survey data and 155(5.5%) were excluded due to BMI<25. Among the 2339 respondents, 671(28.7%) were overweight, with the remainder classified as obese(27.5% obesity class I;20.9% class II,23.2% class III)
Results : Patients with lower annual income (<$50,000/year) reported that their PCP was less likely to have a current role in their weight management, and that they were less likely to be treated as an equal by their healthcare provider. Patients reporting lower levels of education (High School/GED or less and/or less than 4-year college degree) were also less likely to feel respected, believe that their PCP should have a role in their weight management, has a current role in their weight management, and spent enough time with them providing weight loss advice
Discussion : Several barriers exist between patients’ receiving obesity management per established guidelines, and among these are socioeconomic determinants of health. In this large survey of overweight and obese patients, we found that patients’ perceptions of their experiences and expectations regarding weight management differed according to their degree of economic stability and educational status, even when controlling for ethnicity/race
Conclusion : More resources need to be made available to eliminate these barriers, account for social determinants of health, and create a more productive healthcare environment to address the obesity epidemic
Maryam Taufeeq– Fellow, The Ohio State University, Worthington, Ohio
Kyle Porter– Senior Statistician, The Ohio State University
Irina Haller– Research Scientist, Essentia Health
Kate Bauer– Assistant Proffessor, University of Michigan
Steven Bradley– Cardiologist, Allina Health
Lila Rutten– Consultant, Mayo Clinic
Ivana Croghan– Associate Consultant II-Research, Mayo Clinic
David Bradley– Assistant Proffessor, The Ohio State University
The Ohio State University
Clinical Fellow in training
The Ohio State University
Areas of expertise:
Study design and planning of statistical analyses
Complex modeling for longitudinal and other observational studies and for experimental data with dependency structure
Regression modeling (linear, logistic, Poisson, negative binomial, Cox)
Senior Research Scientist II, Essentia Institute of Rural Health (EIRH), Duluth, MN
University of Michigan
Katherine (Kate) W. Bauer is an epidemiologist whose research focuses on identifying social and behavioral determinants of obesity and obesogenic behavior among children and adolescents, and the translation of this etiologic research into feasible and effective community-based interventions. Much of her work focuses on the role of families in children's and adolescents' obesity risk including understanding 1.) how the family environment influences nutrition, physical activity, and obesity risk among youth; 2.) how socio-ecologic stressors affect weight-related parenting, the family environment, and child behavior and weight; and 3.) how to engage vulnerable families in obesity prevention efforts. She is also interested in the application of causal inference methodologies in pediatric obesity research.
The research of Lila J. Rutten, Ph.D., centers around population-level disease prevention and health promotion and the creation, use, and testing of high-value, patient-centered health care to improve population health and health outcomes. Dr. Rutten directs a program of research in population health science focused on disease prevention and health promotion across the disease continuum.
Associate Consultant II-Research
The research interests of Ivana T. Croghan, Ph.D., focus on the areas of community-based interventions for smoking cessation and obesity. Dr. Croghan studies varied populations, such as women, adolescents, Alaska Natives and other diverse ethnic groups, on an international basis. She is interested in health care disparities as they relate to women and adolescents, as well as disease prevention and control with a specific interest in reducing tobacco exposure and obesity.
Dr. Croghan has administered multisite and multicountry studies, including over 325 prospective clinical trials and more than 100 retrospective trials. She serves on the review board for several journals and has authored more than 138 peer-reviewed manuscripts.
The Ohio State University
Dr. Bradley's research focus is on the complex mechanisms responsible for the metabolic alterations associated with obesity such as type 2 diabetes, sarcopenia and cognitive dysfunction during the aging process. His research utilizes stable isotope tracers and detailed tissue analyses to evaluate cellular and whole-body substrate metabolism in humans. He is particularly interested in developing a more complete understanding of the contribution of inflammation to these disorders.