Jan. 28--Blacks have higher rates of obesity than whites, but doctors of black patients are less likely to counsel them on how to lose weight, according to a recent study from Johns Hopkins researchers that raises thorny questions about racial stereotypes and the stigma of obesity.
The findings troubled researchers who set out to tackle what role race played in weight-loss counseling. Coaching patients to eat better and exercise can help fight obesity, but too often primary-care doctors don't have the time or don't make the effort to do so, said Sara Bleich, assistant professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. That's true of patients regardless of their race, but particularly for black adults, 44 percent of whom are obese. That figure is 33 percent for whites.
Bleich, the study's lead researcher, wondered whether patients would be more likely to receive counseling if doctor and patient were of the same race. For the study, published in this month's online issue of Obesity, she examined records of more than 2,000 doctor visits of black and white adult patients in a national database from 2005 to 2007.
But she found no link. In fact, she discovered that, regardless of a physician's race, black patients were less likely to receive counseling.
"It totally surprised me," she said. "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."
Bleich doesn't know for sure why the disparity exists, but she has some theories. Past studies have shown that doctors tend to have negative perceptions about whether a black patient is likely to follow up with a treatment plan.
"Physicians, regardless of their own race, sometimes have pre-existing opinions of their patients," she said. "Those stereotypes are informing their assumptions about their patients' willingness to reduce their risk."
With obesity being so prevalent in black communities, some health providers think treatment isn't going to be effective, said Dr. Elijah Saunders, a professor of medicine and cardiology at the University of Maryland School of Medicine and an expert on racial health disparities. Saunders called the study discouraging because if they do not get help to control their weight, black patients remain at higher risk for diabetes, high blood pressure and heart problems.
Doctors are aware of the criticism, and there are efforts to increase so-called cultural competency in how medicine is practiced, he said.
"There are groups out there that are spending a lot of time with seminars and workshops looking at sensitivity to minorities, but we are just getting into this," he said. "We have suggested that hospitals and medical societies build sensitivity into their training programs. But first we had to define the problem. I think we have finally convinced the medical establishment of that."
Bleich said other factors could explain why blacks are less likely to get counseling. Black physicians may actually be more culturally sensitive to black patients.
"We know that blacks in general have a different body image -- they tend to favor heavier body types than whites," she said. "It could be black physicians are trying to be more culturally sensitive to black patients because they know this to be true."
Or perhaps physicians aren't fully aware of the racial disparity. "Most physicians are aware of health disparities, but they may not understand the magnitude of difference between blacks and whites," she said.
Race aside, talking about obesity is difficult for doctors and patients, Bleich said. Few physicians are trained on weight-loss counseling in general, and without reimbursement, there isn't always incentive to spend time talking through the difficult topic, she said.
"These kinds of things are sensitive and can strain relationships between doctors and patients," she said. "It's much easier for a doctor to say, 'You have high blood pressure, take this pill,' than to say, 'Increase your amount of fruits and vegetables and exercise.'"
Bleich says perhaps the role of weight-loss counseling could be a team approach, with a doctor doing an initial referral, but nurses and nutritionists doing the follow-up with more time to interact and help patients achieve their goals.
kelly.brewington@baltsun.com
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