Blacks With Diabetes Are Under-Diagnosed for Obesity

Obesity is under-diagnosed in people with diabetes overall and especially in African-Americans, even though both conditions are more prevalent in African-Americans than whites, a new study finds.

The data were gleaned from a community health study conducted in Charleston, S.C., part of the Center for Disease Control and Prevention's Healthy People 2010, a large-scale initiative to track and improve the health of people in the United States.

The authors, led by Diane Neal, Ph.D., an epidemiologist at the Medical University of South Carolina in Charleston, analyzed the records of 265 people with diabetes and a body mass index of 30 or greater, which is classified as obese. Three times as many obese whites had been given a diagnosis of obesity as had obese African-Americans.

The authors concluded that "there is under-diagnosis of obesity among people with diabetes mellitus" in their study population. "Further, we believe that there exists racial disparity in both the prevalence of obesity and its diagnosis," they wrote in the CDC's REACH 2010 supplement to the current issue of the Journal of Health Care for the Poor and Underserved.

Obesity places people at risk for a variety of diseases and disorders, including high blood pressure, high cholesterol, heart disease, stroke, arthritis, sleep and respiratory problems and certain cancers. People with diabetes who are obese are at even greater risk than the general population of obese people. Diagnosing obesity is important because it leads physicians to encourage and assist patients with weight-loss strategies.

Neal said it isn't clear why there is a discrepancy in diagnosis, but that the possibility exists of "a perception among physicians that discussion of weight is a waste of limited time as there are no effective treatments, and cultural influences preclude discussion of weight issues with African-American patients. Physicians are overwhelmed by other health issues such as high blood pressure and heart disease."

"There is a lot of literature on weight bias in health care settings," said Rebecca Puhl, Ph.D., a researcher at Yale University. "It is possible that health care providers could in some way be exhibiting bias in ways that lead to lower diagnoses of obesity in African- Americans."

"The solution," Neal said, "is education of health care professionals and patients as to the importance of weight control." She said that studies have suggested that people who have discussed weight with their physicians are twice as likely to be successful in controlling weight as those who haven't. "In people with diabetes, even a small weight loss can improve outcomes, and the best way to avoid acquiring diabetes mellitus is weight control."

Health Behavior News Service