Diabetes Self-Management Blog

Both obesity and Type 2 diabetes have reached striking levels in the United States. This is true among most racial and ethic groups, but particularly among African-Americans. According to the American Diabetes Association, African-Americans are 1.8 times as likely to have diabetes as non-Hispanic whites. They are also 1.5 times as likely to be obese, according to the Centers for Disease Control and Prevention (CDC). Because of these large disparities, research has explored the scope of the African-American “diabesity” epidemic from many different angles — including how race affects what treatments, if any, someone receives for obesity.

In a study published earlier this year in the journal Obesity, researchers sought to find out whether rates of obesity-related counseling were greater among obese black people with black doctors than among those with white doctors. There could be many possible reasons for lower rates of counseling by white doctors, the researchers speculated, ranging from fear of cultural offense to a perception that obesity is normal — or even intractable — in African-Americans. To explore the impact of doctor–patient racial makeup, the researchers looked at data from medical surveys that included information on 2,231 visits to the doctor by obese people who identified as either black or white. Of these visits, 12% involved a black patient seeing a white doctor; 5% involved a black patient seeing a black doctor; 81% involved a white person seeing a white doctor; and 2% involved a white person seeing a black doctor.

According to an article on the study at MedPage Today, the researchers looked at whether three different types of counseling took place during the visit: on weight loss, on diet and nutrition, or on exercise. Among all visits, diet and nutrition counseling was most common, taking place in 30% of visits; exercise counseling took place in 23% of visits, and weight-loss counseling took place in 22%. When viewed through the lens of doctor–patient racial makeup, the group with the highest rate of diet and nutrition counseling was black patients seeing black doctors, at 36.5%; the group with the lowest rate was black patients seeing white doctors, at 24.3%. Although this result would seem to support the researchers’ hypothesis that black patients receive less counseling from white doctors than from black doctors, this pattern does not hold for the other types of counseling. The highest rate of exercise counseling was seen among white patients seeing black doctors, at 29.4%; the lowest rate was seen again among black patients seeing white doctors, at 15%. But the highest rate of weight-loss counseling was seen among white patients seeing black doctors, at 25.5%; and the lowest rate was seen among black patients seeing black doctors. The researchers concluded that although blacks experienced less obesity-related counseling overall, this could not be statistically linked to the race of their doctors. They also noted that rates of counseling for all groups were too low.

Regardless of your race, if you are obese, do you believe that your doctor provides adequate obesity-related counseling? If not, can you guess why he or she might be reluctant to offer it? Could any of these reasons account for the racial disparities seen in the study? Do you have any broader suggestions for addressing the racial gap in obesity and diabetes rates in the United States? Leave a comment below!

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Flashpoints
Chocolate to Fight Diabetes? (12/17/14)
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