Sara Bleich

Weight Counseling in Black and White

By Amy Dusto • Photo by Chris Hartlove

Though obesity has reached epidemic proportions in the U.S.—nearly one in three adults falls into that category—60 percent of physicians in a recent study did not give obese patients weight-related counseling. And, as it turns out, physicians are even less likely to offer such guidance to obese patients who are black.

That finding was a surprise for Sara Bleich, PhD, an assistant professor in Health Policy and Management, who led a study to see if race concordance (when a doctor and patient share the same race) affects weight-related counseling. She wanted to know, for example, would a black doctor talk more about healthy lifestyle choices with a black patient? Bleich found that blacks received less weight-related counseling regardless of their physician’s race. “That result was pretty striking,” she says. She found, for example, that white physicians were 50 percent less likely to offer exercise counseling to black obese patients as compared to white obese patients. And black physicians were 65 percent less likely to offer weight-reduction counseling to blacks as compared to whites.

The study, published online in January in Obesity, focused on obese patients and looked at survey questions that asked physicians whether they gave counseling about weight reduction, diet and nutrition, or exercise. Pulled from a national survey, the 2,000 randomly selected physicians and their patients represented all geographic regions of the U.S. The surprising findings left Bleich and her colleagues with more questions than when they started. “We don’t know exactly what’s going on there,” Bleich says. “If you’re a black obese patient, why are you getting inferior care?”

The answer undoubtedly involves a variety of complicating factors, including social and economic issues, says Bleich. She speculates that physicians on the whole may have a more negative perception of obese black patients—they might think these patients are less likely to follow through after counseling, lack resources like healthy food options or access to gyms, or are more likely to engage in risky behaviors.

This latest finding comes as Bleich continues to push toward her larger goal of finding ways to improve obesity care.

Bleich wonders whether time-pressed doctors, faced with patients who have chronic illnesses such as hypertension and diabetes, find it too daunting to spend precious minutes on weight-related counseling—even though such problems often stem from obesity.

“Should it really be in the hands of physicians?” Bleich asks. Would dietitians or nutritionists—people with time to provide ongoing support—be better suited to providing obesity care?

To find out, Bleich is surveying physicians, this time to find out what assistance they need to provide better weight-related counseling, as well as the extent to which they feel it is their job to do so in the first place.