Prioritizing Equity in Obesity Prevention and Management

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The prevalence of obesity in the United States is high and increasing. This is particularly true in Kentucky where 40.3% of the Commonwealth’s total population had obesity in 2021. As the disease prevalence increases, so do widening disparities among racial groups as influenced by social determinants of health and racism. Not only is obesity a common, serious, and costly disease, but it is also a significant risk factor for developing other comorbidities. On Thursday May 11, the KHC convened a panel of experts for a webinar to examine the root causes of obesity and obesity disparities and discuss approaches to preventing and managing obesity by prioritizing equity.  

The panel was moderated by Nabeel Qureshi, PharmD, Medical Account Associate Director, Novo Nordisk. Other panelists included Christopher F. Bolling, MD, Volunteer Professor of Pediatrics, University of Cincinnati College of Medicine and Member American Academy of Pediatrics (AAP) 2023 Clinical Practice Guideline on the Evaluation and Treatment of Obesity, Jenny Goins, President and CEO, Kentuckiana Health Collaborative, Chiadi E. Ndumele, MD, PhD, FAHA, Associate Professor of Medicine and Director of Obesity and Cardiometabolic Research, Division of Cardiology, Johns Hopkins University School of Medicine, and Alicia Wickliffe, RN, BSN, CMCN, Director, KY KEHP and Commercial Medical Management Anthem Blue Cross Blue Shield.

The discussion focused on the etiology of the disease of obesity, stigma related to weight bias and individual blame, social determinants of health as they impact lifestyle and healthcare utilization, and availability of treatment services based on cost and coverage. Obesity is a chronic disease, despite historical attitudes towards it as a condition driven by individual choices. It is now widely accepted by the medical community that as a chronic disease, obesity is developed through a number of factors, including psychological, genetic, care access, and socio-economic, as shared by Dr. Qureshi in the webinar. Current evidence-based approaches to obesity care involve lifestyle and behavioral therapies, pharmacotherapy, and surgery. Jenny Goins detailed the role employers and healthcare purchasers play in the availability and accessibility of these approaches based on the benefits they provide to employees and their families utilizing employer sponsored health insurance. Dr. Ndumele emphasized how the healthcare system reinforces the availability of these approaches, primarily through education and awareness of the complexity of the disease of obesity and how the factors related to obesity must be addressed. This also includes simultaneously addressing obesity upstream and downstream, or prevention and comorbidities, respectively. Dr. Bolling as a pediatrician emphasized the need to focus on childhood obesity as an approach to prevention of comorbidities and premature mortality, also referencing the recently released guidelines on childhood obesity that he helped author from the AAP.

The panel directly addressed the interplay of these general factors related to obesity and health inequities. Alicia Wickliffe highlighted the importance of trust and communication between providers and patients, particularly through the lens of obesity-related stigma. As obesity is more prevalent among people of color, incorrect assumptions of obesity being related directly to individual choices can be compounded by racism. Dr. Ndumele discussed the importance of making healthy choices easy choices and how health inequities and socioeconomic factors make healthy choices more difficult for underserved populations. Furthermore, Dr. Bolling introduced the influence of biological factors related to stress and its impact on obesity. Communities of color experience high levels of stress related to racism and discrimination at a societal level and this can impact their health outcomes, including the development of biological factors related to obesity.

Obesity is directly related to the development of comorbidities, decreased quality of life, and premature mortality. The disease disproportionately affects Black and Brown communities as influenced by social and economic factors, access to treatment by cost or location, and the quality of care available. To improve obesity outcomes, social determinants of health must be systemically addressed. Providers must foster trusting relationships with their patients free of stigma and personal blame related to weight and obesity. All treatment approaches for obesity, including pharmacotherapy, surgery, and lifestyle and behavioral therapies must be available, high quality, and affordable. Although not all individuals living with obesity will use all of these approaches, they should be available and accessible to patients to utilize as determined by their healthcare provider. The discussion on obesity and obesity disparities is broad and complex.

This webinar was an introduction to these issues and the KHC plans to continue focusing on advancing affordable, high quality, and equitable healthcare for preventing and treating obesity. A recording of this session can be found here. Prioritizing Equity in Obesity Prevention and Management was part of the KHC’s Healthcare Equity Learning Series. Watch past sessions here.

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