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Medical Professionals Not Providing Weight-Loss Education to Low Income Adults

Study finds clinicians less likely to counsel less educated, and younger and older patients.

According to a new study in Preventing Chronic Disease, low-income adults who are overweight or obese are less likely to be counseled to lose weight than adults with higher incomes.

High-risk patients, such as those who are extremely obese or have comorbidities, are most likely to receive weight-loss advice. However, demographic factors also appear to determine who receives advice. Patients who have high levels of education are more likely to receive advice than those who have low levels of education and those who are middle-aged are more likely to receive advice than younger or older patients. Study results are unclear about whether health insurance plays a role in determining who receives weight-loss advice; some studies found that insurance is not associated with receiving weight-loss advice, whereas one study found that patients who had private insurance were more likely than uninsured patients to receive weight-loss advice. Income also appears to play a role; those who have high incomes are more likely to receive weight-loss advice than those who have low incomes.

This study is the first to explore the determinants of receiving weight-loss advice in a sample of overweight or obese individuals from communities with a high proportion of low-income, racial/ethnic minority populations in a multivariate analysis of race/ethnicity, age, sex, health status, income, health insurance status, and education.

Over 1,100 overweight or obese adults from New Jersey were surveyed about whether their healthcare provider had advised them in the past year about weight loss. A substantial proportion of participants had low incomes and were of a racial or ethnic minority.

Only 35% said they had recently been advised by a clinician to lose weight. After adjustment for health insurance status and other variables, participants whose household incomes were above 400% of the federal poverty level had a 64% increased odds of receiving weight loss advice, compared with those at or below the federal poverty level. Participants at 200–399% of that level had 56% higher odds.

The US Preventive Services Task Force recommends that all patients be screened for obesity and, if needed, be provided weight-loss advice. This study aimed to describe the determinants of receiving weight-loss advice among a sample with a high proportion of low-income, racial/ethnic minority individuals.

Data were collected from a telephone survey of 1,708 households in 2009 and 2010, Analyses was limited to 1,109 overweight or obese adults. Of all overweight or obese respondents, 35% reported receiving advice to lose weight. Receiving advice was significantly associated with income in multivariate analysis. Compared with those with an income at or below 100% of the federal poverty level (FPL), those within 200% to 399% of the FPL had 1.60 higher odds of receiving advice, and those with an income of 400% or more of the FPL had 1.73 higher odds of receiving advice. The strength of the association did not change after adjusting for health insurance.

This study examined the association between patient characteristics and reported receipt of weight-loss advice from a health care provider. Several demographic and health-related factors had a significant relationship with receiving weight-loss advice. The finding that individuals in the lowest income group had significantly lower odds than individuals in higher income groups of receiving weight-loss advice from their health care provider is similar to the findings of previous studies. The results for income did not change after adjusting for health insurance, which has been shown to be associated with physicians’ advice in other studies. Our finding on the relationship between income and weight-loss advice is problematic, because people with the lowest incomes tend to have poorer health outcomes than those with higher incomes.

Patients who have risk factors such as obesity, poor health status, diabetes, and asthma would warrant special attention to weight. The finding that these risk factors increased the odds of receiving weight-loss advice aligns with the findings of other studies. Participants in other studies who had a high BMI were more likely to receive weight-loss advice than participants with a lower BMI. In one study, patients with comorbidities such as diabetes or heart disease had more than two times the odds of receiving weight-loss advice. The study found that patients with diabetes had 1.76 higher odds of receiving advice, similar to 1.96 higher odds found in another study.

The low rate of reported health care provider advice to lose weight is concerning; only 35% of the sample received advice. However, this rate did increase as BMI increased; 63% of those whose BMI was 40.0 or higher reported receiving weight-loss advice in the previous 12 months, whereas only 22% of overweight (BMI of 25.0–29.9) participants received advice. The rates found in our study are similar to rates found in previous studies: 33% to 65% of the study samples received weight-loss advice. However, national guidelines recommend that all obese people receive weight-loss advice, and thus current rates are short of national targets.

From the results of the study, it was concluded that income is a significant predictor of whether or not overweight or obese adults receive weight-loss advice after adjustment for demographic variables, health status, and insurance status. Further work is needed to examine why disparities exist in who receives weight-loss advice. Health care providers should provide weight-loss advice to all patients, regardless of income.

Practice Pearls:

  • Income is a significant predictor of whether or not overweight or obese adults receive weight-loss advice.
  • Are we as clinicians are less likely to counsel low-income patients about weight loss?
  • More work is needed to examine why disparities exist in who receives weight-loss advice.

Prev Chronic Dis 2016;13:160183. DOI: http://dx.doi.org/10.5888/pcd13.160183