The Burden of Obesity Is Not Carried Equally
— Misconceptions are hurting the fight for health equity in communities of color
by David Satcher, MD, PhD August 26, 2022
“Since leaving my post in 2002 as the U.S. Surgeon General, the nation’s leading public health role, America has made great strides in battling public health crises. From reducing tobacco use and improving maternal and child health, to most recently advancing vaccine technology to fight the COVID-19 pandemic. Yet, another epidemic has gained strength, debilitating and killing millions of people on its deadly upward trajectory. The chronic disease of obesity is a misunderstood condition impacting millions of Americans from every demographic group living in every corner of the country. Unfortunately, obesity and comorbid diseases disproportionately impact communities of color in nearly incalculable ways.
In the early 2000s, the national adult obesity rate was 30.5% and we had made progress on achieving many health goals related to heart disease, type 2 diabetes, cancer, and multiple other chronic health challenges. Back then, my office released “The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity,” which underscored the increasing severity of obesity’s impact on our collective health and outlined a vision for the future. Today, the adult obesity rate has climbed to 42.4% and is projected to reach nearly 50% by 2030.
Disparities in obesity rates between racial and ethnic groups are stark. The latest data show that non-Hispanic Black adults have the highest age-adjusted prevalence of obesity in the country at 49.6%, followed by Hispanic adults at 44.8%, and non-Hispanic white adults at 42.2%. Obesity is also a significant health challenge among American Indians and Alaskan Natives, with adults in those communities 50% more likely to have obesity than white adults. Furthermore, a projection of obesity rates found that “severe obesity” will become the most common BMI category among non-Hispanic Black adults (31.7%) — as well as among women (27.6%) and low-income adults (31.7%) — by 2030.
Despite researchers making significant advances in the last 2 decades, obesity is too often myopically viewed as the result of an individual’s lifestyle choices around diet and exercise. Viewing the disease through this lens omits that body weight is determined by a combination of genetic, metabolic, behavioral, environmental, cultural, and socioeconomic factors. In fact, we know that a significant proportion of obesity can be influenced by genetics.
While recent scientific discoveries have greatly improved obesity care options, our collective effort to stem the tide of the disease has fallen short. Obesity is a public health crisis deserving maximum effort from policymakers, healthcare providers, insurers, and community partners working in concert to dramatically reduce the burden of this disease.
Our politicians and policymakers must focus on the core causes and dire consequences of unchecked increases in obesity rates among the people they serve. It is imperative that updated federal, state, and local policies grant equitable access to the full continuum of obesity care. Healthcare providers must seek continuing education on advances in metabolic science and the availability of pharmacotherapies that are proven to safely reduce disease prevalence and the impact of comorbid diseases. Insurers must take a long view of obesity care, taking immediate action to close coverage gaps that block access to obesity trained physicians, consultation with nutritionists, physical therapists, and prescriptions for FDA-approved metabolic therapies. Our community leaders must advocate for healthcare equality and equitable access to obesity care to lift the physical, mental, and financial burden of the disease on all Americans, especially Black and brown people.
I believe generating coordinated, sustained solutions for a positive impact on obesity in America will come from the hard work of public health stewards, policymakers, healthcare providers, and community leaders at the intersection of health equity and policy. I am making a renewed call to action for the challenging situation we find ourselves in. Every one of us deserves the opportunity to live our healthiest life. It is time we remove the impediments to health equity through access, and promote a path that eliminates the obesity epidemic persisting in communities of color across our nation.”
Those interested should also read the book by Sandra Aamodt, Ph.D., Why Diets Make Us Fat: The Unintended Consequences of Our Obsession with Weight Loss. More emphasis should be placed on the development of how to control or manage damaging weight regain after endless weight loss attempts. Sally Feltner, M.S, Ph.D.