New research was published this month showing racial disparities in obesity care and underscoring the need for a more holistic, community-based approach to weight loss treatment. The study found that even though services like behavioral care and surgical interventions are often needed in order for patients to lose weight and keep it off, people of color don’t have the same access to these services as their White counterparts.
The research was sponsored by Enara Health, a San Mateo-based startup that helps primary care and cardiology clinics launch multidisciplinary, insurance-covered weight loss programs.
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To conduct the literature review, researchers analyzed data from 44 studies published between 2000 and 2022, all of which compared results for weight loss interventions between different racial and ethnic groups.
They found that there was “minimal to no evidence” of racial disparities when it came to pharmacological interventions. But drugs don’t magically cure obesity — most patients need holistic care that incorporates services like nutrition coaching, talk therapy or surgical intervention in order to actually treat their condition long-term, Enara CEO Rami Bailony argued.
“For lifestyle and behavioral programs and surgical interventions, people from racial and ethnic minorities will lose less weight or will have less improvements in their diabetes, blood pressure or cholesterol than their Caucasian counterparts. On top of that, they also get referred less to those programs, have less access to those programs, and have more complications from surgeries,” he said in an interview.
Bailony pointed out that some people might think “Why would some people lose less weight than others if they’re all doing the same program?”
A Personalized Approach to Medication Nonadherence
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
His answer is that obesity can be an incredibly complex condition — often impacted by genetics, income, environment and lifestyle choices both within and outside of patients’ control.
“If racial and ethnic minorities are disadvantaged socially and/or environmentally, that impacts the weight set point and creates a stronger biological drive to regain weight. And so that’s why, for example, they’ll lose less weight with surgery, or they’ll lose less weight with behavioral and lifestyle interventions,” Bailony explained.
Even though the study didn’t find racial disparities in weight loss results when analyzing drug interventions, it did find that people of color don’t have insurance coverage for these medications as often as their White counterparts.
But to truly make obesity care more equitable, it’s going to take a lot more than increasing payers’ coverage of these medications, Bailony noted. He said healthcare providers need to “dispense the medication using a care model that is community-tailored and addresses social and economic barriers to adherence and insurance.”
To Bailony, the main takeaway of the study is that the U.S. healthcare system needs to change the way it leverages weight loss drugs. The research found that medications can potentially alleviate disparities in obesity, but this will only be true if the industry innovates the care models used to dispense these drugs, he declared.
“If Medicare is going to cover obesity drugs while still paying doctors $20 for 15 minutes of obesity counseling, it’s probably not going to be enough to incentivize clinics, which are dealing with the most complex patients, to really be able to sit down with them and explain what these medications really do,” Bailony explained.
Photo: Peter Dazeley, Getty Images
