Curbing the Obesity Epidemic in the Latino Community
Posted on 06/29/2021 @ 02:15 PM
By Dr. Jose Aleman Diaz
NYU Lagone Health, VA New York Harbor Healthcare System
My family, originally from Puerto Rico, has been fortunate that none of us have developed serious complications from our weight. Still, overweight and obesity remain a concern for me when I think about my loved ones and the broader Latino community. When I came to the United States to attend Harvard Medical School, I studied metabolism, the way our body uses and redistributes energy, and endocrinology, the science of the body’s glandular systems. Both are integral to how we think about obesity as a disease.
Before we go further, I need to make the distinction between weight and obesity. A person’s weight is the number they see when they step on a scale. As individuals we naturally come in varying shapes and sizes but the moment excess weight begins to negatively impact your health – shortness of breath, elevated blood sugar levels indicating pre-diabetes, and more – we have to begin addressing the onset of the disease obesity. The World Health Organization (WHO) and the American Medical Association (AMA) define obesity as excess fat accumulation that leads to complications in a person’s health.
In the Latino community, rates of obesity are higher than in the general population, and they are increasing at alarming rates. In my research I focus on fat tissue and how it communicates with other cells in the body to produce inflammation which predisposes a person with obesity to other diseases like diabetes, heart disease, a variety of cancers and more recently complications from COVID-19. Obesity is a risk factor for severe COVID-19 illness and leads to higher rates of hospitalization, ICU admission, and death.
Obesity is a multifactorial disease influenced by a person’s environment, lifestyle, access to health care, and more. Our tools for treating people with obesity include trained physicians, lifestyle interventions, new safe and effective medicines, and surgery. Most often a person with obesity may need a combination of those, in a continuum of care, to reach their health goals.
Do I Have Obesity?
How do you know if you have obesity? Doctors use a calculated formula of your weight and height to generate what’s known as your body mass index or BMI. A normal BMI is 18 - 25. Overweight BMI in class 1, is between BMI 25-29.9 and the BMIs for obesity increase from there. Class 1 overweight is 30-34.9, class 2 obesity is 35-39.9, class 3 obesity is BMI greater than 40. It’s important to note that the risk of developing health complications increases with each higher class of obesity you may have. However, more than simply looking at numbers, your doctor evaluates your body for where it stores fat. Specifically, when fat is stored in internal organs, like the liver, the complexities can ultimately lead to enlarged and diseased organs requiring a transplant or making bariatric surgery more complicated. Diabetes caused by obesity is the most common cause for kidney failure leading to renal disease, forcing patients into dialysis treatment.
Considering these classes, your physician can work with you to create a care plan that dictates the treatments you need to meet your BMI goals. Together, you’ll decide on a combination of diet and exercise, medicines, and possibly surgery to help you reach a healthier BMI for your body.
What Causes Obesity?
Researchers are investigating the causes this multifactorial disease. A person’s environment is one of the most important factors in the disease’s prevalence. Highly caloric diets lacking nutritional value can manifest in food deserts where Latinx communities don’t have access to healthy nutrient rich, lower calorie food. Social determinants of health such as lack of access to care, differences in care delivery, and health disparities are also contributors.
Lack of exercise and an active lifestyle is a secondary factor, but it’s a common misconception that exercise is highly important. Ask anyone who’s been trying to burn calories on a treadmill, and they’ll tell you the calories in one donut or soft drink would immediately put back the calories they burned during the workout. However, exercise is still important for maintaining weight loss.
Family history needs to be considered and rare genetic mutations occasionally cause obesity. Hormone treatments are available to treat those one in one-million cases.
Psychologically, food is comforting to many people so there’s also a mental health component to managing obesity. Comorbid mental health issues, like depression, can be significant factors in obesity’s grip on a person’s individual health progress. It’s important to consider addressing food dependence with mental health professionals.
Under diagnosis and Under Treatment of the Disease
Before obesity was recognized as a disease by the American Medical Association in 2013, medical school training didn’t have the language to educate doctors on obesity as a disease, there was no framework to treat people with obesity, and there have been no mechanisms for dedicated professionals to treat the disease. In the last decade recognizing and treating obesity has emerged as a priority and it’s becoming clear there is a shared responsibility among those of us in the medical profession, patients and families, policy makers and insurers to address obesity in a multidisciplinary way.
There are very significant efforts to educate my clinical colleagues through the Obesity Society or the American Board of Obesity Medicine (ABOM). ABOM is growing very rapidly as we see physicians of diverse specialties learning and applying obesity medicine to their work. Still, discomfort with discussing obesity with patients and patient discomfort having the conversation with their physician are challenges to effective treatment. I often counsel my colleagues to ask permission to discuss obesity related issues with questions like, “Can we discuss how your weight might relate to your health?”
Another concerted effort from the Obesity Society, Obesity Care Advocacy Network (OCAN) and other professional societies is to increase access to anti-obesity medicines (AOMs) by supporting the Treat and Reduce Obesity Act (TROA). The legislation will increase access to obesity treatments and AOMs, addresses inequities in obesity care, and fights stigma and weight bias in the U.S.
Stigma and Weight Bias
People with obesity might not receive adequate health care, and they might be discriminated against in the places we live, work, and play. Disparities in access to health care, quality of service, and the burden of preventable chronic illnesses continue to be deeply impactful issues in Latino communities. Excluding and marginalizing people with obesity leads to inequities throughout the health care system. For instance, rates of bariatric surgery are extremely low, only 1% of eligible patients receive the surgery, in part because many of my colleagues don’t perceive obesity as a serious disease and therefore don’t refer their patients to specialty obesity care or surgery.
Obesity stigma occurs at many different levels, therefore acknowledging the existence of the disease, diagnosing it accurately, and offering appropriate obesity treatments along a continuum of care are important for a new mindset toward those who are struggling. It’s time to improve our actions and our language. Using person-centered language like, “persons with obesity” instead of “obese”, helps remove the negative connotation of the adjective. It seems subtle but adopting de-stigmatizing language goes a long way to help patients feel empowered.
The Cost of Obesity
The financial toll of obesity is commonly overlooked. Not only is the disease detrimental to your health, obesity is extremely costly. It’s the kind of medical problem that could threaten to bankrupt the U.S. healthcare system. The severity of the disease’s far reaching medical toll is estimated to put the financial burden at $480-500B. The individual financial toll of obesity is estimated to be $2500 annually per person with obesity. For example, reducing obesity lowers the risk for type 2 diabetes, and therefore eliminates the costs associated with diabetes-related health care visits, insulin prescriptions, diabetes-related comorbidities and more. Weight and maintaining a lower BMI can save your life and save the system money.
What You Can Do
Talk to your doctor – If you are concerned about your overweight or obesity negatively affecting your health, have an honest conversation with your doctor and ask about getting support. Request a referral to an obesity care physician to start a treatment program tailored to your goals and needs. Your program should include nutritional education, physical activity options, psychological support, prescribed anti-obesity medications (AOMs) as appropriate, and surgery when necessary. The right combination of these factors can help you reach and maintain your BMI goal.
Make Incremental Sustainable Changes – You should start by making small changes that you can manage and are sustainable for your lifestyle. You’re more likely to maintain smaller incremental dietary, and movement goals than you are to try to sustain drastic lifestyle changes. Managing obesity with your physician’s support is a marathon, not a sprint.
Keep Moving Forward – Focus on new personal health care regimens while breaking old habits, beliefs, and addictions. Consistently make weight management part of your daily routine while accepting that you might need help along the way. Treating any chronic disease, like obesity, requires dedication to meeting your health goals and an open mind to accept the support your body needs. You can do it. There are so many personal benefits to a healthier, more active, longer life when you’re committed to managing obesity. There’s no solution that’s right for every patient, and each person needs a support system to maintain progress. Obesity is at the center of so many health, economic, and mental health issues that we must get a handle on it individually, and as a community. We can get there if we manage obesity together.
Learn more about Dr. Jose Aleman’s work and research at www.ltor.org.