Strategies to overcome common barriers: Public hospital obesity treatments for low-income, urban, and disproportionately minority populations

Background

Safety net hospitals play an important role in stemming the racial, ethnic, and socioeconomic disparities in obesity incidence. Research indicates that people with low income, low levels of education, and racial and ethnic minority populations, which comprise the safety net hospital patient base, experience obesity more frequently than wealthier non-minority patients.

To ascertain innovative approaches to providing obesity treatment for minority and low-income groups and populations with low health literacy, the National Public Health and Hospital Institute (NPHHI) conducted a study of obesity treatment programs in public safety net hospitals. This presentation will indicate the barriers encountered in providing treatment for traditionally underserved populations, and reveal innovative approaches used by successful obesity programs to address those challenges.

Study Design

NPHHI surveyed obesity treatment program managers in 123 public hospitals. Fifty-four respondents identified the most common barriers to providing obesity interventions for uninsured, low-income and diverse patients in safety net hospitals, as well as successful strategies to address these challenges. Major themes from this qualitative data were ascertained using content analysis.

Findings

Safety net hospitals face numerous barriers in providing adequate obesity treatment for vulnerable populations. For example: 60% report high attrition rates, 57% complain that their patients lack access to adequate and safe exercise facilities, and 54% note that patients lack adequate access to healthy foods in their communities.

Specific components of model obesity programs have proven effective at overcoming these challenges. The most successful programs tailor treatment to members of specific demographic groups (e.g., providing group sessions with culturally similar patients, promoting healthy diets that incorporate or even rely on culturally-accepted foods, and educating providers about cultural norms of their patients). Strategies to provide care for low-income patients include partnering with community resources to ensure access to safe exercise areas and working with local farmer's markets to provide healthy foods. Strategies to assist patients with low health literacy include offering educational materials that use pictures, designing food label tools and videos to help patients read food labels, and offering multiple modalities for learning about obesity treatment.

Conclusions

Given that no single obesity treatment intervention will prove successful for patients in all demographic groups, this study determines which interventions and factors lead to the best outcomes for certain patient groups. Although the study focused exclusively on safety net hospital obesity programs, the strategies used to provide successful treatment for vulnerable populations can be implemented in other health care settings.