Overweight/obesity and weight-related treatment among racially and ethnically diverse patients in federally supported health centers

BACKGROUND: The Health Resources and Services Administration funds health centers to improve access to primary care for 19.5 million medically underserved patients. The prevalence of overweight/obesity is a growing public health problem, and health centers are well-positioned to address the epidemic among vulnerable populations. We determined the prevalence of overweight/obesity, weight-loss attempts, and weight-related counseling among adult health center patients, and investigated whether racial/ethnic disparities existed for these measures. METHODS: Nationally representative data came from the 2009 Health Center Patient Survey. Analyses were limited to adult patients (n=3,949). We examined several weight-related measures, including body mass index (BMI), self-perceived weight, and weight-loss attempts. We also included weight-related treatment measures: being told by provider of a weight problem, receipt of weight management counseling, nutritionist referrals, weight-loss prescriptions, and cholesterol checks. We determined the distribution of weight-related measures for the total sample, and also by race/ethnicity. We ran logistic regressions to determine which sociodemographic and health-related factors were associated with weight-loss attempts in past year and with being told by a provider of a weight problem. RESULTS: Overall, 76% of health center patients were overweight or obese (BMI ≥ 25.0 kg/m2). Only 55% of overweight patients, and 87% of obese patients correctly perceived themselves as overweight. There were no racial/ethnic differences in BMI categories or self-perceptions of weight. About 60% of overweight/obese patients tried to lose weight in the past year. There were no disparities in several treatment measures among overweight/obese patients, including weight management counseling, weight-loss prescriptions, and cholesterol checks. However, a larger proportion of Hispanic/Latino and African American patients received nutritionist referrals compared with White patients. In adjusted regressions, overweight/obese patients had higher odds of a weight-loss attempt if they perceived themselves as overweight (OR=3.30, 95% CI: 1.88-5.77), were female (OR=1.95, 95% CI: 1.05-3.64), or were African American (OR=3.34, 95% CI: 1.29-8.66) or Hispanic/Latino (OR=2.14, 95% CI: 1.13-4.06). Overweight/obese patients had higher odds of being told by a provider that they had a weight problem if they were Hispanic/Latino (OR=2.56, 95% CI: 1.21-5.38) or if they had two or more chronic conditions (OR=2.77, 95% CI: 1.28-6.01). CONCLUSIONS: Health centers are uniquely positioned to address the obesity epidemic among a vulnerable segment of the population. Efforts to promote weight counseling during primary care visits, and patient education on healthy weight, diet, and physical activity have the potential to reduce the burden of obesity and its sequellae among health center patients.