Disparities in who receives doctor's advice to lose weight: Does income make a difference?

Background: The high rate of overweight and obesity (OW/OB) in adults is a public health concern, especially in disadvantaged populations.  Primary care physicians are in a unique position to provide weight loss advice to patients at risk.

Methods: Data were collected using a household phone survey with adults responsible for food shopping in five New Jersey cities in 2009-10. Analyses presented are limited to OW/OB participants (n=1,117). Multivariate logistic regression analysis determined the association of participants’ characteristics with receiving doctor’s advice to lose weight.

Results: Receiving doctor’s advice was significantly associated with income, calculated as a ratio of the federal poverty level (FPL). Compared to an income below 100% FPL, those within 100-200% FPL had 1.9 times higher odds of receiving advice (p=0.009), 200-400% FPL had 2.3 times higher odds of receiving advice (p=0.003), and incomes over 400% FPL had 3.22 times higher odds of receiving advice (p<0.001).

OW/OB individuals with diabetes and/or asthma had significantly higher odds of receiving weight loss advice (p=0.019 and p=0.009, respectively).

Although individuals with income under 100% FPL were least likely to receive advice, they had the highest rate of asthma, at 19.7%, and of diabetes, at 19.9%.

Conclusion: While those with higher health risk were more likely to receive weight loss advice, individuals with the lowest income were least likely to receive advice—even though they had the highest rates of diabetes and asthma. Interventions in medical practices for OW/OB adults should promote weight loss advice to all individuals, regardless of income.