Ethnic Differences in the Self-Recognition of Obesity and Obesity-Related Comorbidities: A Cross-Sectional Analysis

Abstract

BACKGROUND: Obesity and its related co-morbidities place a huge burden on the health care system. Patients who know they are obese may better control their weight or seek medical attention. Self-recognition may be affected by race/ethnicity, but little is known about racial/ethnic differences in knowledge of obesity's health risks. OBJECTIVE: To examine awareness of obesity and attendant health risks among US whites, Hispanics and African-Americans. DESIGN: Cross-sectional self-administered survey. PARTICIPANTS: Adult patients at three general medical clinics and one cardiology clinic. MAIN MEASURES: Thirty-one questions regarding demographics, height and weight, and perceptions and attitudes regarding obesity and associated health risks. Multiple logistic regression was used to quantify the association between ethnicity and obesity awareness, controlling for socio-demographic confounders. KEY RESULTS: Of 1,090 patients who were offered the survey, 1,031 completed it (response rate 95%); a final sample size of 970 was obtained after exclusion for implausible BMI, mixed or Asian ethnicity. Mean age was 47 years; 64% were female, 39% were white, 39% Hispanic and 22% African-American; 48% were obese (BMI ≥30 kg/m 2 ). Among obese subjects, whites were more likely to self-report obesity than minorities (adjusted proportions: 95% of whites vs. 84% of African-American and 86% of Hispanics, P= 0.006). Ethnic differences in obesity recognition disappeared when BMI was >35 kg/m 2 . AfricanAmericans were significantly less likely than whites or Hispanics to view obesity as a health problem (77% vs. 90% vs. 88%, p<0.001); African-Americans and Hispanics were less likely than whites to recognize the link between obesity and hypertension, diabetes and heart disease. Of self-identified obese patients, 99% wanted to lose weight, but only 60% received weight loss advice from their health care provider. CONCLUSIONS: African-Americans and Hispanics are significantly less likely to self report obesity and associated health risks. Educational efforts may be necessary, especially for patients with BMIs between 30 and 35.KEY WORD: obesity; ethnic difference; self recognition.

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“…A review of the literature suggests that Black adults are less likely to perceive BMI as a threat to health and as a risk factor for developing chronic health conditions Table 2 Intercorrelations between demographic variables, BMI, number of CHCs, and MC-motivation when compared to non-Hispanic Whites and Hispanics [29]. This finding in the literature could be partially attributed to the belief in what has been described as "healthy obesity."…”

The Impact of Racial and Socioeconomic Disparities on Binge Eating and Self-Efficacy among Adults in a Behavioral Weight Loss Trial

“…Growing evidence highlights the presence of reported differences between obesity recognition in white and nonwhite people ( Johnson, Bouchard, Newton, Ryan, & Katzmarzyk, 2009;Sivalingam et al, 2011). Among white people, there is greater likelihood of self-reported obesity and identifying its association with related comorbid conditions and mortality.…”

“…However, among nonwhite people, specifically African Americans, there is less recognition of obesity as a health problem. In fact, higher obesity prevalence in one's own ethnic or gender group may have a normalizing effect, and may further complicate one's ability to recognize obesity and its health-related risks ( Sivalingam et al, 2011).…”

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