Is Race A Factor In Obesity Counseling? Is Water Wet? - A Black Girl's Guide To Weight Loss

Is Race A Factor In Obesity Counseling? Is Water Wet?

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From the National Institute of Health’s Medline Plus:

Obese black patients receive less weight reduction and exercise advice from doctors than obese white patients, a new study finds.

The researchers at the Johns Hopkins University Bloomberg School of Public Health also said they were surprised to find that white patients treated by black doctors were still more likely to receive weight and exercise counseling than black patients treated by black doctors.

“Our findings could be due to a number of factors such as negative physician perspectives towards black patients or a lack of sensitivity to the underlying levels of obesity risk for black patients as compared to white patients,” study author Sara Bleich, an assistant professor in the Department of Health Policy and Management, said in a university news release.

For this study, the researchers analyzed national data from 2,231 visits of black and white obese patients to their doctors. The findings appear in the January online issue of the journal Obesity.

“Previous studies have shown disparities in the proportion of black obese adults informed by physicians that they were overweight compared to white obese patients. We now also see that black patients are receiving different medical counseling as well,” senior author Dr. Lisa Cooper, a professor in the Department of Epidemiology and Health, Policy and Management, said in the news release.

“Further research is needed to understand how to improve obese patient counseling, particularly among the black population,” Cooper added.

In the United States, blacks have a much higher rate of obesity than other races, which puts them at increased risk for a number of chronic conditions such as diabetes, high blood pressure and heart disease.

Sorry for the sarcasm… or am I?

I mean, allow me to just shoot off the top of my head, for a moment.

If well over 2/3rds of African Americans can be classified as [at least] overweight, and overweight people have a tendency to fear going to the doctor because they don’t want to be confronted about their weight… is it that hard to believe that a doctor, one who is following this line of thought, might want to avoid the subject altogether to avoid losing a patient? And don’t get me wrong – that’s not in defense of the doctors by any means. That’s just a reality. A doctor’s office is a business just like any other, and they have to do what they have to do to keep patients.

Or…. if the assumption – made by the doctor – is that their Black patient won’t have the resources necessary to lose the weight (read: access to “healthy food,” money to purchase it… in other words, the doctor assumes the patient is poor because they’re Black), why even broach the subject? “I’ll only be telling them to do stuff that they can’t afford, anyway.”

And if that’s the case then, once again, healthy lifestyles are made out to be class issues… and class is lazily being determined by race. “If a person is Black, they must be poor.” Even if it weren’t about race, it’d still be about “you’re poor, you have limited resources, you couldn’t do it anyway” instead of “you have limited resources, but let’s see how we can use what you’ve got to get what you want.” (If you know where that quote comes from… I’m sorry. For both of us.)

And, as I found the press release for the study that came directly from Johns Hopkins itself, there’s something else that really should be paid close attention:

When it comes to advising obese patients, blacks receive less weight reduction and exercise counseling from physicians than their white counterparts. This is according to a recent study conducted by researchers at the Johns Hopkins Bloomberg School of Public Health who examined the impact of patient and doctor race concordance on weight-related counseling. The results are featured in the January 2011 online issue of Obesity.

“Contrary to our expectations, we did not observe a positive association between patient-physician race concordance and weight-related counseling,” said Sara Bleich, PhD, lead author of the study and an assistant professor with the Bloomberg School’s Department of Health Policy and Management. “Rather, black obese patients seeing white doctors were less likely to receive exercise counseling than white obese patients seeing white doctors. We also found that black obese patients seeing black doctors were less likely to receive weight reduction counseling than white obese patients seeing black doctors. This suggests that regardless of the physician’s race, black obese patients receive less weight-related counseling than white obese patients. Our findings could be due to a number of factors such as negative physician perspectives towards black patients or a lack of sensitivity to the underlying levels of obesity risk for black patients as compared to white patients.”

I’m not going to lie – my own experiences echo the findings of this study:

I remember being in high school.. and my doctor never – never – mentioned my weight. I can’t say, for sure, exactly why that was… but this very cheery, young, happy doctor would tell me “Well, you’re 215lbs, but that’s ok.. you’re just tall.” He wouldn’t look at last years chart to see whether or not I’d gained 20lbs in one year. He wouldn’t talk to me about food or activity levels at all. He’d just bypass the subject altogether.

I’d eventually go on to gain weight at a pretty ridiculous rate for the next few years.

Excerpted from Doctors, Bedside Manner, and Weight: Fat Prejudice in Health Care | A Black Girl’s Guide To Weight Loss

How are we supposed to live healthier lives if our doctors fear even mentioning the problem to us? If they fear mentioning it to us, how are we ever supposed to find the answers we need to help us get there?

What are your thoughts? Let’s hear it!

PS: You know I’m looking for a copy of this study, right?

The proud leader of the #bgg2wlarmy, Erika Nicole Kendall writes health, fitness, nutrition, body image and beauty, and more here at #bgg2wl. After losing over 150lbs, Kendall became a personal trainer certified in fitness nutrition, women's fitness, and weight loss from the National Academy of Sports Medicine. She now lives in New York with her family, and is working on her 4th, 5th and 6th certificates.

47 Comments

  1. Betti

    January 24, 2011 at 12:52 PM

    I decided to get serious about weight loss and decided that I wanted to see a nutritionist for some professional help. Ha! My insurance company told me that unless I was morbidly obese or had a nutritional deficiency/issue like PKU or diabetes, they wouldn’t pay for it. So I have to be seriously ill before my health insurance will help me even though they can help prevent me from getting sick in the first place?! And the most ironic part of this is that the company decide that they are going to put more focus on wellness and preventative medicine! I already sent my HR dept. a scathing email about it and they refered me to a “health coach” and Weight Watchers. If I could have screamed without getting fired I would have.

    • Erika

      January 24, 2011 at 2:45 PM

      That’s another element of this – do we have the requisite health care coverage necessary to help us get the REAL resources we need? *big sigh*

    • Ms. Bad Mama Jama

      March 7, 2012 at 5:31 PM

      Hi Betti…Do you still need/want to work with a dietitian? Your local grocery store may have one that you can work with – without insurance or a doctor’s referral. My insurance through work did allow me to a dietitian as a specialist. However, I found the co-pay for the visits expensive. I started searching for other options. I found working with the dietitian in the grocery store a much more affordable option and convenient. I had the options of one consultation, a package of consultations, or participating in a small group.

  2. D

    January 24, 2011 at 1:11 PM

    Interesting…but no, I’m not surprised. I have relatives who avoid the doctor like the plague. So if their doctor were to tell them about their unhealthy weight and advise them they probably wouldn’t go back to treat their other problems (blood pressure, heart disorders, etc). Ironically most of these problems are related to their weight gain and immobility.
    If a patient is willing to listen what can the doc do?

    I do think we have an underlying problem of associating black with poverty in this country. Doctors have made assumptions about me, not my weight because that wasn’t an issue until after I had surgery 2 years ago (and even now is borderline overweight so bears no mentioning…although i would disagree and respect my doc more for saying “hey get to it! drop that extra 10-20lbs”). Instead I get the constant assault with STD testing and birth control EVEN after I say I am and have been happily married for almost 5 years AND we are trying to conceive. there is just this belief that all young 25-35 black women MUST be “loose and wild” because naturally that is what we see on TV. It’s awful and so is the surprise testing fees that I didn’t know were taking place….

  3. D

    January 24, 2011 at 1:20 PM

    ps—emailed you a copy of the article! I work in a lab so we have access…I couldn’t wait to read the full study…..ok my nerd is showing. time to go back to lurking.

    • Erika

      January 24, 2011 at 2:43 PM

      You are just… the best ever.

  4. Pdb

    January 24, 2011 at 1:31 PM

    This is when taking control of your own health becomes important. My main dr is a black woman and whenever I go in for my annual
    Physical she asks me about my first and exercise and i ask her a lot of questing because I know my family health history. My gyno is a black man and he has never mentioned those things but i always make sure my numbers are right during my annual exam (I want to get my copay’s worth out of my visit lol). I wonder if the sex of the patient and doctor plays a factor in
    talking about weight.

    • Erika

      January 24, 2011 at 2:46 PM

      That’s a good darn point – I’m going to look at the study (as it was already sent to me) and see if it mentions gender at all in the numbers.

    • Toni

      January 14, 2013 at 2:27 PM

      I’m 5’8″. After I had my daughter I was 170 lbs and asked my black male ob/gyn how much weight I needed to lose and he told me I was fine at my weight. He saw patients who needed to lose 100 lbs or more. I wonder how much gender and the perception of the “thick, curvaceous” black woman play into this.

  5. Trina

    January 24, 2011 at 1:40 PM

    When I was 10-12, I had strep throat about 4 times. Each time, I had to go to the doctor, they threatened to take out my tonsils and all that jazz. When I was 10, I was 150lbs…obviously overweight and short for my age. They didn’t say anything. The last time I had strep, I was 243lbs, I was 12 and again, they didn’t say anything. But I remembered the scale…how they set me at 150, ran out of room and had to set me at 200…saw them push that little metal thing all the way over…my blood pressure went through the roof. And even though my blood pressure was high, the doctor only talked about how if I got sick again, those tonsils were coming out.

    I didn’t go to the doctor again for 7 years. I’m not going to get into how my mother was…well, she let me do whatever. I said I didn’t want to go anymore and she didn’t make me. I didn’t want to see the scale. Even if the doctor didn’t say anything, I knew that I was 4’9, 243lbs and 12 years old and something was wrong with that. I just didn’t know how to fix it. That’s the sad part about it. I didn’t know how to work out or what to eat or even how to eat–portion control? I had no idea what portion control was. The fact that a medical professional didn’t say anything…it does make me wonder if they were just like, “Well, they’re obviously poor, they can’t fix it.”

    • Erika

      January 24, 2011 at 2:26 PM

      Highlighting:

      When I was 10, I was 150lbs…obviously overweight and short for my age. They didn’t say anything. The last time I had strep, I was 243lbs, I was 12 and again, they didn’t say anything. But I remembered the scale…how they set me at 150, ran out of room and had to set me at 200…saw them push that little metal thing all the way over…my blood pressure went through the roof. And even though my blood pressure was high, the doctor only talked about how if I got sick again, those tonsils were coming out.

      Did you ever find out if they talked about it with your Mother?

      • Trina

        January 24, 2011 at 2:47 PM

        To my knowledge, they did not. If they did, my mom never did anything about it. My mom was just….I wouldn’t say she didn’t care. I wonder…but I won’t say that. She just stopped being a parent at some point. The doctor could have said something to her–if it involved any work or money on her part, then yeah, she may have ignored it. Kind of like when I was 9y/o I wanted to join drill team…I was 112lbs at that point. Drill team marched in the parades and stuff. I was so excited when I brought home the permission slip…but my mom took one look at the uniform cost and said “No. Why do you want to join drill team? You don’t even like to walk!” And that was that. LOL! We had this same conversation when I wanted to take gymnastics…I was/am very flexible and petite. She didn’t want to pay for it–said I’d quit because I was scared of heights.

        Ahh…good times.

  6. Daphne

    January 24, 2011 at 2:15 PM

    Co-sign with this article. At one point, I did a bit of research on the fat acceptance movement and was perplexed to find blogs and sites that described patients’ experiences with being hounded by their doctors about losing weight. Because that had certainly had NOT been my experience, generally speaking. Nor the experience of blacks I knew who were also overweight. But when I found out those sharing their experiences were mostly white, there was an “Aha” moment for me.

    I was raised in a small town among working-class blacks, and my family rarely went to the doctor, anyway, unless there was something actually wrong. Even then, something had to be broken, bleeding, etc……and couldn’t be cured by “home” remedies. There is a curious intersection of race and class when it comes to this subject, one that doesn’t appear to be explored often, probably because the American picture of poor people is usually black, occasionally Hispanic.

    I think poor(er) people just don’t go the doctor as it is, as a matter of affordability (even WITH some kind of health insurance) and are most likely to skip out entirely if they are told something they don’t want to hear. And because we are always inundated with having to buy something (whether it’s a program, pills, shakes, “special” food, gym membership, books) in order to achieve weight loss, who’s trying to hear that they need to lose weight? That’s just mo’ money. Trying to keep the lights on, okay?

    Still, that’s on the doctors, too, for not doing their research and understanding how to educate their patients, based on where they are. Most of what I’ve learned about health hasn’t been from doctors – it’s because I pursued the knowledge on my own. Even THEN, knowing and taking action are two different things.

    But also, I think there is a distinct, modern cultural difference regarding weight between whites and blacks. It’s been my observation that dress size and pounds are tied to a person’s worth, especially women, among whites much more than among blacks. Which has absolutely nothing to do with health, but about how thin (translucent?) you are. That’s not to say that black women don’t have their share of issues, but it’s not as inherent in the culture. Of course, class intersects then, as well. So even if doctors engage white patients more, it may have little to do with actual health, even if the advice may benefit the patient healthwise. The healthier behavior could be a side benefit, with the primary concern being about how the patient LOOKS.

    • Erika

      January 24, 2011 at 2:25 PM

      I just did the tootsie roll in my chair reading this.

      My goodness, the BGG2WL readership is BRILLIANT.

  7. Kjen

    January 24, 2011 at 2:22 PM

    I am leery whenever I hear stories along this line – this, being a study – doesn’t haven’t the same venom as others but the narrative is the same – “Black people aren’t being told enough how fat/obese they are” compared to white people.
    And the solution tends to be make sure to tell more Black people that they are fat.
    Because obesity and weight loss is driven largely by appearances first, health second, I am always worried this is another way of saying that black people, women in particular, should work to idealize the same slender frames deified amongst white women.

    • Erika

      January 24, 2011 at 2:52 PM

      “And the solution tends to be make sure to tell more Black people that they are fat.”

      Is it “tell more Black people that they are fat,” or is it “be fairer across the board with providing access to information on how to control one’s weight?”

      And really, not trying to be dismissive, but considering the percentage of the overweight in America… do doctors even HAVE the right answers?

      Weight management might be driven by appearances first, but the reality is that obesity is paired with metabolic syndrome because the same problem causes both… so regardless of the reason WHY weight management might be addressed, the answer to THAT problem would be the answer to MOST of the other issues that come paired.

      The issue is the fact that Blacks are being denied access to resources based solely on race… we can’t even get to the “looks” part of this because the subject isn’t even being approached, you know? I’m just NOT willing to put the cart before the horse on this issue. Not at all.

      • Rooo

        May 17, 2013 at 12:49 PM

        Sometimes it really is “tell more Black people that they are fat” – and/but I think that’s tied into socioeconomic conditions in more than one way.

        I go to a well-regarded clinic in Manhattan that sees a lot of performing artists. I was there once seeing an older white male doc about a possible strained wrist/forearm because I’d overrotated in crow pose (one of the many reasons I switched from yoga to Pilates, LOLsigh, but I digress).

        He basically told me I had no business being up there in crow pose in the first place because he didn’t think I had the upper body strength to hold my body weight. o.O
        My question to him as to whether his viewpoint might be slightly askew on the issue given the fact that a substantial portion of his practice’s remainder consisted of ABT size zero blonde principals which might therefore have an interesting effect on his perspective on how women “should” look was out of my mouth before I had a chance to think twice.

        And I think I already shared about the rounds I went through with the ortho I went to for my knee. Good thing I’m a self-activating girl; I’d never have found my current trainer (even though he’s leaving – with very little notice to the owners or his clients, which is a whole different box of problems *lil sob*) because it’s not like she would have recommended him. Because apparently “WOCs don’t train”, according to white docs, not even for rehab. I mean, look how they treated Taylor Townsend – and okay, she might be a little chunky (and less in person) but she’s a world class athlete.

        /stops rant before it really gets going

        • Erika Nicole Kendall

          May 17, 2013 at 2:50 PM

          Keep going. I can’t be the only Ranty Raven around here. LOL

          And, unless he performed some kind of InBody-esque assessment or a fitness assessment on you, he has no idea what you are capable of. It’s frustrating that he tried to pigeonhole you in that way, but I’m glad that you seem unfazed by it.

          • Rooo

            May 18, 2013 at 1:23 AM

            “unless he performed some kind of InBody-esque assessment or a fitness assessment on you”

            I’m sure you know there were none of these^^.

            I do have a nicer shoulder cap and better triceps now than I did then, but that’s b/c I’ve had some good guidance in how to make it happen. #strivingforMObamaarms

            But I’m also short-waisted and long-legged, with more junk in the trunk than anybody that ever auditioned for ABT or New York City Ballet had ever dragged in there. And, well, that’s what he’s been used to looking at — little bitty Natalie-Portman-in-Black-Swan-sized girls.

            I think it’s interesting and ties into what I saw elsewhere in comments about how the media and what we see conditions our eye — and therefore, our minds — without us even noticing it (the “curvaceous WOC” stereotype, forex).

            What troubles me is that clearly the medics think they’re “too smart” to fall prey to that, when they only get about 8 hours of nutrition training in about 8 years of med school, and everybody’s subconscious mind works pretty much the same way (which is why some forms of subliminal advertising have been outlawed), regardless of whether they have MD behind their names or not.

            /turns off rant faucet again

  8. Tam

    January 24, 2011 at 2:48 PM

    This article is interesting. My Primary Care Doctor is actually an overweight white woman. At my appointment the other day the first thing she said to me was how great I looked and asked what I was doing to lose weight. The last time I saw her was a year ago September and she suggested I see a nutritionist because my colesterol was a bit high and thought it would be a good idea to start to manage my weight. We looked my weight up in my chart from last year and I was really “ONLY” 187 lbs at 5’6″ and according to my BMI I was technically overweight. Now I am at a “normal” weight for my age and height.

  9. Tiffany

    January 24, 2011 at 3:11 PM

    I have actually had the opposite happen to me. When I was in middle school at about 11 or 12 yrs old 115lbs 5’1″ or so was the first time I was told that I needed to lose weight. I dont remember exactly how much weight I was told to lose or if I was given a plan of action to lose the weight. I was very active at the time and not over eating. I have had doc also in recent years tell me I need to lose weight. I was turned off a bit because she was pushing this specific program she wanted me to use or weight watchers. Both of which I didn’t have finances to afford. The doc was a black woman. She was in the process of losing weight herself with this plan that her office sold for $200 plus dollars a month. She told me you can take it out of your food, budget. My response was: What is my husband supposed to eat that is my food budget? Although both of these doctors saw that I had issues they didn’t direct me with proper ways to lose the weight. Also at the time I may not have been in a place to here it. I also think that I didnt work on my weight because of the women in my family. There have been a few times where I have told my grandmother or aunt that I want to be a size ten and they say that this is to small. I think that our perception of a healthy weight for your height and age can be blurred because of what we have been taught. I am doing my best to push past this. I know that she is grandmom or auntie even momma,but she doesn’t know everything and everything she says is not the gospel truth either!

  10. Eva

    January 24, 2011 at 3:23 PM

    Interesting. I wonder if the doctors were the patients regular GP’s or not. My regular GP AND my gynecologist told me last year that I had to lose about 15 pounds before I hit menopause. However, I’ve been seeing both of these doctors for years, they know where I work and that I have and do work with MD’s, so maybe that’s the reason.

  11. Danielle

    January 24, 2011 at 4:51 PM

    This is a great article!

    I work in a hospital- not on the clinical side- but of course I hear what people (medical staff) say. This is my behind the scenes take on it.

    Some are honestly intimidated by black folks especially black women. They won’t come out and say ‘I’m scared to tell that black man/black woman that they are overweight because I don’t want a negative reaction’ but the attitude suggests it. Like a lot of times when a black person asks a question or rebuts something, it is taken as being confrontational when it’s a mere question asked.

    Is this professional ? Absolutely not. How do we fix it? I have no idea.

    • Eva

      January 25, 2011 at 11:56 AM

      Danielle: I too work in a hospital and I’ve heard doctors echo something like what you said. There is a perception that a black person is going to be more confrontational when that might not be the case.

      And there’s something else too. About 20 years ago I used to ride our hospital shuttle with a white man, a GP who worked in a poor black neighborhood as part of his residency. He told me he was frustrated because when he’d tell his patients to do something like, eat fresh fruits and vegetables (some times this was for their children), he’d see them a few months later with the same issues. So he’d ask them if they’d been doing what he told them and they’d say no. His attitude was “why am I here if they’re not going to do what I tell them to for their health?”

      I asked him if he was sure they understood what he was telling them, he said language wasn’t a problem. So I asked if maybe they had a hard time finding fresh fruits and vegetables. And his response was, “Well why didn’t they say so?”

  12. Kara

    January 24, 2011 at 5:15 PM

    Funny, but I had the same experience all of my life. It wasn’t until two years ago when I switched my primary physician to a no-nonsense Indian woman. She and I clicked immediately when she told me that she refuses to prescribe medications for problems that could be easily solved myself if I put a little work into my health. As a result of our heart-to-heart conversations, I am on the road I needed to be on a long time ago. My blood pressure is normal, my cholesterol low, my weight is slowly leaving, but it’s leaving. Sometimes I believe that it’s just a matter of finding a doctor that’s “real” and someone you feel comfortable with. If anyone ever asks me about a recommendation, I always recommend my doctor. She’s blunt, but she’s effective. I’m very glad I found her.

  13. Chintel

    January 24, 2011 at 5:45 PM

    I have ran into the same issues as most of you. A doctor has never told me anything about my weight. Since i was 18 i make sure to go to the Doctor once a year for my annual, a fewe times in between if i was sick. Im 25 now and in that time only one doctor has evertold me anything about my weight. She was a white women, i think she felt uncomfortable to speak on it. She was very brief. Told me i needed to lose weight then kinda under her breath looking every where but at me says”probably 100lbs at least”. I knew that but to hear it out loud was shocking. I asked her questions of what she thought i should do and where to start, she couldnt tell me anything. Had no answers for me.

    So I had to help myself.

    Maybe Doctors think if they keep u unhealthy thats more money they can make off of u. They must be mad at me now because since 2008 i have only been to the Doctor for my annual and i get it all in at once. Physical, pap, and I ask her to go over all my #’s from the year before to see if im improving. I have no money to waste. LOL

  14. JoAnna

    January 24, 2011 at 6:30 PM

    I have been warned that I was gaining too much weight for about 10 years before I developed diabetes. But I never thought I would get really sick, ’cause all the women in my family are heavy. I looked like them, ate like them. Didn’t all people get sicker as they got older anyway?

    That said, I love, LOVE my current doc! When I was 1st diagnosed w/Type 2, we went over my diet, and he told me I could be put on insulin injections in 2-3 years, and probably start losing limbs in 5-10. Or I could modify my diet, exercise, and maybe eventually get off diabetes meds. He’s a white doc, works in the inner city, and about 90% of his patients are black. After I lost the first 50lbs, he told me that many of his patients don’t follow his advice, like 1 in 10. So his approach is to give the information to the patient, and see if s/he will run with it. At first I was a bit put off. How dare this white man tell me that I was going to be on insulin injections? I had control of my body, didn’t I?

    But changing my diet has not been the easiest task. Backing off of processed foods was difficult. Eating more vegetables than animal protein is sometimes still hard. And avoiding sugars … Let me just say that that crack is everywhere! You can pick up some quarter candy (no penny candy anymore) and fruit “drink” when you can’t find an apple or plain bottled water.

    Once my doc saw that I was willing, he worked with me. I will never forget on my 3rd visit (10lbs weight loss) he gave me a pack of Trident apple/pineapple gum and told me to chew it anytime I wanted something sweet. He also gave me a list of sugar-free candies and substitutes. But he forgot to tell me about Malitol. I was still in that “If the bag is open, you might as well finish it…” frame of mind, when I bought a package of sugar-free strawberry Twizzlers. I snacked on that package all night. No sugar right? Doc said sugar-free, right? So I can have my sweet and eat it too. Woke up in the dead of night with stomach cramps… And had to rush to the bathroom… and pretty much stayed there the rest of the day. Somehow those sugar-free candies and cookies didn’t taste at all good after that. On my next visit, I told him what happened, and he laughed himself silly before saying “The WHOLE bag JoAnna? Let’s go over portion control…”

    I think patients have to be willing to listen and follow given medical advice, but still research their condition. Docs need to be willing to give additional advice to all patients who take responsibility for their health, in addition to providing standard treatment options. Think of how kids study today. How many students study/cram just for the test, and then promptly forget the info? And then you have other students who ask questions, do extra credit work, get tutoring, etc… Which group of students will get more attention from the teacher, regardless of income or race? Doctors aren’t that different.

  15. Rachael Nobles-Glispie

    January 24, 2011 at 7:58 PM

    I just have one question: Is this type of bad attitude, or nonchalant approach reflecting on or children and making them obese as well?

  16. Lorrie

    January 25, 2011 at 5:57 PM

    I agree with Kjen. There are certainly more variables than are presented in that article. There may be a lack of equal care when it comes to treatment and counseling with obesity and African Americans however there are so many other variables not mentioned -such as great overall health despite being out of line with BMI calculations. The BMI calculations are not necessarily able to quantify accurately the body types of all races ethnicities and body shapes. My sons have always been taller, larger, stronger and older looking than their classmates and teachers (white and hispanic counterparts). At one time they were more overweight than I desired however even when they did lose weight and we were practicing balance living, exercising and eating we were still not always able to fit the “charts.” The problem is the over emphasis on appearance and the narrow valuation of the BMI chart and not whether or not you are actually healthy and fit inside and out with core strength, muscle mass, stamina and energy. There are many factors in Urban African American poor communities that contribute to weight gain. Here are a few examples: environment: no parks, no gyms, food deserts and no walkable communities, medications: birth control specifically Depovera and other hormonal drugs scientifically cause weight gain, hereditary: fibroids cause lethargy, low metabolism and anemia, body shape: much larger thighs and butt which make it very difficult to move when combined with any of the previous conditions mentioned above not to mention hard to go in public among peers in the gym, misdiagnoses: In addition to that I had to pry the information out the doctor to find out that hypothyroidism actually causes a spike in cholestorol. That is only the tip of the ice berg. Imagine then, no grocery stores, no methodology to adapt for a healthier lifestyle change and and over emphasis on being skinny instead of healthy and fit. I have normal cholesterol, low blood pressure, no diabetes, my heart works fine even with a murmur and I was so distraught over my weight, still am, but when I go to the gym (twice a day) I can exercise longer and faster than some of my slimmer counterparts. I had half of my thyroid surgecially removed and I was then diagnosed with hyperthyroidism and take daily medication to keep my thyroid working properly but only got this diagnosis because I was persistant and requested the tests I wanted. Although I had overall health inside I was steadily gaining weight over the years before I was diagnosed. Where is the category for that? I am so tired of the negative approach used to address black weight issues that I want to explode.

  17. asada

    January 28, 2011 at 4:52 PM

    I often wonder if the country is capable of working with people who are poor. I mean providing quality service in such a way that people dont get the short stick and inefficiency is low. It seems not. Especially with economic decline, rich and poor NEED good health care at prices they can afford.

    That is all. I think I will do more research on this valuable topic.
    Thank you Erika!

  18. Ms. Bad Mama Jama

    March 7, 2012 at 6:47 PM

    I found this post interesting…

    Earlier this year, Dr. Barbara Berkeley (author of Refuse to Regain and obesity doctor) wrote a post on her blog (refusetoregain.com) that as many as 78% of physicians currently give no counsel to overweight patients about losing weight. And, when they do they often lack the words and manner on how to communicate about it effectively. http://refusetore gain.com/refusetoregain/2012/01/sir-i-detect-an-excess-of-avoirdupois.html. I think so many doctors have limited time with patients and have so many issues to discuss – certain issues don’t get discussed (especially if you are visiting a doctor for a specific issue). What’s more depending on the doctors specialty, he or she may feel another doctor or specialist is better to discuss weight issues — it may be more than a feeling another doctor or specialist may indeed be better equipped to handle discussions and suggestions for weight loss. So, I think this issue effects peoples of all colors.

    However, I couldn’t help but wish there was more research on WHY less black patients were counseled. Pre-conceived notions on the resources available to them (or the lack there of)? Risking negative reactions from other black patients claiming racism or classicism? A known segment of blacks (particularly women) who don’t see anything wrong with “extra” meat on their bones?

  19. Erica

    March 7, 2012 at 8:09 PM

    All the commenters here are awesome. It is so refreshing when we collectively as a community can have a candid and enlightening dialogue. I have experienced all of the discussed issues: doctor indifference, cultural backlash (feeling sterotyped by health care professionals) as well as being skeptical of the medical information I received. There are so many complex issues – the medical industry, medical ethics, U.S. history and its treatment of women. There isn’t one approach to address all of our concerns. It is important that we continue to educate ourselves and to read/comment on blogs like Erika’s to inform and support each other.

  20. Violets Mommy

    May 2, 2012 at 12:05 PM

    I think patients have to be willing to listen and follow given medical advice, but still research their condition. Docs need to be willing to give additional advice to all patients who take responsibility for their health, in addition to providing standard treatment options. Think of how kids study today. How many students study/cram just for the test, and then promptly forget the info? And then you have other students who ask questions, do extra credit work, get tutoring, etc… Which group of students will get more attention from the teacher, regardless of income or race? Doctors aren’t that different.

    Very true. My doctors are pretty good at asking me about my weight, I am a active participant in my care. Doctors don’t read minds, they aren’t babysitters they are supposed to be working with you 50/50 in YOUR care. So I recommend either researching, such as doing here or bringing it up to your doctor. Like everyone the Dr has to feel it out and know that your weight is an issue for you. I wish this article would be more in depth about the why’s and hows, there is more to the story.

  21. P.T.

    August 9, 2012 at 10:48 PM

    I once had an annual physical with a black female physician. At the end of the exam she was about to send me on my merry way when I pointed out to her my concern that I was 5’6, 200lbs and she hadn’t bothered to suggest I do anything about my weight. She honestly looked at me and said, “You weight that much?” I was incredulous. She then went on to say, “You must be big boned.” WTH? I asked her where she went to medical school and if she had ever seen a fat skeleton. I ended our time together by telling her, “I must have to have diabetes or high blood pressure before someone says anything.” Needless to say, I never went back to see her.

    • Charey

      April 1, 2013 at 4:57 PM

      That is terrible! But lol@fat skeleton

  22. Tes

    January 14, 2013 at 4:11 PM

    Health care, as it relates to insurance, is simply big business. I made my choices for the upcoming year and intentionally looked for a provider that would give counseling as it relates to eating disorders. The rep @ the 800# I called said when looking for a therapist be sure NOT to mention eating disorders because they won’t cover it. She said make it about other mental health concerns and see if I could filter my way to a counselor or nutritionist that could help with eating disorders… I was like what :-O !!!

    I really want to tackle my overall health so that my weight can continue to be managed and not just have a band aid on it! Ridiculous.

  23. Pat Rice

    January 19, 2013 at 10:35 AM

    This is definitely about race and class. But I wonder how much is the doctors’ fault and how much is the patient’s fault. I work with a Black woman who is obese and after her doctor’s visits, she comes back to work, complains that the doctor told her she needs to lose weight. Doctor even gave her referrals (for dietician, nutritionists…)and useful info, she shrugged this off! I work for an insurance company and she is covered! Her Dr is facing an uphill battle and I’m guessing he won’t mention her weight again. Several co-workers have invited this woman to join WW or walk at lunch…she’s not ready to hear about weight loss from ANYONE! More often than we want to believe, we black women are in denial about our weight…we tell ourselves we’re PHAT…not FAT. Those other factors play a role but ultimately its up to us to take control of our bodies and our healthcare and ask questions and DEMAND answers from our health care providers.

    • Erika Nicole Kendall

      January 21, 2013 at 9:31 AM

      There are enough women in this community for me to feel comfortable saying… Black women, as a whole, are not in denial about their weight. Some may be, but they don’t stand for the whole. And, quite frankly, being delusional about weight isn’t resigned only to women of color.

      One delusional woman – or, maybe she’s just not ready, or maybe she simply hasn’t had her “come to fitness moment” – doesn’t represent the entirety of the population, and I think we do ourselves a disservice when we group us all together like this. We’re unique; different. “All of us” are not the same, and we would be wise to remember that.

  24. NativeNuYorker

    February 3, 2013 at 9:00 AM

    Hmmm! My obese doctor often told me that I was overweight and needed to lose. I heard him and came close to asking him why didn’t he follow his own advice.

  25. Subrina

    August 8, 2013 at 10:23 AM

    There are enough women in this community for me to feel comfortable saying… Black women, as a whole, are not in denial about their weight.

    …are you serious? Are the numbers are lying…and if we are not in denial…why do we need the Dr. to tell us we are overweight. There are so many examples as a whole that would suggest either we are in denial or have resigned to be overweight, or it’s ok.

    I understand this issue on both sides. But I think we must first find ourselves accountable to our own health. I have been fortunate that my Drs. have told me to lose weight, and have given great suggestions. Both male and female, both white and black. But I really think they felt comfortable, because I have always taken a big part in my own health. I come to my appointments with my medications, supplements, questions, etc.

    • Erika Nicole Kendall

      August 8, 2013 at 10:35 AM

      “…are you serious? Are the numbers are lying…and if we are not in denial…why do we need the Dr. to tell us we are overweight. There are so many examples as a whole that would suggest either we are in denial or have resigned to be overweight, or it’s ok.”

      Very serious. Do you know how many Weight Watchers centers, how many different communities – online or off, how many organizations are ALL created within the past 3-5 years to focus on weight in the inner city? Do you know how many conversations I’ve had with women, over the course of the FOUR years I’ve had this blog in full existence, talking about their weight?

      I mean, I don’t even have to challenge the “numbers” and their inaccuracy. I can simply tell you that the ONLY reason YOU seem to think that Black women are somehow in denial about their weight… is the fact that they are still, in some ways… fat. Doesn’t matter if their weight might be decreasing; doesn’t matter if, while their weight might be the same, the other factors contributing to death – like high blood pressure, diabetes, and the like – might be decreasing; doesnt even matter if they’re losing fat and gaining muscle, huh? All that matters is that they’re STILL registering high on THESE numbers, THIS chart and THIS scale, and that’s bad.

      Chile, stop. LMAO

      Progress, for ANY collective, doesn’t happen immediately. It doesn’t happen overnight. Please think critically outside of what some numbers say.

  26. Subrina

    August 8, 2013 at 11:41 AM

    I’m from a different time period….I was just looking at my yearbook. And there were few that were overweight. And those that were, by today’s standards definitely are not even overweight.

    So somewhere there was a disconnect…and denial started somewhere (and still exist, imo and from the facts that I’ve read and studied).

    So from my perspective.. I totally disagree with you.

    • Erika Nicole Kendall

      August 8, 2013 at 11:49 AM

      You can blame it on anecdote – I’m sorry, your yearbook – but that doesn’t really stand up to facts.

      Everyone wants to go on with this self-hating tirade of “these women are just in denial.” Um, I do this, for a living, now. I travel and speak to people. You haven’t dialogued with more women than I have, and I can assure you that you don’t know as much as I do about the initiatives going on in different cities PROVING that it’s not merely a matter of people simply being in denial.

      You might be from a different time period, but that doesn’t mean your mind has to stay closed to the truth of what’s actually going on in other communities. It’s easier for you to believe that people don’t care, are in denial, whatever, instead of understanding the myriad of factors that contribute to obesity, contribute to weight loss progress, contribute to weight loss success, and contribute to people learning and doing better? Why, because “those are excuses?” How can you solve a problem without understanding what contributes to its existence? If you understood better, you might not think it was such a matter of denial.

      Oh, but you’re from “a different time period.” Okay. Good luck with that.

      • Subrina

        August 8, 2013 at 12:02 PM

        Wow…I was not self hating.

        I understand the issues of obesity is bigger than denial. But there is denial. There are a lot of factors. And black women are in these numbers.

        And many perspectives. Just live a little.

        • Erika Nicole Kendall

          August 8, 2013 at 12:57 PM

          “Wow…I was not self hating.”

          You sure about that? A large-scale, systemic condition, with a MYRIAD of contributory factors, and YOUR answer is not in ANY way reflective of that… it’s merely, “these Black women are in denial?”

          I’m sorry, do we treat any other collective of people, any other group that way? Or do we assume the worst of Black women, the way we’re encouraged to do by so many others, without giving them a chance?

          I’m living quite fine. I’m also out here learning about what’s going on in the communities around me and doing what I can to contribute positively, instead of playing in recidivist logic and calling people “in denial.” What about you?

          • Subrina

            August 8, 2013 at 1:20 PM

            All I can say is ….OK…you read a lot into my comment, that I did not even say.

            I don’t know where all of what you are saying is coming from. You are making it so personal. .

            But I believe denial is part of our problem…and not just black women. I don’t know how you find this do negative.

            Once again as I said…It’s perspective.

            Peace and Blessings

          • Erika Nicole Kendall

            August 8, 2013 at 1:42 PM

            It’s not personal, at all. You’re not talking about me or my story – you’re talking about the people around you. You “opened a yearbook.”

            I’m telling you to think deeper than that. You apparently don’t want to. I’m reading the words you’re typing and thinking critically about why you’re refusing to be receptive to information that proves you wrong. You apparently just wanted to type into the Internet and leave your words there, with no response.

            I find the whole “denial” meme negative because it ignores all the other contributory factors of obesity. Furthermore, what woman is going to publicly admit something she’s concerned about to people she doesn’t think are going to support her or help her – i.e., strangers? How many people were lying about their finances, telling people everything was OK, only to have their homes foreclosed upon in 2008-2010? Just because someone’s not pouring their heart or soul out to you about how depressed and unhappy they are about their size doesn’t mean they’re “in denial.” It means they don’t want to talk to YOU. There are close to a million people who visit this blog REGULARLY. They might not be talking to YOU, but they’re talking to ME. You don’t like to listen. I can only do so much typing.

            It’s not perspective – it’s facts. You don’t like facts, I can’t help you.

            Peace, indeed.

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