PROGRAMS FOR FELLOWS AND JUNIOR FACULTY
THE COMMONWEALTH FUND/HARVARD UNIVERSITY FELLOWSHIP IN MINORITY HEALTH POLICY
FELLOWS' PRACTICUM: 2003-2004
Nefertiti Durant, MD, CFHUF Fellow
“Overweight and Obesity Issues for Users of Federally Supported Community Health Centers”
Studies such have shown that overweight and obesity are particularly prevalent among minority groups and those with a lower family income. The aims of this study were to assess the prevalence of overweight and obesity among federally funded community health center (CHC) users by race/ethnicity and socioeconomic status, assess the prevalence of obesity related care among CHC users by race/ethnicity and socioeconomic status and assess the perception of the damage that weight causes to health among CHC users by race/ethnicity and socioeconomic status.
Services Resource Administration/Bureau of Primary Health Care was conducted to achieve the study aims. The survey, modeled after the CDC National Health Interview Survey, collected data on demographic characteristics, medical conditions, health status, health care utilization and patient satisfaction. The study included only adults aged 20 and older, a total of 1487 individuals which correlates to a population estimate of 3.6 million. First, demographics and prevalence of overweight and obesity of the population were assessed. Bivariate analysis was conducted to examine the relationship between the dependent variable of weight and the independent variables of race/ethnicity and socioeconomic status. Bivariate analysis was conducted to examine the relationships between the dependent variables of obesity related care and perception of weight and the independent variables of race/ethnicity, socioeconomic status, and weight status. Multivariable logistic regression models were created to examine the relationships between the dependent and the independent variables.
Analysis of the demographic data showed that 63% of respondents were racial/ethnic minorities. 99% of respondents were uninsured or received public insurance. Less than one half of respondents had completed high school. The combined prevalence of overweight and obesity in the CHC population are 75%. There are no CHC user disparities in overweight and obesity by race/ethnicity or socioeconomic status. Eighty per cent of overweight CHC users were not told by their physicians that they were overweight. The majority of overweight CHC users do not feel their weight is damaging to their health. Hispanic CHC users (OR 2.2, 95% CI [1.1-4.3]) and CHC users with public insurance (OR 2.1, 95% CI [1.1-4.2]) were more likely to be told by their physicians that they are overweight. Multivariable analysis revealed that overweight Non Hispanic, Black CHC users (OR 0.4, 95% [CI 0.2-0.6]) are less likely to think their weight is damaging to their health.
There are no racial/ethnic disparities or socioeconomic disparities in the CHC population in the prevalence of obesity and overweight. However there are racial/ethnic and socioeconomic disparities in obesity related care and racial ethnic disparities in perception of the damage that weight causes to health. Resources need to be allocated research to determine best practices of obesity related care and develop culturally competent and effective interventions for weight loss. Resources need to be allocated to improve education of practitioners regarding disparities in patient care and perceptions as well as to improve education of patients.
Felicia L. Collins, MD, MPH, FAAP, Chief, Clinical Quality Systems Branch, Health Resources Services Administration/Bureau of Primary Health Care, Division of Clinical Quality
Barbara A Bartman, MD, MPH , Clinical Quality Systems Branch, Health Resources Services Administration/Bureau of Primary Health Care, Division of Clinical Quality
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