If you were asked to take ten seconds to name someone you know with high blood pressure, diabetes, or heart disease, you probably wouldn’t need a second. Unfortunately, the African American community is at high risk for a variety of illnesses and conditions that we’re all too familiar with, and the situation is getting worse. But most people don’t know that one disease is a major risk factor for a wide array of other diseases prevalent in the Black community. That disease is obesity — yes, obesity is a disease.
Obesity underpins a variety of serious health conditions affecting almost 1 in 2 African Americans. Adding to its extensive damaging effects, obesity has been shown to be a strong predictor for COVID-19 complications and increased severity of the disease. Recently on “Life Hacks with Darrell & Grace: Obesity 04,” we shared our insights on how obesity is medically defined, addressed bias and stigma associated with the disease, and explored interventions people can seek along with a full continuum of obesity care. Below are some of the highlights.
DEFINING AND DIAGNOSING OBESITY
All told, obesity is a chronic disease with correlations to over 60 comorbidities — additional conditions that develop or are exacerbated by obesity. But medically speaking, how do we define obesity, especially for Black people?
Obesity is commonly estimated through your body mass index or BMI. A healthcare professional can help you calculate your BMI by comparing your height and weight to understand your body’s mass. In general, overweight and obesity are defined in four classes:
Overweight – BMI is 25.0 to 29.9
Class 1 obesity – BMI is 30.0 to 34.9
Class 2 obesity – BMI is 35.0 to 39.9
Class 3 obesity – BMI is equal to or greater than 40.0
Other factors may play a role in the diagnosis of obesity, for example, waist circumference, and more sophisticated diagnostic tools like an MRI may also be used.
Evidence has shown that people with higher BMIs have a higher likelihood of experiencing comorbidities like diabetes, hypertension, kidney disease, osteoarthritis, respiratory problems, sleep apnea, numerous cancers, and more. Obesity is a multifactorial disease and needs to be addressed as such. When diagnosing and treating the disease, we must consider a variety of inputs from a person’s diet, genetics, and exercise regimen to their environment and access to health care and medications.
It’s also important to note that obesity differs in men and women and there’s further variation across races and ethnicities. For example, African American women have the highest rates of obesity on the BMI scale at 56.9 percent and this has been directly linked to a higher prevalence of the cardiovascular disease. Black men have higher rates of obesity than white men, causing an earlier onset of chronic conditions and sometimes premature death.
Our goal in obesity care is to improve proper diagnosis and treatment. Unfortunately, it isn’t broadly recognized as a disease with wide-ranging treatment options and many physicians aren’t well versed in its diagnosis. Furthermore, patients and physicians don’t often feel comfortable enough having the conversation about the disease for the physician to offer help and for the patient to accept it.
OBESITY, BIAS, AND STIGMA
Most people who want to get to a healthier weight are working hard at it, but they’re judged by society as lacking will power to reach their goals. What’s poorly understood is the metabolic challenges obesity presents that cannot be willed away. If a patient’s willpower were the central issue impacting progress toward better health, then we would be asking patients with high blood pressure to will their blood pressure down as well. Chronic diseases don’t operate in that fashion and in many ways a person’s body may be working against the achievement of their health goals. Therefore, it can be exhausting to repeatedly alter diet, increase exercise, and still yo-yo up and down gaining and losing weight.
Our brains have a set point for our body’s weight and will try to help our bodies get back to that weight while we’re trying to lose it or keep it off. Accordingly, multiple factors work to counteract your best efforts to lose weight, including some of the hormones in your body such as ghrelin, which is produced in the stomach and increases appetite. That is partly why, of the many patients who have bariatric surgery, over 50 percent of them regain their pre-operative weight. Regaining weight after bariatric surgery or lifestyle adjustments is not a personal failing of willpower alone. Obesity must be treated like the chronic disease that it is.
What’s required is a comprehensive approach to patient needs across a continuum of care. A full continuum of obesity care might include: meeting with patients regularly to monitor weight and discuss goals, teaching new personal training and nutritional approaches, scheduling sessions with a psychologist to break down eating disorders, prescribing medications where applicable, and recommending surgery where necessary. All of these supports together or in various combinations are the key to helping patients reach their goals and maintain that achievement over the long term.
Until recently, we’ve been accustomed to addressing obesity as a state of being or an adjective to describe a person, but now we know better. The language we use can be stigmatizing to people with obesity. It’s important that we broadly recognize obesity as a condition a person lives with and use patient-centered language such as “living with obesity” — the same way we call someone a cancer survivor and not “cancerous.” We should take care to put the person first, and the disease they live with second.
WHAT YOU CAN DO
Talk to your health care provider – If you are concerned about your weight or BMI, have an honest conversation with your doctor and ask about getting support if you’re battling obesity. Request a referral to an obesity care physician to start a treatment program tailored to your goals and needs. Your program should include nutritional education, physical activity options, psychological support, prescribed anti-obesity medications (AOMs) as appropriate, and surgery when necessary. The right combination of these factors can help you reach and maintain your BMI goal.
Don’t give up – Treating any chronic disease, like obesity, requires a commitment to meeting your health goals and an open mind to accept the support your body needs. There are several parts of the puzzle when managing obesity and it can be tough to manage them all. But you can do it. Focus on breaking old habits, beliefs, and addictions in favor of new personal health care regimens. Consistently make your weight management part of your daily routine while accepting that it’s okay to admit that you need help from a medical professional, nutritionist, personal trainer or psychologist, or others to support you.
There are so many personal benefits to a healthier, more active, longer life when you’re committed to managing obesity. There’s no solution that’s right for every patient, and each person needs a combination of supports to maintain progress. Obesity is at the center of so many health, economic, and mental health issues that we must get a handle on it individually, and as a community. We can get there if we manage obesity together. ●
