Weight-Loss Education Missing for Low Income Adults

A new study finds clinicians less likely to counsel less educated, and younger and older patients. According to a study in Preventing Chronic Disease, low-income adults who are overweight or obese are less likely to be counseled to lose weight than adults with higher incomes.

High-risk patients, such as those who are extremely obese or have comorbidities, are most likely to receive weight-loss advice. However, demographic factors also appear to determine who receives advice. Patients who have high levels of education are more likely to receive advice than those who have low levels of education and those who are middle-aged are more likely to receive advice than younger or older patients. Study results are unclear about whether health insurance plays a role in determining who receives weight-loss advice; some studies found that insurance is not associated with receiving weight-loss advice, whereas one study found that patients who had private insurance were more likely than uninsured patients to receive weight-loss advice. Income also appears to play a role; those who have high incomes are more likely to receive weight-loss advice than those who have low incomes.

This study is the first to explore the determinants of receiving weight-loss advice in a sample of overweight or obese individuals from communities with a high proportion of low-income, racial/ethnic minority populations in a multivariate analysis of race/ethnicity, age, sex, health status, income, health insurance status, and education.

Over 1,100 overweight or obese adults from New Jersey were surveyed about whether their healthcare provider had advised them in the past year about weight loss. A substantial proportion of participants had low incomes and were of a racial or ethnic minority.

Only 35% said they had recently been advised by a clinician to lose weight. After adjustment for health insurance status and other variables, participants whose household incomes were above 400% of the federal poverty level had a 64% increased odds of receiving weight loss advice, compared with those at or below the federal poverty level. Participants at 200–399% of that level had 56% higher odds.

The US Preventive Services Task Force recommends that all patients be screened for obesity and, if needed, be provided weight-loss advice. This study aimed to describe the determinants of receiving weight-loss advice among a sample with a high proportion of low-income, racial/ethnic minority individuals.

The finding that individuals in the lowest income group had significantly lower odds than individuals in higher income groups of receiving weight-loss advice from their health care provider is similar to the findings of previous studies. Patients who have risk factors such as obesity, poor health status, diabetes, and asthma would warrant special attention to weight. The finding that these risk factors increased the odds of receiving weight-loss advice aligns with the findings of other studies.

From the results of the study, it was concluded that income is a significant predictor of whether or not overweight or obese adults receive weight-loss advice after adjustment for demographic variables, health status, and insurance status. Further work is needed to examine why disparities exist in who receives weight-loss advice. Physicians should provide weight-loss advice to all patients, regardless of income.

If You Have Type 2 Diabetes, Avoid Most Potatoes

This is a little off topic, but when I read this in Diabetes Health, I had to think about what I had just read. Did I believe this? No, I do not believe this. Why do I not believe this? In the way the study was done, I have to believe that it may work for some people and the study in essence is too small and too short a time frame. Twelve weeks and 90 people assigned to three groups do not make sense.

And for this to be in a diabetes magazine make me wonder why it did not include people with type 2 diabetes. For a person with diabetes, most types of potatoes will bust a diet and destroy good management of blood glucose. Those on no medications or on oral medications will develop problems with diabetes management. A few on insulin can manage blood glucose, but even then, they must be careful.

I can understand why the blog is very short, as the author has no intention of getting into detail of any significance because the study itself was lacking detail often seen as part of the better studies. And being from the Journal of the American College of Nutrition, this is easy to understand that the study would be small and short to avoid problems that could be experienced from an longer study.

In viewing the full report, this seems very typical of nutrition studies - “Exclusions for study participation were the following: food allergies or intolerances to potatoes, cigarette smoker, currently modifying diet or exercise patterns to gain or lose weight, excessive exercisers or trained athletes, taking any medications that would affect glucose metabolism, or the presence of other health problems requiring ongoing intervention by their personal physician. Eligible men and women were overweight based on their body mass index (BMI = 25–37 kg/m²), over 18 years old, light to moderate exercisers and had normal fasting plasma glucose and were able to meet the time and effort requirements required for study participation.”

Some of the above are reasonable exclusions, but selection was apparently looking for participants that fit very limited criteria and help the people doing the study arrive at the desired results. Probably why the study was only 24 weeks,

Excess Weight Is a Weighty Issue

How long will people keep their resolution of lose the excess weight they are carrying around? This is a problem for many people. The New Year starts out with good intentions, but by the end of the month, the intentions are gone and people are back to old habits. Yes, it is the beginning of February, and in contacting the local Weight Watchers and Curves offices, the numbers in attendance has declined almost as expected.

Curves is slightly up over normal and they are working to keep people coming. What has helped this year? Mainly it is grouping people into similar weight groups so that there is not the cross comparison and put-downs from those not having to lose as much weight. There was some extreme confrontations in the first session to weed out those that had no desire in the first place. In the five new groups, the first session eliminated one group, but the remaining four only lost two of their number.

In further conversations, they have only lost five more, which is less than they normally lose. The grouping has helped as they can more easily tailor the class to fit their needs and keep everyone moving at a similar pace. They are expecting four of them back after they heal from accidents that happened away from Curves – one a severe burn, two falling on ice, and one in an auto accident. Also, they found that by using age as a common factor in the grouping has been somewhat helpful, but that has not been a great concern for many.

Weight Watchers has lost participants at the same rate as in prior years and they are now down to the dedicated few they normally have and work with for at least the coming year. Even adding some incentives has not retained attendees. They had hoped that the fall out rate would have been lower this year.

In asking questions about what diseases may have been involved, I could not get any of this information, so I don't know if anyone has diabetes. I can appreciate the confidential nature of this relating to any individual, but I had hoped to get some numbers at least. I had asked for numbers of memberships and new members, but even this was not information they would give.

Two people that I knew were joining Weight Watchers I did talk to. I did find out why they had stopped. Both said that even though they had requested staying off third party promotion lists, they were inundated with junk mail and email for this special and that special for exercise equipment and other weight loss information. This was upsetting to them and they felt if their request could be ignored, then what other expectation did they have for any privacy.

The short “letter to the editor” in Diabetes in Control is what got me interested in this. I will admit that I was surprised by what I learned from former Weight Watchers members. When I asked about this, the question was ignored and the benefits of advertising was promoted especially stating how deep the bargains were and the benefits of exercise were so beneficial that they could not be ignored.