Exploring Demographic Disparities in Obesity: A Retrospective Observational Study on the Representation of Minority Groups in an Indianapolis Weight Loss Clinic

Abstract

Introduction/Background: Obesity is a complex multifactorial disease with a disproportionally high impact on socially disadvantaged populations. The state of Indiana exhibits the ninth highest obesity prevalence in the United States at nearly 38%, of which a disproportionate amount are Hispanic and/or non-Hispanic Black adults. Although the use of multimodal interventions including behavioral, medical, and surgical methods have proven to be effective weight loss strategies for Hoosiers, addressing obesity with an equity-informed approach is crucial to improving patient outcomes. Adequate representation of minority populations in weight loss clinics is therefore essential for clinical interventions to effectively address health inequities in obesity and improve overall population health. Study objective/Hypothesis: The purpose of this study is to compare patient demographics of an effective weight loss clinic in the Indianapolis area to a model clinic with an Indiana-specific idealized set of patient demographics. By detecting any underlying sex, age, and/or race/ethnicity-related disparities, this study aims to characterize the scope of this clinic’s patient panel, inform future clinical interventions, and reframe health care delivery to more effectively address obesity in Indiana. Methods: This is a retrospective observational study which utilizes sex, age, and race/ethnicity demographic data collected from adults with a BMI over 30 who visited an Indianapolis-based IU Health medical and endoscopic weight loss clinic between Sept. 1, 2016, and Sept. 1, 2023. These findings are then compared to a model obesity clinic with an idealized demographic breakdown specific to the state of Indiana. This is estimated via statistical modeling using a combination of 1) self-reported survey data on the prevalence of obesity within demographic subgroups and the overall population provided by the CDC’s Behavior Risk Factor Surveillance System, and 2) population statistics provided by the US Census Bureau. Results: A total of 699 patients were identified in the Indianapolis weight loss clinic’s database. In comparison to the model clinic’s demographic breakdown, there was significant underrepresentation of multiple subgroups in the clinic, including Hispanic patients (1.9% vs 8.7% [95% CI 7.9-9.7]), male patients (17.0% vs 48.8% [95% CI 48.1-49.7]), patients from 18 to 24 years of age (0.1% vs 8.8% [95% CI 7.5-9.8]), and patients 65+ years of age (9.3% vs 19.3% [95% CI 18.3-19.5]). Noteworthy overrepresented subgroups include non-Hispanic black patients (20.0% vs 11.4% [95% CI 10.5-12.2]), Asian patients (1.7% vs 0.7% [95% CI 0.3-1.6], and female patients (83.0% vs 51.2% [95% CI 50.4-51.9]). Conclusions: Effectively addressing obesity requires an equity-informed approach. This study revealed inadequate representation of Hispanics, males, young adults, and senior adults in an Indianapolis weight loss clinic. These disparities may be secondary to a complex interplay of multiple phenomena, both on a structural and individual level, including historical racial discrimination, built environmental factors, socioeconomic factors, health care access, weight stigma, and more. Limitations of this study include small sample sizes in certain subgroups, use of survey data with self-reporting, and inherent assumptions in statistical modeling methods. However, the results may identify disparities in patients receiving obesity treatment with the hope of informing future interventions to better address obesity in Indiana and improve overall health equity.