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Racial Differences in Diagnosis of Overweight and Obesity: Results from the National Health and Nutrition Examination Survey (NHANES) 2009–2016

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Abstract

Background

Diagnostic standards and codes related to excessive weight exist so that clinicians may inform patients that they are overweight: a status which may be a harbinger of more severe obesity and negative health outcomes. Equipped with this knowledge, patients may pursue medical interventions or behavioral changes to reduce their risk. However, diagnoses of overweight are unequally applied in the United States along racial lines.

Methods

Binary logistic regression was used to analyze National Health and Nutrition Examination Survey (NHANES) 2009–2016 data from 7460 participants to examine the relationship between race of non–Hispanic White and non–Hispanic Black Americans and having ever been told that one is overweight by a clinician when controlling for demographic and socioeconomic factors. The body mass index (BMI) of participants along with obesity-associated comorbidities was then incorporated into the model to see if physical size or disease status mediated the primary relationship.

Results

Black Americans are significantly less likely to report being told that they are overweight by a clinician than are White Americans regardless of clinical weight status and weight-associated comorbidities. We find that these racial differences are greatest when respondents’ BMIs approach the lower threshold for clinical obesity.

Conclusions

Our findings suggest that the lower likelihood of Black Americans to be told they are overweight compared to their White counterparts can result in serious health implications. We posit that implicit biases among clinicians may partly explain this disparity, which may exacerbate health outcome inequalities.

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Notes

  1. Among other applications, BMI also allows researchers to compare groups of different height and body compositions to one another, which was in fact its original purpose.

  2. Although “overweight” and “obese” are two discrete categories by today’s standards, this was not always the case in the twentieth century. At times, any BMI or other corporeal status that exceeded what was considered clinically desirable was classed as simply “overweight” [67]. This has led to a kind of rectangle-and-square relationship between the two terms in lay speak, with some writers and observers casually noting percentages of Americans who are “overweight” and then specifying that a percentage of that group is in fact “obese.” This is technically improper, but it implies that we often think of obesity simply as a more extreme form of overweight, which is not an unreasonable position to take.

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Acknowledgements

Special thanks to Dr. Lin Zhu, Dr. Gretchen Condran, and Dr. CiAuna Heard for their invaluable assistance and feedback on this paper.

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Authors and Affiliations

  1. Department of Sociology, Sussex County Community College, 1 College Hill Rd., Newton, NJ, 07860, USA

    Chuck Galli

  2. Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N. Broad St., Philadelphia, PA, 19140, USA

    Tiffany Li

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Chuck Galli contributed to the study conception and design and data analysis. The first draft of the manuscript was written by Chuck Galli, and revision and editing of the manuscript was performed by Tiffany Li. All authors read and approved the final manuscript.

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Correspondence to Chuck Galli.

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Table 6

Table 6 How respondents consider their current weights by clinical BMI category, race, and sex
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Galli, C., Li, T. Racial Differences in Diagnosis of Overweight and Obesity: Results from the National Health and Nutrition Examination Survey (NHANES) 2009–2016. J. Racial and Ethnic Health Disparities 10, 1096–1107 (2023). https://doi.org/10.1007/s40615-022-01297-4

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