ABSTRACT
Racial/ethnic disparities in obesity are evident in North America; Black women have the highest obesity prevalence compared to other population sub-groups. Measures of obesity such as BMI are highly correlated with total body fat, but levels of adiposity differ at the same BMI across racial/ethnic groups; physicians should recognize that certain racial/ethnic groups are at elevated risk at the same BMI. Racial/ethnic minorities are subject to systemic racism, referring to social conditions causing elevated risk for obesity and its complications through economic inequity, systemic bias, discrimination, mass incarceration, predatory marketing by corporations, and other factors. Physicians, while unable to fix these problems, can acknowledge them and initiate compassionate discussions with patients about social factors largely beyond their control. Population-specific BMI thresholds can also be considered, in line with prior development for Asian populations, whose cut-offs are lower than the traditional WHO and NIH cut-offs. Some minority populations do not benefit to the same extent from behavioral programs and bariatric surgical interventions targeting obesity, which could further increase health disparities. There is an urgent need to develop effective interventions in all racial/ethnic groups, which calls for identifying mediators of the racial differences observed, including systemic racism, and tailoring intervention delivery methods.
