A Health Equity Approach to Obesity Efforts Proceedings of a Workshop (2019) / Chapter Skim
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3 Disparities in the Prevalence of Obesity
3 Disparities in the Prevalence of Obesity
Pages 11-24
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From page 11... ...
• Disaggregated data on Asians and Pacific Islanders are limited, but the disaggregated data that do exist reveal differences in the prevalence of obesity and type 2 diabetes in single racial groups within these populations. Asian Americans have a high prevalence of undiagnosed diabetes and are now screened for diabetes at a BMI of 23; this population's tendency for excess ectopic fat, low lean muscle mass, and poor adiponectin profile is hypothesized to contribute to its excess diabetes risk.
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From page 12... ...
, opened her presentation by declaring that disparities in obesity prevalence are complex. Before launching into the salient statistics, Ogden clarified that her data describe weight status based on body mass index (BMI)
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. 39.7 39.7 38.1 37 30.1 11.9 White Black/African American Indian Asian Native Hawaiian 2 or More Races American or Alaska Native or Other Pacific Islander FIGURE 3-1 Prevalence of obesity in U.S.
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From page 14... ...
BMI is a screening tool that measures body mass and does not serve as a direct measure of body fat, she pointed out, and therefore, disparities based on BMI may not translate to disparities in actual adiposity. She referenced data on the varying prevalence of high BMI among girls in three racial/ ethnic groups, noting that the differences disappear when the measure used is the prevalence of high adiposity (Flegal et al., 2010)
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From page 15... ...
SOURCES: Presented by Cynthia Ogden, April 1, 2019 (Ogden et al., 2017)
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. She added that the prevalence of severe obesity in youth is nearly double in rural compared with urban areas, but pointed to the absence of significant trends in youth obesity or severe obesity in either urban or rural areas from 2001 to 2016 (Ogden et al., 2018a)
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Department of Health and Human Services, and provides direct health care services to qualified members of 573 federally recognized tribes in 36 states. She noted that health care is also provided by tribes, which have the right to assume control and management of health care programs.
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that help predetermine behaviors and physiological risk. She cited the National Survey of Children's Health, which indicated that AI/AN children up to 17 years old were more likely than their white counterparts to have experienced multiple adverse childhood experiences.
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From page 19... ...
. She also highlighted My Native Plate, a resource that adapts national nutrition guidelines for AI/AN populations, and referenced a tool for use by clinicians to screen for food insecurity, as well as a form they can complete to direct patients to local resources for accessing healthy foods (IHS, 2015, 2018)
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From page 20... ...
Araneta went on to observe that among the 21 million Asian Americans in the United States, the largest groups are Chinese, Asian Indians, and Filipinos; Native Hawaiian and other Pacific Islander populations are estimated to total 1.3 million people (U.S. Census Bureau, 2018a)
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From page 21... ...
, Filipinos, and South Asians; followed by Latinos, African Americans, and Native Americans; then other Asian groups; and finally, whites (7.3 percent) (Karter et al., 2013)
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From page 22... ...
Based on the unexpected results of the Kaiser Permanente data, Araneta explained, the American Diabetes Association contacted four research groups with Asian American cohorts -- because there is no national study of this population -- to write a position statement that would inform revised guidelines on BMI cutpoints for diabetes screening among Asian Americans. By pooling data from the four cohorts, it was determined that at the previous BMI screening cutpoint of 25 kg/m2, more than one-third of all Asian Americans with diabetes would be missed -- 37 percent of women and 21 percent of men with newly diagnosed diabetes, including a woman with a BMI of 16 (Araneta et al., 2015)
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From page 23... ...
. Citing a third study, Araneta mentioned that for both men and women, visceral fat was lowest among African Americans and significantly higher among Chinese Americans and South Asians, and South Asians had the highest levels of intermuscular fat and lowest levels of lean body mass (Shah et al., 2016)
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From page 24... ...
She asked Bullock whether data for urban AIs might be more similar to data for the urban African American population than to data for the American Indian population in general. Bullock replied that more Native Americans live off than on reservations, but despite the existence of urban Indian organization clinics and IHS and tribal clinics in urban areas, most urban Native Americans do not access care consistently from one of those sources.
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