Obesity has been making headlines recently, with Oprah’s TV special on weight loss and news of widespread shortages of weight-loss medications like Wegovy. A billion people are estimated to have obesity worldwide, and in the United States, Black, Native, and Hispanic Americans are more likely to have obesity than white Americans. This week’s guests on Basic Black discussed racial disparities around obesity and its various treatments, including diet and exercise, anti-obesity medications, and bariatric surgery.
Dr. Abdelrahman Nimeri, Director of Bariatric Surgery at Brigham & Women’s Hospital, says people should approach obesity like they would any other disease. “Most patients with the disease of obesity, they know the disease, and they try to figure it out on their own. They try diet, it doesn’t work, they try exercise. And then rather than saying this is not working, let me see someone, they blame themselves,” he said, pointing to the stigma around obesity. “Someone with the disease needs an evaluation,” he said, so that doctors can determine the appropriate treatment.
Obesity and mental health are connected, according to Dr. Stephen Tourjee, a child, adolescent, and adult psychiatrist and founder of Transcend TMS Boston. “If somebody’s depressed, they’re gonna have changes in their mood, their sleep, their appetite… they might have some weight gain and feel less motivated,” he said. “[If] you’ve been struggling with obesity all your life, you’re going to potentially internalize that struggle and that shame and the stigma that society places on us, and that’s a heavy burden to carry too, and you can become depressed over time,” he said.
Long-term stressors like poverty and racism can also contribute to obesity. Dr. Fatima Cody Stanford, an obesity medicine physician scientist and associate professor of medicine at Massachusetts General Hospital, said that’s part of why Black Americans are more likely to have obesity than white Americans. “Stress leads to storage of fat,” she said. “When we experience this chronic stress, our body doesn’t recognize that a famine isn’t happening. It’s storing adipose and fat to prepare for a famine, but that famine may not come,” she said.
Christine Sinclair, RD, is a licensed dietitian nutritionist with Stop & Shop Nutrition Partners. She provides workshops and free consultations at the Grove Hall Stop & Shop store in Dorchester. “There’s no insurance involved, there’s no cost involved, and we consider ourselves the bridge between the clinical providers,” she said. “Even reading a nutrition label, for some, is really confusing,” she said, so she works to help customers read labels and understand which foods suit their needs.
Genetics also play a role. “Patients should not feel that this disease came from them, because obesity is 60 to 70% genetic,” said Dr. Nimeri. “The effects of epigenetics, what we eat, how we exercise, the types of foods we eat, adds to that,” he said.
