Mertalaine Mulatre, MS , Lloyd Werk, MD, MPH , Michael

Racial Differences in Obesity Behavior and Outcomes in Adolescents
Mertalaine Mulatre,
1
MS ,
Lloyd Werk, MD,
2
MPH ,
Michael Campbell, PhD,
1,2
Barkley, MD
2
LCSW ,
Xin Yan,
1
PhD ,
Lisa
1, University of Central Florida College of Medicine, Orlando , FL 32827
2, Nemours Children Hospital, Orlando, FL 32827
Abstract
Obesity has become a major problem in America. This epidemic is
reflected in adolescents. It is becoming a necessity to understand
the factors leading to these increased rates of obesity especially
among minorities. The rationale and acceptance of a bigger body
size among minorities may be a contributing factor for decreased
motivation to lower BMI. By retrospectively reviewing medical
records from a multidisciplinary weight management clinic at
Nemours Children's Clinic, we will examine the association
between race/ ethnicity with the number and distribution of goals
and targeted behaviors and determining the association between
race/ethnicity with change in BMI percentage.
Introduction
There has not been research to correlate if preference and
acceptance of a bigger body size among minorities may
contribute to the high obesity rates. Blacks preferred a
significantly larger body size than whites when asked to select
ideal body size1, 2. Among teenagers, black adolescent girls were
much more likely than white girls to be satisfied with their body
size, to describe themselves as thinner than other girls, and to say
that they were not overweight2,3. Since motivational interviewing
is the therapy for obesity and is dependent on the patient
identifying targeted behaviors to change with their provider – it
is possible that they may have fewer targets to change. Among
Black adolescents seen in a weight management clinic compared
with teens of Hispanic or White race/ethnicity, they will have
fewer goals and behaviors targeted for change; different
distribution of targeted behaviors in the areas of nutrition,
activity and environment; and would have less change in BMI %.
If a relationship can be established it can help healthcare
providers to gain a better understanding on how to approach the
adolescent obesity epidemic that is prevalent in the minority
population.
Black
N = 15
Hispanic
N = 29
White
N = 24
Other
N=6
40
34
8 (20.00)
7 (20.59)
12 (30.00)
17 (50.00)
14 (35.00)
10 (29.41)
6 (15.00)
0 (0.00)
14.54
14.94
14.87
14.25
40.40
38.34
40.66
32.78
98.99
98.64
98.63
97.87
2.50
2.46
2.43
2.11
3 (8.33)
12 (31.58)
15 (41.67)
14 (36.84)
14 (38.89)
10 (26.32)
4 (11.11)
2 (5.26)
18.75
33.33
39.42
8.33
Gender
[# female (%)]
[# male (%)]
Mean Age at 1st encounter
Mean BMI at 1st
encounter
Mean BMI % at 1st
encounter
Mean BMIZ at 1st
encounter
Insurance Categories
# Commercial (%)
# Non-commercial (%)
Drop-out rate after 1st
encounter (%)
36
38
Table 1 Demographic of the study cohort
Total
N = 48
Gender
[# female (%)]
[# male (%)]
Mean BMI at 1st
encounter
Mean BMI % at 1st
encounter
Mean BMIZ at 1st
encounter
Drop-out rate after 4
encounters (%)
Mean BMI at last
encounter
Mean BMI % at last
encounter
Mean BMIZ at last
encounter
Black
N=9
Hispanic
N = 16
White
N = 19
Other
N=4
39.85
40.05
42.85
33.13
98.76
98.41
98.87
98.15
2.47
2.56
2.52
2.15
78%
25%
42%
75%
30.53
34.65
42.29
33.12
96.57
98.77
99.26
97.85
1.95
2.36
2.54
2.16
26 (21.85)
22 (27.85)
Table 2. Demographic of Eligible Participants
# of
Goals
0
Methods and Materials
We will be extracting demographic and key clinical information
from the electronic medical records for approximately 250 patients
seen in the NCC-O Healthy Choices Clinic (HCC). Our data
sample will include new patients, 13 – 18 years old, seen January
1, 2009 – September 30, 2010. There will be a one year
observation period for each patient. The exclusion criteria are less
than 1 office encounters during the one year study period.
Total
N = 74
Black Hispanic White
Other
5
8
7
2
1
0
0
2
0
2
1
3
3
1
3
3
3
4
0
4
0
2
3
1
Total
9
16
19
4
# targeted behaviors in
nutrition domain
# targeted behaviors in
physical activity domain
# targeted behaviors in
psychosocial domain
Final BMI%
22.67
Hispanic White
20.56
15.61
We examined 74 medical records in our study. Our study population
was decreased to 48 after the inclusion criteria of one encounter
were applied. Fewer Blacks dropped out after the first encounter
compared to White or Hispanics. There was no significant
difference in our baseline population. This demonstrated the
strength of our cohort. We were able to observe that adolescents
that participated in the Nemours Healthy Choices Clinic did see a
decrease in BMI and BMI% (Table 2). Fewer White and Hispanic
teens dropped out after four encounters than Black teens. Black
adolescents had a larger decrease in BMI percentile than White and
Hispanic adolescents. Compared to Blacks, Hispanics and White
Adolescents had more total goals (Table 3). However, Black
adolescents has more targeted behaviors in the areas of nutrition,
exercise and psychosocial than their Hispanic and White
counterparts (Table 4).
Conclusions
Since our small sample size is undersized, we can’t deny or
confirm our hypothesis. Therefore we are only reporting our
observations. To get significant statistical and clinical results, we
would need to increase the sample size. To augment our study we
would also have to define what success in a weight management
clinic is. Perhaps establishing a weight endpoint will allow
inference to be made whether or not a weight loss clinic is
successful.
Despite the outcome of our research, it is imperative that a
solution to adolescent obesity is sought. Adolescent obesity is a
crisis that must be addressed. The solution to solving this
epidemic remains complex. Research must be continued in order
to solve this problem and save this upcoming generation.
References
Table 3. Number of Goals among Race
Black
Results
Other
14.00
20.17
15.78
9.77
13.00
5
3.69
4
2.5
96.57
98.77
99.26
97.85
Table 4. Mean
Distribution of
Targeted Behaviors
among Race
1.Wilson DB, Sargent R, Dias J. Racial differences in selection of ideal
body size by adolescent females. Obes Res. Jan 1994;2(1):38-43.
2.Cachelin FM, Rebeck RM, Chung GH, Pelayo E. Does ethnicity
influence body-size preference? A comparison of body image and
body size. Obes Res. Mar 2002;10(3):158-166.
3.Kemper KA, Sargent RG, Drane JW, Valois RF, Hussey JR. Black
and white females' perceptions of ideal body size and social norms.
Obes Res. Mar 1994;2(2):117-126.
Researcher contact info: mmulatre@knights.ucf.edu