In addition to making serious commitment to increase diversity, institutions


should make a parallel commitment to offer high-quality, evidence-based obesity care. Clinicians can achieve this goal by pursuing an obesity medicine fellowship and taking the ABOM exam. Clinicians who are ABOM diplomates (meaning they have passed the ABOM exam) offer care that aligns with evidence-based guide- lines, such as the prescription of FDA-approved antiobesity medications and recommendations for nutrition, exercise, and behavioral services.145


If institutions


increase the number of providers specifically trained to treat obesity, they may improve patients’ ability to access to evidence-based treatments. In addition, efforts to increase the representation of registered dietitian nutritionists who iden- tify as racially or ethnically marginalized in organizations dedicated to providing high-quality obesity care (eg, the Academy of Nutrition and Dietetics) can also improve the quality of care.98


However, educating care providers on weight stigma


is still important because even those who specialize in obesity treatment can exhibit bias against patients with higher weights.138


With the continued increase in


obesity prevalence, the commitment of institutions to thoroughly train providers in the treatment of this chronic disease is a worthy endeavor. Lastly, the rebuilding of the relationship between the health care system, clini-


cians, researchers, and patients from marginalized racial and ethnic groups should be the utmost priority. The relationship between researchers, clinicians, and diverse patient groups has been understandably strained throughout US history due to highly unethical practices conducted against systematically oppressed populations in the name of “science” and “advancing medicine.”146


Continued mistrust, a ratio-


nal response to untrustworthy institutions, has been highlighted during the recent COVID-19 pandemic, specifically in the context of vaccination of marginalized racial and ethnic groups.147,148


Because of implicit and explicit biases and the lack of


appropriately tailored weight-management interventions, the distrust of health care providers likely extends to the clinical sphere of weight management. Research has shown that the stigma associated with obesity results in health care avoidance, and, thus, weight-based stigma further affects health care inequities.149


The combination


of racial, ethnic, and weight bias may, therefore, place marginalized patients at increased risk for health care avoidance. Continued commitment to patient-centered care and efforts to prioritize patient needs, goals, and desires are actionable steps that clinics and providers can take to begin to heal this relationship.


Summary


Patients from marginalized racial and ethnic groups face a range of barriers to weight management. These barriers contribute to inequitable risk for the development and maintenance of obesity. Some barriers rooted in historical and enduring structural inequalities cannot fully be addressed within clinical practice. Redressing the harms of systematic racism requires policy changes in a wide range of institutions, from housing, finance, and education to criminal justice, the food system, and more. Nevertheless, clinics and providers can still take action to address inequities and heal the historical mistrust of health care organizations. Key steps include using quanti- tative and qualitative assessments of social determinants of health, increasing repre- sentation of marginalized racial and ethnic groups in research and health care fields, striving to recognize cultural differences and promote patient autonomy, improving the readability and accessibility of evidence-based weight-management information, and establishing a commitment to diversity within health care institutions.


CHAPTER 2: Health Inequities in the Development, Management, and Treatment of Obesity 37


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