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Weight Management

Investigating Reasons for Racial Disparities in Behavioral Weight-Loss Treatment Outcomes

(PS13-A9) Investigating Reasons for Racial Disparities in Behavioral Weight-loss Treatment Outcomes

Sunday, November 19, 2023
9:00 AM – 10:00 AM PST
Location: Regency Ballroom, Level 7
Research shows that behavioral weight loss (BWL) treatments are less effective for Black participants than White participants; however, the reasons for this racial disparity in BWL outcomes are ill-understood. Given that there are sociocultural differences and structural health inequities between the Black and White population, we hypothesize that the following pretreatment factors could mediate the relationship between race and % weight loss: 1. motivation level because increased day-to-day stress faced by minorities may reduce motivation level, which is a predictor of weight loss outcomes; 2. type of motivation for weight loss because research suggests that Black participants are less extrinsically motivated for weight loss; 3. dietary quality because racial minorities can be more exposed to unhealthy food options; and, 4. starting BMI because Black participants tend to have higher pretreatment BMI’s, which research suggests is associated with greater leptin resistance and thus can make weight loss harder. Using bootstrapped mediation analyses, we tested whether these factors mediated the relationship between race (Black vs White) and % weight loss among a group of participants (N = 282; 67% White; 18% Black; mean BMI = 35.8 kg/m2) who received 1-year of BWL as part of a larger clinical trial. In this sample, Black participants lost 2.9% less weight than White participants at post-treatment (Black % weight loss = 5.79; White % weight loss = 8.78; p < 0.01). In support of the hypothesis, BMI at pretreatment partially mediated the relationship between race and % weight loss (indirect effect = 0.6; p < 0.01). However, pretreatment motivation level, type of motivation, and dietary quality were not shown to be mediators. While existing theories speculate that differences in motivation and dietary quality between Black and White participants could explain racial disparities in BWL outcomes, the findings of this study suggest that pretreatment BMI could play a key role in contributing to this disparity. These findings suggest that researchers should consider the role of pretreatment BMI when reporting % weight loss by race. Moreover, these findings suggest that researchers should consider testing treatments that are more likely to be effective for participants in the higher BMI range when trying to design more effective treatments for Black participants, rather than only adapting treatments to address potential psycho-social-behavioral differences by race. Future research should examine the generalizability of these findings and test other potential mediators that could explain the racial disparity in BWL outcomes, such as the amount of experienced discrimination and day-to-day stress.
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