Combating Obesity Among Lower-Income Patients

The current epidemic of obesity in the United States disproportionately affects low-income and minority populations. For example, according to the National Health and Nutrition Examination Survey (NHANES), the incidence of obesity among African-American women is 40.4% and 26.1% among Hispanic women, compared to 20.5% among Caucasian women.

The Venice Family Clinic, Venice Beach, CA, is the largest free clinic in the U.S., and 84% of its clients live below the poverty level. In 2001, the Clinic opened a nutrition clinic to meet the demands of the increasing number of obese clients who were unable to lose weight, even with regular primary care visits.

Partial meal replacement

One method that has been explored is partial meal replacement, but this had not been tested among low-income populations. Health-care professionals at the UCLA Center for Human Nutrition, the UCLA Department of General Surgery and the Venice Family Clinic examined the effectiveness of offering meal replacements (Ultra Slim-Fast with Soy Protein™) to low-income obese patients over a 6-month period. Sixty-three patients who had been followed at the free clinic by their primary care doctor for at least 6 months were enrolled in the study. The mean body mass index was 40 kg/m2, and 72% were Hispanic, 25% Caucasian, and 3% African-American. These patients had a variety of conditions besides obesity, including hypertension (45%), diabetes mellitus II (50%), gastroesophageal reflux disease (34%), osteoarthritis (51%), and high cholesterol levels (48%).

Meal replacements were to be consumed twice a day and the patients were instructed to eat one complete low-calorie meal per day. The goal for total caloric intake for each patient was from 800 to 1800 kcal/day. Patients were also counseled to increase their daily activity by walking for 30 minutes at least three times a week. The researchers then compared the results with past routine care by a primary care physician (Int J Obesity 2004; 28:1575).

Drs. S. Huerta and Z. Li reported that although there had been no significant weight loss among the patients during the 6 months before the subjects enrolled in the nutrition program, a very different picture emerged after the patients participated in the nutrition program. Six months after enrolling in the nutrition program there was a mean decrease of 7% body weight with a mean reduction in BMI from 40 to 37 kg/m2.

Secrets to the program’s success

Why did this program succeed when primary care visits did not? As the authors note, adhering to any diet is notoriously difficult in outpatient populations, and they had expected to see large number of the study group drop out, particularly since the nutrition clinic was offered only one evening a week. However, they believe the low dropout rate could be tied to the fact that most of the patients seen at the Venice Clinic have obesity-related conditions that require frequent visits for follow-up and/or adjustments in their medication. A second factor that affected the success rate is that the clinic has an aggressive retention program. For example, if a patient misses one appointment, he or she is placed on a long waiting list. Thus, once a patient has an appointment, she rarely misses it. In this program, the only incentive given was the meal replacement.