Home access to a weight scale in the Hispanic/Latino population attending a community-based free clinic

1 INTRODUCTION

The current overall rate of adult obesity in the United States (US) is 42% with the highest prevalence seen in racial minority groups, including 47% of Hispanic adults and 46.8% of non-Hispanic black adults.^{1, 2} The Hispanic/Latino community makes up 18.5% of the American population and in several states it is the predominant racial minority group.³ In numerous studies, it has been shown that many US adults underestimate their body mass index (BMI) by underreporting weight and overreporting height.^{4, 5} A study using NHANES data found that Mexican Americans underestimate BMI by −0.37 for men and −0.76 kg/m² for women.⁶ Thus, knowing a patient's measured height and weight can help in correctly identifying obesity prevalence. While obtaining measured height and weight is routine for in-person clinic visits, medicine has evolved to include more virtual visits where patients are asked to self-report their current weight. This important part of vital signs relies on patients having a scale on which to weigh themselves.

Additionally, one of the most basic lifestyle changes that health care providers (HCPs) can promote to patients is to weigh themselves daily. Studies have shown that in a dose-dependent manner frequently stepping on a scale significantly helps with weight management.^7-9 Patients who weigh daily have better weight loss than patients who weigh weekly, monthly, or not all.^7-9 In addition, weighing daily is acceptable, perceived positively by patients, and without adverse effects.¹⁰ However, implementing this weight management tool requires access to a weight scale.

The overarching purpose of this study was to evaluate scale access and reliability of reported or perceived height and weight in a community-based free clinic that serves a predominantly Hispanic/Latino population. Data obtained from these Hispanic/Latino uninsured patients were compared with medically insured primary care patients of mixed ethnicities typical of California. The primary goal of this study was to determine whether there are differences in access to a home weight scale in the Hispanic/Latino community using the community-based free clinic compared with a primary care medicine clinic that sees patients with health insurance in the same area. The secondary goal was to evaluate differences in perceived height and weight.

2 MATERIALS AND METHODS

3 RESULTS

One hundred patients at the primary care clinic and 117 patients at the free community clinic consented to participate. All patients at the primary care clinic were health-insured, and all of the patients at the community clinic were without medical insurance. The demographic characteristics of all respondents are shown in Table 1. Only patients with complete height and weight data were included in the final analysis (99 health-insured patients and 86 community-clinic patients).

Community-clinic patients had less access to a scale than primary-care patients ($${\chi }_{1}^{2}=21.8$$, p < 0.001) (Table 1). The odds of having access to a scale were 5.2 (95% CI; 2.6, 10.5) higher for primary-care as compared to community-clinic patients. Thus, approximately half (52%) of the community-clinic patients reported having access to a scale and 48% did not.

For the group as a whole (both primary-care and community-clinic (N = 185) the measured mean BMI and standard deviation was 29.0 ± 7.09 kg/m². The mean BMI of the community-clinic group was 29.8 ± 6.73 kg/m². The mean difference for the group as a whole (N = 185) between actual BMI and reported (perceived) BMI was − 0.58 ± 2.39 kg/m². For the community-clinic group, the mean BMI difference − 0.6 ± 3.21 kg/m² (N = 86). Both groups underreported BMI. Height difference between reported height and measured height was overreported by a mean of 0.57 ± 3.88 cm for the group (N = 185, t_(df = 184) = 1.99, p = 0.024) and 0.24 ± 5.28 cm for the community-clinic patients (N = 86, t_(df = 85) = 0.415, p = 0.34). The weight difference between reported and measured weight was underreported by a mean of −1.10 ± 4.76 kg for the group (N = 185, t_(df = 184) = −3.14, p = 0.99) and −1.48 ± 6.23 kg for the community-clinic patients (N = 86, t_(df = 85) = −2.21, p = 0.98).

The community-clinic population had a higher disease burden than the health insured population for the three diseases recorded (Table 1). Diabetes was noted in 26% of the community-clinic patients and in 6% of the health-insured patients. Hypercholesterolemia was noted in 26% of the community-clinic patients versus 18% of primary-care patients, and hypertension was reported in 42% of community-clinic patients versus 19% of primary-care patients.

4 DISCUSSION

This research identifies a previously unrecognized barrier to weight management in the Hispanic/Latino population attending a community-based free clinic. Approximately half of the Hispanic/Latino patients from the community clinic did not have access to a scale. This is an important finding because daily weighing is a well-documented form of lifestyle management for weight loss and prevention of weight gain.^{7, 8} Simply put, HCPs working at similar community clinics need to be aware that patients may not have access to a scale.

As medicine has evolved to include virtual visits, having access to a scale can help with obtaining an important vital sign that is usually obtained at most in-person primary care visits. Many diseases benefit from knowing recent weight changes (e.g., diabetes, hypertension, fluid overload, etc.) and healthcare providers need to be aware that patients may simply not have access to a scale.

Similar to a previous report comparing subjective and objective measures of height and weight, we found that self-reported height was usually taller than measured and self-reported weight was less than measured.⁵ In our study, this led to a BMI that was 0.6 kg/m² lower than that measured. In a previous study by Opichka and Smith in a predominantly low-income US population, overreporting of height and underreporting of weight led to misclassification of BMI in 3%–8% of Hispanic/Latino patients.⁴ It should be noted that underreporting weight and overreporting height is common and our findings were similar to other studies regardless of race or income.^4-6

In looking at the disease burden, it was noted in our study that the disease burden was higher in the primarily Hispanic/Latino community-clinic group versus the racially mixed primary-care group. There are many potential reasons for this difference. It is possible that health-insured primary-care patients have access to specialists for diabetes and other conditions, whereas patients attending the community clinic do not. It is also well recognized that diseases related to obesity, such as diabetes, hypertension, and cardiovascular disease disproportionately, affect the Hispanic/Latino community. The prevalence of type 2 diabetes in the Hispanic/Latino population is about twice that of non-Hispanic whites.^12-14 Additionally, the comorbid diseases commonly associated with obesity are seen at a lower BMI in the Mexican population relative to Caucasians.¹⁵ These factors highlight the need to address weight management in this underserved group.

This study is limited by the small number of patients. The other limitation is that although patients at the community clinic were 98% Hispanic/Latino, due to the close proximity to the Mexican border, the vast majority were Mexican, and this population represents a specific subset of the Hispanic/Latino community. Also, although our translators were Mexican and fluent in Spanish and English, the questionnaire was not specifically written to be culturally Mexican.

Self-monitoring of weight has been a cornerstone of weight management as well as a lifestyle tool recommended in obesity medicine guidelines.¹⁶ Although HCPs can educate patients to weigh daily, only half of the patients surveyed in the community clinic had access to a scale. Thus, for this lifestyle intervention to be implemented, HCPs need to be aware that patients may not have access to a scale and the clinic would need to provide the scale.

AUTHOR CONTRIBUTIONS

Ken Fujioka: Conceptualization; methodology; investigation; writing - original draft; writing - review & editing; supervision; project administration; funding acquisition. Jacob Fujioka: Conceptualization; methodology; investigation; supervision. Kaley Mafong: Investigation. Nicole Wetherhold: Investigation. Sally Kim: Investigation. Amin Rasul: Supervision. Alyssa Lopez: Formal analysis; writing - review & editing. Kevin Cummins: Formal analysis; writing - review & editing.

CONFLICT OF INTEREST STATEMENT

The authors have no conflicts of interest to declare.