Obesity and Weight Gain Among HIV+ Uninsured Minorities
Obesity and Weight Gain Among HIV+ Uninsured Minorities
Background: Obesity and HIV disproportionately affect minorities and have significant health risks, but few studies have examined disparities in weight change in HIV-seropositive (HIV+) cohorts.
Objective: To determine racial and health insurance disparities in significant weight gain in a predominately Hispanic HIV+ cohort.
Methods: Our observational cohort study of 1214 nonunderweight HIV+ adults from 2007 to 2010 had significant weight gain [≥3% annual body mass index (BMI) increase] as the primary outcome. The secondary outcome was continuous BMI over time. A 4-level race–ethnicity/insurance predictor reflected the interaction between race–ethnicity and insurance: insured white (non-Hispanic), uninsured white, insured minority (Hispanic or black), or uninsured minority. Logistic and mixed-effects models adjusted for baseline BMI, age, gender, household income, HIV transmission category, antiretroviral therapy type, CD4 count, plasma HIV-1 RNA, observation months, and visit frequency.
Results: The cohort was 63% Hispanic and 14% black; 13.3% were insured white, 10.0% uninsured white, 40.9% insured minority, and 35.7% uninsured minority. At baseline, 37.5% were overweight, 22.1% obese. Median observation was 3.25 years. Twenty-four percent of the cohort had significant weight gain, which was more likely for uninsured minority patients than insured whites [adjusted odds ratio = 2.85, 95% confidence intervals (CIs): 1.66 to 4.90]. The rate of BMI increase in mixed-effects models was greatest for uninsured minorities. Of 455 overweight at baseline, 29% were projected to become obese in 4 years.
Conclusions and Relevance: In this majority Hispanic HIV+ cohort, 60% were overweight or obese at baseline, and uninsured minority patients gained weight more rapidly. These data should prompt greater attention by HIV providers for prevention of obesity.
Obesity has become a leading health threat in the United States. In the National Health and Nutrition Examination Survey from 2009 to 2010, 35.7% of US adults were obese. Obesity is more prevalent in Hispanic and non-Hispanic black populations and in persons of lower socioeconomic status (SES). Minority race and low SES are also associated with increased risk for HIV infection. Thus, communities most severely affected by the HIV epidemic are also more likely to have a high prevalence of obesity. However, few studies have examined the health disparities in the prevalence of obesity and weight gain in HIV-infected (HIV+) populations.
Traditionally, the focus of HIV providers has been on preventing HIV-related wasting, weight loss, and lipodystrophy. With the advent of highly active antiretroviral therapy (ART), HIV-specific morbidity and mortality have diminished, whereas non-HIV–specific conditions such as cardiovascular disease have grown as health threats for HIV+ persons. In this environment, providers may need to pay greater attention for preventing obesity and related conditions such as diabetes and cardiovascular disease.
The prevalence of obesity in HIV+ cohorts ranges from 17% to 32% in cross-sectional studies. However, point prevalence studies do not elucidate weight change patterns that are indicative of the future severity of this problem. Previous studies of weight change in HIV+ cohorts have focused on the first 12–24 months on ART, when weight gain may be considered beneficial, or on military cohorts with low baseline rates of obesity. To the best of our knowledge, longitudinal analyses of weight changes have not been conducted in HIV+ cohorts on long-term ART.
We examined change in body mass index (BMI) over a 4-year time frame in a Hispanic-majority HIV+ cohort receiving care from the largest HIV clinic in south-central Texas. This region is greatly affected by obesity. In 2010, 32.4% of adult residents in south-central Texas were obese, and 66.3% were either overweight or obese. Because the vast majority of the cohort is receiving chronic ART, we hypothesized that the prevalence of obesity would approximate that observed in the local population. We hypothesized that there would be significant disparities in weight gain such that uninsured minorities would be the most severely affected by significant weight gain, as seen in general populations. Furthermore, we hypothesized that health insurance status, as a correlate of SES, would modify the association of race–ethnicity with weight gain, such that uninsured minorities would be the most severely affected by significant weight gain, as in general populations.
Abstract and Introduction
Abstract
Background: Obesity and HIV disproportionately affect minorities and have significant health risks, but few studies have examined disparities in weight change in HIV-seropositive (HIV+) cohorts.
Objective: To determine racial and health insurance disparities in significant weight gain in a predominately Hispanic HIV+ cohort.
Methods: Our observational cohort study of 1214 nonunderweight HIV+ adults from 2007 to 2010 had significant weight gain [≥3% annual body mass index (BMI) increase] as the primary outcome. The secondary outcome was continuous BMI over time. A 4-level race–ethnicity/insurance predictor reflected the interaction between race–ethnicity and insurance: insured white (non-Hispanic), uninsured white, insured minority (Hispanic or black), or uninsured minority. Logistic and mixed-effects models adjusted for baseline BMI, age, gender, household income, HIV transmission category, antiretroviral therapy type, CD4 count, plasma HIV-1 RNA, observation months, and visit frequency.
Results: The cohort was 63% Hispanic and 14% black; 13.3% were insured white, 10.0% uninsured white, 40.9% insured minority, and 35.7% uninsured minority. At baseline, 37.5% were overweight, 22.1% obese. Median observation was 3.25 years. Twenty-four percent of the cohort had significant weight gain, which was more likely for uninsured minority patients than insured whites [adjusted odds ratio = 2.85, 95% confidence intervals (CIs): 1.66 to 4.90]. The rate of BMI increase in mixed-effects models was greatest for uninsured minorities. Of 455 overweight at baseline, 29% were projected to become obese in 4 years.
Conclusions and Relevance: In this majority Hispanic HIV+ cohort, 60% were overweight or obese at baseline, and uninsured minority patients gained weight more rapidly. These data should prompt greater attention by HIV providers for prevention of obesity.
Introduction
Obesity has become a leading health threat in the United States. In the National Health and Nutrition Examination Survey from 2009 to 2010, 35.7% of US adults were obese. Obesity is more prevalent in Hispanic and non-Hispanic black populations and in persons of lower socioeconomic status (SES). Minority race and low SES are also associated with increased risk for HIV infection. Thus, communities most severely affected by the HIV epidemic are also more likely to have a high prevalence of obesity. However, few studies have examined the health disparities in the prevalence of obesity and weight gain in HIV-infected (HIV+) populations.
Traditionally, the focus of HIV providers has been on preventing HIV-related wasting, weight loss, and lipodystrophy. With the advent of highly active antiretroviral therapy (ART), HIV-specific morbidity and mortality have diminished, whereas non-HIV–specific conditions such as cardiovascular disease have grown as health threats for HIV+ persons. In this environment, providers may need to pay greater attention for preventing obesity and related conditions such as diabetes and cardiovascular disease.
The prevalence of obesity in HIV+ cohorts ranges from 17% to 32% in cross-sectional studies. However, point prevalence studies do not elucidate weight change patterns that are indicative of the future severity of this problem. Previous studies of weight change in HIV+ cohorts have focused on the first 12–24 months on ART, when weight gain may be considered beneficial, or on military cohorts with low baseline rates of obesity. To the best of our knowledge, longitudinal analyses of weight changes have not been conducted in HIV+ cohorts on long-term ART.
We examined change in body mass index (BMI) over a 4-year time frame in a Hispanic-majority HIV+ cohort receiving care from the largest HIV clinic in south-central Texas. This region is greatly affected by obesity. In 2010, 32.4% of adult residents in south-central Texas were obese, and 66.3% were either overweight or obese. Because the vast majority of the cohort is receiving chronic ART, we hypothesized that the prevalence of obesity would approximate that observed in the local population. We hypothesized that there would be significant disparities in weight gain such that uninsured minorities would be the most severely affected by significant weight gain, as seen in general populations. Furthermore, we hypothesized that health insurance status, as a correlate of SES, would modify the association of race–ethnicity with weight gain, such that uninsured minorities would be the most severely affected by significant weight gain, as in general populations.