2633-P: Uncovering Racial and Ethnic Disparities in Referral to Weight Management Treatments

Introduction and Objective: Health risks associated with excess body weight vary based on race and ethnicity. As such, standard analytics may underestimate disparities in referral to weight management treatments (WMTs). The objective of this study was to compare standard vs. risk-based estimates of disparities in WMT referral. Methods: This retrospective study includes adults with obesity [BMI ≥30 (≥25 for Asian patients)] and without T2D with ≥ 1 primary care visit from 1/1/21-6/30/23 at an academic medical center. We calculated propensity score weights with gradient boosting models to achieve age, sex, weight-related condition, and obesity class covariate balance for standard (Non-Hispanic single-race and Hispanic categories with uniform obesity classes) and risk-based (includes multiracial patients and Asian-specific obesity classes) analyses for Black, Asian, Hispanic, and Non-Hispanic White patients. We estimated risk ratios for referrals to either nutrition counseling, medical nutrition therapy, diabetes prevention programs, anti-obesity medications (AOMs), or bariatric surgery with multivariate logistic regression. Results: Compared to standard analyses (N=36,522), risk-based analyses (N=38,847) revealed deep disparities for Asian patients, who were 43% less likely than Black patients [RR (95% CI): 0.57 (0.51-0.63); p<0.001], 42% less likely than Hispanic patients [RR (95% CI): 0.58 (0.52-0.66); p<0.001], and 36% less likely than White patients [RR (95% CI): 0.64 (0.59-0.70); p<0.001] to be referred to any WMT. With standard analyses, disparities disappeared when Asian patients were compared to Black [RR (95% CI): 0.91(0.80-1.04); p=0.16], Hispanic [RR (95% CI): 0.90 (0.78-1.03); p=0.13], and White patients [RR (95% CI): 1.00 (0.89-1.13); p=0.97]. Conclusion: Risk-based analyses revealed WMT referral disparities for Asian patients that standard methods masked. Findings suggest the need for risk-stratified eligibility criteria, diverse analytical methods to monitor disparities, and policies that support equitable access to WMTs. Disclosure C.D. Turner: None. D. Griauzde: Other - I received an honorarium for speaking.; Ended; American Diabetes Association. Research Support; Current; National Institute of Diabetes and Digestive and Kidney Diseases.