title: Frequency of 'obesity' in medical records and utilization of out-patient health care by 'obese' subjects in Germany. An analysis of health insurance data.
abstract: OBJECTIVE
  The aim of this study was to assess the frequency of the diagnoses 'overweight' or 'obesity' in medical records and to examine the utilization of the out-patient health care system by 'obese' subjects.
  
  
  METHODS
  All claims-cards, prescriptions and other diagnosis-carrying medical certificates from 1990 of a representative sample of members of a large local health insurance were collected and analyzed anonymously in a patient-related approach.
  
  
  METHODS
  A 5% random sample (n = 6085) of all members of the general local health insurance (AOK) in the city of Dortmund, Germany.
  
  
  METHODS
  The percentage of subjects carrying the diagnosis of 'overweight' and/or 'obesity' was determined. In addition, the utilization of medical services and the presence of comorbid conditions in the documents of the AOK was recorded.
  
  
  RESULTS
  A total number of 377 'obese' subjects was identified corresponding with a prevalence rate of 6.2%. Among those, more women than men carried one of these diagnoses (240 vs 137, 7.3% vs 4.9%, p < 0.01). In comparison with an age- and sex-matched control group (n = 1131) the 'obese' subjects had significantly more practice contacts (25.7 vs 17.5/year, p < 0.01) and received more medical services (64.2 vs 43.0/year, p < 0.01), including more prescriptions (20.9 vs 15.5/year, p < 0.01). Furthermore, the 'obese' subjects had more additional diagnoses indicating a higher comorbidity and received more drugs for diseases and complications which are characteristic of obesity but also for other diseases.
  
  
  CONCLUSIONS
  This data suggests that in view of its high prevalence in Germany obesity is perceived and documented by health professionals only in a minority of affected subjects indicating that this disorder is considerably under-estimated. It is also evident from the data that obesity is mainly noticed in those who have other serious health problems.
authors.affiliation: Klinische Abteilung des Diabetes-Forschungsinstituts, Heinrich-Heine-Universität Düsseldorf, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Hauner
authors.forename: I
authors.initials: I
authors.lastname: Köster
authors.forename: L
authors.initials: L
authors.lastname: von Ferber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002648:Child; D011307:Drug Prescriptions; D005260:Female; D005858:Germany; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000191:economics / Q000453:epidemiology*