title: Excess use of general practitioners by obese adults: does health-related quality of life account for the association?
abstract: As general practitioners (GP) are seeing, and are likely to continue to see, increasing numbers of obese patients in their practices, it is relevant to know with which needs these patients enter general practice. The present study aims to determine whether besides physical comorbidities, health-related quality of life (HRQOL) accounts for associations of obesity with GP use. In a general population survey in Augsburg, Germany (KORA-Survey S4 1999/2001), anthropometric body mass (BMI in kg/(m(2))), physical comorbidities, HRQOL (the 12-item Short Form; SF-12), and visits to GP were assessed, and analyzed by logistic and zero-truncated negative binomial regressions (two-part model). Gender, age, socio-economic status, marital status, health insurance, and place of residence were adjusted for. The sample consisted of N = 942 residents aged 25 - 74, who had been randomly sampled from 17 cluster-sampled communities, and were either normal-weight, overweight, moderately obese, or severely obese. The moderately obese group had higher odds than the normal-weight to report any GP use; however, while being predictive, neither physical comorbidity nor HRQOL mediated this. In contrast, with regard to number of GP visits among users, the severely obese group (BMI >/= 35) reported significantly more visits than the normal-weight group, and both physical comorbidity and physical (but not mental) HRQOL accounted for this. In conclusion, physical comorbidity and HRQOL mediate excess use of GP by severely obese users in terms of number of visits. Thus, for this group, subjective physical health seems to be important besides physical comorbidities, suggesting for general practice to focus both on evaluated and perceived needs of these patients.
authors.affiliation: Hannover Medical School, Medical Psychology Unit, Hannover, Germany. lengerke.thomas@mh-hannover.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Von Lengerke
authors.forename: Jürgen
authors.initials: J
authors.lastname: John
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005858:Germany; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009765:Obesity; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011788:Quality of Life