title: Obesity disparities in preventive care: findings from the National Ambulatory Medical Care Survey, 2005-2007.
abstract: Obesity and its consequences are a major health concern. There are conflicting reports regarding utilization of preventive health-care services among obese patients. Our objective was to determine whether obese patients receive the same preventive care as normal weight patients. Weighted patient clinic visit data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed for all adult patient visits with height/weight data (N = 866,415,856) from 2005 to 2007. Preventive care practice patterns were compared among different weight groups of normal, obese, and morbidly obese. Obese patients received the least number of preventive exams with a clear gradient present by weight. Obese patients were significantly less likely to receive cancer screening including breast examination (normal weight, reference, obese, odds ratio (OR), 0.8), mammogram (obese OR, 0.7), pap smear (obese OR, 0.7), pelvic exam (obese OR, 0.8), and rectal exam (obese OR, 0.7). The obese population also received less tobacco (obese OR, 0.7) and injury prevention education (obese OR, 0.7), yet significantly more diet, exercise, and weight reduction education. Significant differences in clinic practice patterns relative to normal weight patients were also evident with more physician referral (obese OR, 1.2) and less likely to see physician at the index clinic visit (obese OR, 0.8) and less likely to receive psychotherapy referral (obese OR, 0.6). Significant gaps in preventive care exist for the obese including cancer screening, tobacco cessation and injury prevention counseling, and psychological referral. Although obese patients received more weight-related education, this emphasis may have the consequence of de-emphasizing other needed preventive health measures.
authors.affiliation: SCORE (Stanford Center for Outcomes Research and Evaluation), Department of Surgery, Stanford School of Medicine, Stanford, CA, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Hernandez-Boussard
authors.forename: Shushmita M
authors.initials: SM
authors.lastname: Ahmed
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
mesh_terms: D001835:Body Weight; D003695:Delivery of Health Care; D004032:Diet; D055088:Early Detection of Cancer; D015444:Exercise; D005260:Female; D019538:Health Care Surveys; D006266:Health Education; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008327:Mammography; D001523:Mental Disorders / Q000517:prevention & control; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control; D009765:Obesity / Q000150:complications*; D009767:Obesity, Morbid; D016017:Odds Ratio; D065006:Papanicolaou Test; D010808:Physical Examination; D010818:Practice Patterns, Physicians'; D011314:Preventive Health Services; D011613:Psychotherapy; D012016:Reference Values; D012017:Referral and Consultation; D016540:Smoking Cessation; D014626:Vaginal Smears; D015431:Weight Loss; D014947:Wounds and Injuries / Q000517:prevention & control