title: Body mass index and health care utilization in diabetic and nondiabetic individuals.
abstract: BACKGROUND
  Although controversial, most studies examining the relationship of body mass index (BMI) with mortality in diabetes suggest a paradox: the lowest risk category is above normal weight, versus normal weight in nondiabetic persons. One proposed explanation is greater morbidity of diabetes in normal weight persons. If this were so, it would suggest a health care utilization paradox in diabetes, paralleling the mortality paradox, yet no studies have examined this issue.
  
  
  OBJECTIVE
  To compare the relationship of BMI with health care utilization in diabetic versus nondiabetic persons.
  
  
  METHODS
  Population-based cross-sectional study.
  
  
  METHODS
  Adults in the 2000-2011 Medical Expenditures Panel Surveys (N=120,389).
  
  
  METHODS
  Total health care expenditures, hospital utilization (≥1 admission), and emergency department utilization (≥1 visit). BMI (kg/m) categories were: <20 (underweight); 20 to <25 (normal); 25 to <30 (overweight); 30 to <35 (obese); and ≥35 (severely obese). Adjustors were age, sex, race/ethnicity, income, health insurance, education, smoking, co-morbidity, urbanicity, region, and year.
  
  
  RESULTS
  Among diabetic persons, adjusted mean total health care expenditures were significantly lower in obese versus normal weight persons ($1314, 95% confidence interval [CI], $513-$2115; P=0.001). By contrast, among nondiabetic persons, total expenditures were nonsignificantly higher in obese versus normal weight persons (-$229, 95% CI, -$460 to $2; P=0.052). Findings for hospital and emergency department utilization exhibited similar patterns.
  
  
  CONCLUSIONS
  Normal weight diabetic persons used substantially more health care than their overweight and obese counterparts, a difference not observed in nondiabetic persons. These differences support the plausibility of a BMI mortality paradox related to greater morbidity of diabetes in normal weight than in heavier persons.
authors: UC Davis School of Medicine, Department of Family and Community Medicine and Center for Healthcare Policy and Research, Sacramento, CA.
authors: Anthony
authors: A
authors: Jerant
authors: Klea D
authors: KD
authors: Bertakis
authors: Peter
authors: P
authors: Franks
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult