title: National Disparities in Colorectal Cancer Screening Among Obese Adults.
abstract: BACKGROUND
  Obesity is a major risk factor for colorectal cancer (CRC), particularly among men. The purpose of this study was to characterize the prevalence of guideline-adherent CRC screening among obese adults using nationally representative data, assess trends in screening strategies, and identify obesity-specific screening barriers.
  
  
  METHODS
  Data from 8,550 respondents aged 50-75 years in the 2010 National Health Interview Survey, representing >70 million adults, were analyzed in 2015 using multivariable logistic regression. Prevalence of guideline-adherent CRC screening, endoscopic versus fecal occult blood test screening, and reasons for non-adherence were compared across BMI categories.
  
  
  RESULTS
  Obese class III men (BMI ≥40), compared with normal-weight men, were significantly less likely to be adherent to screening guidelines (38.7% vs 55.8%, AOR=0.35, 95% CI=0.17, 0.75); less likely to have used an endoscopic test (36.7% vs 53.0%, AOR=0.37, 95% CI=0.18, 0.79); and had a trend toward lower fecal occult blood test use (4.2% vs 8.9%, AOR=0.42, 95% CI=0.14, 1.27). Among women, odds of guideline adherence and use of different screening modalities were similar across all BMI categories. Reasons for non-adherence differed by gender and BMI; lacking a physician screening recommendation differed significantly among men (29.7% obese class III vs 15.4% non-obese, p=0.04), and pain/embarrassment differed significantly among women (11.6% obese class III vs 2.6% non-obese, p=0.002).
  
  
  CONCLUSIONS
  Despite elevated risk, severely obese men were significantly under-screened for CRC. Addressing the unique screening barriers of obese adults may promote screening uptake and lessen disparities among the vulnerable populations most affected by obesity.
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts. Electronic address: ryan.seibert@bmc.org.
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Seibert
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts; VA Boston Healthcare System, Boston, Massachusetts.
authors.forename: Amresh D
authors.initials: AD
authors.lastname: Hanchate
authors.affiliation: Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Berz
authors.affiliation: Section of Gastroenterology, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Schroy
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003113:Colonoscopy / Q000592:standards / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D009780:Occult Blood; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012737:Sex Factors