Obese and overweight patients do not appear to receive inferior health care, compared with normal-weight patients, according to a recent report.
In fact, patients with a higher body mass index may be more likely than normal-weight patients to undergo lipid screening and hemoglobin A1c testing; vaccination for influenza and pneumococcus; and screening for breast, colorectal, and cervical cancer, said Dr. Virginia W. Chang of the University of Pennsylvania, Philadelphia, and associates.
“While it may be true that physicians often harbor negative attitudes toward obesity, such attitudes may not be borne out in lower quality of care,” they noted (JAMA 2010;303:1274–81).
The investigators examined whether quality of care differs by patient weight status because in many studies, physicians have admitted to feeling discomfort with and dislike toward overweight patients, reluctance to treat them, and dissatisfaction with managing their care.
In addition, more than half of overweight patients in one study reported being stigmatized by a physician on multiple occasions, and physicians have been cited by overweight people as one of their most common sources of weight-related bias.
Dr. Chang and her colleagues assessed the issue using data from two large patient populations: nationally representative samples of 36,122 Medicare beneficiaries and 33,550 VA patients. The prevalence of obesity was 20% in the Medicare group and 39% in the VA group.
Eight quality-of-care measures were examined: whether diabetic patients received eye examinations, lipid screening, and HbA1c testing; whether appropriate patients received influenza and pneumococcal vaccines; and whether appropriate patients were offered mammography, Pap smears, and colorectal cancer screening.
“Across all measures in both Medicare and VHA samples, there was no instance in which obese or overweight individuals were estimated to have significantly lower odds of recommended care relative to normal-weight individuals,” the researchers wrote.
Moreover, overweight and obese patients “often had higher estimated odds of care, and the increase in odds from normal, to overweight, to obese sometimes exhibited a monotonic pattern,” they added.
Dr. Chang and her associates noted that this study did not address health conditions and needs other than the eight specific indicators assessed here, “and obese patients may have experienced inferior care along other dimensions of medical care.”
In addition, “it is important to note that our findings may not be generalizable to quality of care in younger populations, in which the stigma and stereotypes associated with obesity may be more salient,” they said.
This study was supported by the Veterans Health Administration and the Robert Wood Johnson Foundation. No financial conflicts of interest were reported.