As Weight Increases, Preventive Care Decreases

Obese people are less likely to receive preventive services such as mammograms, Pap smears, and flu shots from health-care providers, according to an analysis of health-care data by Duke Medical Center researchers.

The study, published in the September 2005 issue of the American Journal of Public Health, examined data from two National Institute of Aging studies that began in 1993. Examining a sample of white middle-aged women, researchers found that, as body mass index (BMI) went up, the odds of receiving mammograms and Pap smears went down. BMI is a measurement of body fat based on weight adjusted for height. In data gathered in 2000, a white woman of normal weight was more than 50 percent more likely to receive a mammogram than a severely obese white woman (BMI greater than 40), the study showed.

The researchers found a similar inverse correlation between obesity and flu shots among elderly white women and men. However, they found no significant association between obesity and all three preventive services among African-American study participants. The services selected for the study have been shown to be effective in preventing serious illness and have been designated a priority by the U.S. government.

"Despite knowing that obese women have a higher risk of breast and cervical cancer, and that obese elderly have a higher risk of complications from flu, obese people are less likely to receive clinical preventive services," says Truls Ostbye, a physician and professor in Duke's department of community and family medicine who was the lead author of the study.

Based on their analyses, Ostbye and his co-authors found that income, education, and access to health care were not important reasons for the discrepancies in care. The researchers suggest that significant causes may include social stigma, avoidance of health care by patients, and bias by health-care providers.