While obese individuals in the general population utilize health care at higher rates than their normal weight counterparts, some studies show that they may be less likely to receive certain preventive services. Examining this issue in the Veterans Affairs healthcare system may provide new insights given the size and characteristics of its population, and its universal coverage of preventive services.
The purpose of this study is to examine whether BMI is associated with variations in receipt of clinical preventive services in veterans. Our hypothesis was that, similar to what has been observed in the general population, VA outpatients who were overweight or obese would be less likely to receive these clinical preventive services compared to those whose weight was within the recommended range.
We conducted a retrospective cohort study of nearly 1.7 million veterans with one or more visits to 136 national Veterans Affairs (VA) outpatient clinics in the United States in the year 2000. Using medical facilities data, we assessed receipt of the following preventive services over 5 years of follow-up: screening for prostate, breast, cervical, and colon cancer, and vaccination against influenza and pneumonia. We performed multivariable analyses of the relationships between body mass index (BMI) category (Underweight, Normal Weight, Overweight, Obese 1, Obese 2, and Obese 3) and receipt of the preventive services, adjusting for sociodemographic, health, and health care factors.
The inception cohort included 1,699,219 patients: 94% men, 48% white, and 76% overweight or obese. After adjusting for factors related to receipt of health care, overweight and obese men and women had higher odds of receiving each of the clinical preventive services as recommended over 5 years compared with their normal weight counterparts. The odds for receiving vaccinations increased linearly with BMI category for men and women: influenza (Men: OR=1.13 for Overweight to OR=1.42 for Obese Class 3; Women: OR=1.15 for Overweight to OR=1.61 for Obese Class 3) and pneumococcus (Men: OR=1.02 for Overweight to OR=1.15 for Obese Class 3; Women: OR=1.08 for Overweight to OR=1.28 for Obese Class 3). The odds for receiving each of the cancer screening services typically peaked in the mild-moderately obese categories. For prostate cancer screening, the highest OR was in Obese Class 2 (OR=1.29); for colorectal cancer, the highest OR was in Obese Class 1 (men: OR=1.15; women OR=1.10); for breast cancer screening, the highest OR was in Obese Class 2 (OR=1.19); and for cervical cancer screening, the highest OR was in Obese Class 2 (OR=1.06).
In a large national sample of veterans, obese patients received preventive services at higher rates than their normal weight peers. This may be due to the VA health service coverage and performance directives, a more homogeneous patient demographic profile, and/or unmeasured factors related to service receipt.
- Yancy WS, McDuffie JR, Stechuchak KM, Olsen MK, Oddone EZ, Kinsinger LS, Datta SK, Fisher DA, Krause KM, Østbye T. Obesity and receipt of clinical preventive services in veterans. Obesity (Silver Spring). 2010 Sep 1; 18(9):1827-35.
- Jackson GL, Cho A, Strauss JL, McDuffie J, Grambow SC, Jeffreys AL, Yancy WS. Impact of Perceived Ability to Cope with Stress on Desired and Actual Weight Loss. Paper presented at: AcademyHealth Annual Research Meeting; 2010 Jun 28; Boston, MA.
- Yancy WS, McDuffie J, Stechuchak KM, Olsen MK, Datta SK, Fisher DA, Oddone EZ. Obesity is not associated with lower receipt of Clinical Preventive Services in Veterans. Paper presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD.
- Yancy WS, McDuffie J, Stechuchak KM, Olsen MK, Datta SK, Fisher DA, Oddone EZ. Relationship between obesity and receipt of clinical preventive services in Veterans. Poster session presented at: Obesity Society Annual Scientific Meeting; 2008 Oct 5; Phoenix, AZ.
- McDuffie, Ostbye, Stechuchak, Olsen, Datta, Krause KM, Fisher, Oddone, Yancy. The relationship between obesity and receipt of clinical preventive services in Veterans. Presented at: AcademyHealth Annual Research Meeting; 2008 Jun 8; Washington, DC.
Obesity, Utilization patterns