Study Shows Obese and Overweight Patients Receive Equal or Better Care than Patients of Normal Weight
FINDINGS:
- Among Medicare and VA patients, there was no evidence across eight quality performance measures that obese and overweight patients received worse care than normal weight patients.
- Obese and overweight patients received marginally better care on certain measures. For example, there were higher rates of vaccination among overweight and obese patients in both the VA and Medicare populations, as well as higher rates of mammography among overweight Medicare patients, and higher odds of CRC and cervical cancer screening among overweight VA patients.
- The most notable differences were for recommended diabetes care among Medicare beneficiaries: comparing obese and normal weight patients with diabetes, obese patients were more likely to receive recommended care on lipid screening (72% vs. 65%) and HbA1c testing (74% vs. 62%).
- Prevalence of obesity was higher among VA patients (39%) compared to Medicare patients (20%), and performance success was higher in the VA than Medicare across all measures.
BACKGROUND:
Prior studies have shown that some clinicians openly admit to negative attitudes toward obese patients, while other studies suggest that clinicians prefer not to manage obesity or obese patients. Moreover, a study of overweight and obese women found that more than half experienced weight-related stigma from a doctor on multiple occasions. These observations raise the possibility that obese patients may experience lower quality of care. This study examined whether quality of care differed by patient weight status using eight common outpatient quality performance measures related to diabetes management, adult vaccinations (e.g., flu, pneumonia), and cancer screening (e.g., CRC, cervical, mammography) among 36,112 Medicare patients and 33,550 VA patients. Investigators identified these two national-level patient populations using Medicare data (1994-2006) and VA data (FY03-FY04). All analyses were adjusted for sociodemographics, health status, clinical complexity, and visit frequency.
LIMITATIONS:
- Only eight performance measures for preventive healthcare were included in this study. Although these indicators reflect common conditions and needs, there is much more to healthcare quality than what is reflected by them, and obese patients may experience worse care along other dimensions of medical care.
- Success and failures along these measures reflect contributions of patients as well as clinicians, and investigators could not be sure what factors explain observed differences in the receipt of care.
- In the Medicare data, height and weight were self-reported.
AUTHOR/FUNDING INFORMATION:
The study was partly supported by HSR&D (IIR 06-096). Dr. Werner also was supported by an HSR&D Career Development Award. All authors are part of HSR&D's Center for Health Equity Research and Promotion in Philadelphia, PA.
Chang V, Asch D, and Werner R. Quality of Care among Obese Patients. JAMA April 7, 2010;303(13):1274-1281.
