Heavier Patients Not Found to Receive Inferior Care

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Obese and overweight patients don’t appear to receive inferior care compared with normal-weight patients across a variety of performance measures, although being overweight or obese is associated with a slightly higher rate of recommended care on some measures, according to research published in the April 7 issue of the Journal of the American Medical Association.

Virginia W. Chang, M.D., of the University of Pennsylvania School of Medicine in Philadelphia, and colleagues analyzed data from 36,122 Medicare beneficiaries and 33,550 individuals receiving care from the Veterans Health Administration. They included eight quality measures for outpatient preventive services related to diabetes management, cancer screening, and adult vaccinations.

The researchers didn’t find evidence that overweight or obese patients were less likely to receive recommended care compared to patients with a normal weight.

In fact, success rates were marginally higher for overweight and/or obese patients on several measures. Among the Medicare beneficiaries, obese patients with diabetes were more likely to have recommended care for lipid screenings than normal-weight patients (72 versus 65 percent), as well as glycated hemoglobin testing (74 versus 62 percent).

“Although the prevention of obesity is considered a public health priority, the majority of U.S. adults are already overweight or obese, so it is equally vital to ensure that these patients receive equitable and effective treatment,” the authors conclude. “Being obese or overweight was associated with marginally higher rates of recommended care for several measures. 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.”

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Design, Setting, and Participants Eight different performance measures were examined in 2 national-level patient populations: (1) Medicare beneficiaries (n = 36 122) using data from the Medicare Beneficiary Survey (1994-2006); and (2) recipients of care from the Veterans Health Administration (VHA) (n = 33 550) using data from an ongoing performance-evaluation program (2003-2004).

Main Outcome Measures Performance measures among eligible patients for diabetes care (eye examination, glycated hemoglobin [HbA1c] testing, and lipid screening), pneumococcal vaccination, influenza vaccination, screening mammography, colorectal cancer screening, and cervical cancer screening. Measures were based on a combination of administrative claims, survey, and chart review data.

Results We found no evidence that obese or overweight patients were less likely to receive recommended care relative to normal-weight patients. Moreover, success rates were marginally higher for obese and/or overweight patients on several measures. The most notable differentials were observed for recommended diabetes care among Medicare beneficiaries: comparing obese vs normal-weight patients with diabetes, obese patients were more likely to receive recommended care on lipid screening (72% vs 65%; odds ratio, 1.37 [95% confidence interval, 1.09-1.73]) and HbA1c testing (74% vs 62%; odds ratio, 1.73 [95% confidence interval, 1.41-2.11]). All analyses were adjusted for sociodemographic factors, health status, clinical complexity, and visit frequency.

Conclusions Among samples of patients from the Medicare and VHA populations, there was no evidence across 8 performance measures that obese or overweight patients received inferior care when compared with normal-weight patients. Being obese or overweight was associated with a marginally higher rate of recommended care on several measures.

Author Affiliations: Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Department of Medicine, University of Pennsylvania School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania (Drs Chang, Asch, and Werner); and Department of Sociology, University of Pennsylvania (Dr Chang), Philadelphia, Pennsylvania.

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Virginia W. Chang, MD, PhD; David A. Asch, MD, MBA; Rachel M. Werner, MD, PhD

JAMA. 2010;303(13):1274-1281.

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