Despite concerns about stigma faced by obese patients—and research suggesting an inverse relationship between physicians’ respect for patients and patients’ weight—a new study published in the Journal of the American Medical Association suggests that obese patients receive the same quality of care as their slimmer peers. A team of researchers from the University of Pennsylvania examined data on more than 36,000 patients included in the Medicare Beneficiary Survey and nearly 34,000 patients included in a Veterans Health Administration (VHA) outgoing performance evaluation program, analyzing physician performance on eight different measures—including diabetes care, vaccinations and cancer screenings. They found that, in population studied, obese patients not only got the same level of recommended care in the eight measures assessed, but that, in some instances, they had a marginally higher levels of recommended care.
The measures included in the study were eye exams, hemoglobin testing and lipid screening for diabetes care, pneumococcal and influenza vaccinations, and screening for breast, colon and cervical cancers. Either self-reported height and weight (Medicare) or in-office measurements (VHA) were used to determine body mass index (BMI), and patients with a BMI lower than 18.5 were considered underweight; 18.5–24.9, normal weight; 25.0–29.9, overweight; and 30 or higher, obese.
The team of researchers, including Drs. Virginia W. Chang, David A. Asch and Rachel M. Werner, found that obese patients did not receive inferior care, and that this remained the case regardless of severity of obesity. They write that patients with higher subcategories of obesity—with a BMI higher than 35, or higher than 40—”did not have significantly lower odds of care and frequently had higher odds of care related to the normal-weight category.” What’s more, among all obese patients, not only was care on par with that of normal-weight patients, but, for several measures, they received recommended care more frequently. In both groups studied, obese and overweight patients had higher levels of vaccination, for example. And in both the Medicare and VHA populations researchers noted greater likelihood of cancer screening for overweight patients: compared with normal-weight patients, overweight patients on Medicare were more likely to get mammograms, and those in the VHA population were more likely to be screened for cervical cancer.
“Although previous research has raised the possibility that obese patients may receive lower quality of care,” the authors conclude, “we found no evidence that obese or overweight patients are less likely to receive recommended care than normal-weight patients.”