Do Obese People Get Poorer Health Care?

I have previously blogged about the problem of weight bias amongst health professionals and how this can possibly lead to poorer health care for people with excess weight.

A new study by Virginia Chang and colleagues from the University of Pennsylvania, just published in the Journal of the American Medical Association (JAMA) suggests that the quality of health care may not necessarily be worse for obese people compared to normal weight folks.

The reserachers examined eight different performance measures in two US national-level patient populations: (1) Medicare beneficiaries (n = 36 122) and (2) recipients of care from the Veterans Health Administration (VHA) (n = 33 550).

The performance measures included diabetes care (eye examination, glycated hemoglobin [HbA(1c)] testing, and lipid screening), pneumococcal vaccination, influenza vaccination, screening mammography, colorectal cancer screening, and cervical cancer screening.

Based on these data, the researchers found no evidence that obese or overweight patients were less likely to receive recommended care relative to normal-weight patients.

In fact, comparing obese vs normal-weight patients with diabetes, obese patients were more likely to receive recommended care on lipid screening (72% vs 65%) and HbA(1c) testing (74% vs 62%).

Obese patients were also more likely to receive pneumococcal vaccinations (53% vs. 49%).

In fact, there was no measure in which obese people were less likely to receive care compared to people with normal weight.

Of course, this study says nothing about attitudes or bias amongst health care professionals, which continues to be a concern, and it should perhaps be noted that the patients in both of these data bases tend to be older.

While the authors interpret these findings as evidence that perhaps more attention is now being paid to health in people presenting with excess weight, they also suggest that previous reports on poorer care for obesity may in part be due to self-reported recall biases in retrospective studies.

I wonder what my readers think about this issue: any personal stories or anecdotes are most welcome.

Edmonton, Alberta

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Chang VW, Asch DA, & Werner RM (2010). Quality of care among obese patients. JAMA : the journal of the American Medical Association, 303 (13), 1274-81 PMID: 20371786