Overweight People Get Less Preventive Care

Overweight people are less likely to receive recommended preventive care services, such as mammograms, Pap smears, and flu shots, according to a new study.

Overweight women are more likely to get breast and cervical cancer, and overweight elderly people have a higher risk of complications from flu, says researcher Truls Ostbye, MD, PhD, a professor of community and family medicine at Duke University, in a news release.

Despite this, overweight people are less likely to receive preventive services, he says.

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More Weight, Less Services

Researchers found that the more overweight middle-aged white women were, the less likely they were to receive mammography or Pap smears to screen for these diseases.

For example, white women of normal weight were more than 50 percent more likely to receive a mammogram than a severely obese white woman in 2000.

Even moderately overweight women were less likely to receive mammograms and Pap smears.

In addition, elderly obese white men and women and were less likely to get their recommended flu shots.

However, the study showed that the link between obesity and less frequent use of these three preventive care services was not found among black men or women.

The results appear in the September issue of the American Journal of Public Health.

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Obese Miss Out on Cancer Screening, Flu Shots

In the study, researchers analyzed the relationship between body mass index (BMI, a measure of weight in relation to height used to indicate obesity) and use of the following preventive care services: mammograms to screen for breast cancer, Pap smears to screen for cervical cancer, and flu shots to reduce the risk of influenza.

Researchers found that as BMI increased, the likelihood of receiving each of the three recommended preventive care services decreased in 1995-1996 and in 2000, although overall use of these services increased during this time period.

Mammograms. 75 percent of normal-weight women had received a mammogram for breast cancer screening within the last two years compared with 67 percent of obese women in 1996. The same trend held true in 2000, although a greater proportion of all women received screening mammograms. Pap tests. 73 percent of normal-weight women vs. 66 percent of obese and 54 percent of severely obese women (BMI over 40) received Pap smears in 2000. Flu shots. 78 percent of normal-weight men and women received flu shots in 2000 compared with 70 percent of moderately obese people and 56 percent of severely obese.

The higher a person's BMI the less likely they were to receive any of the preventive services. In other words, normal-weight people most likely received these services, followed by overweight people and then obese people.

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Missing Out on Screening Risky

Researchers say delaying or avoiding cancer screening can make the difference between life and death in some cases. Earlier detection and treatment leads to better chances of survival.

In addition, failure to get a flu shot among the elderly increases the risk of potentially deadly complications from influenza.

Ostbye says the study suggests that income, education, and access to health care were not important reasons for the discrepancies in preventive care services. Instead, researchers say significant reasons may include social stigma, avoidance of health care by patients, and bias by health care providers.

They say these results present an example of the "inverse care law" in which people who need health care services the most are often the least likely to get them.

Everyone, including normal- and overweight people, needs to discuss the need for preventive services with their doctor.

By Jennifer Warner, reviewed by Michael W. Smith, MD

SOURCES: Ostbye, T. American Journal of Public Health, September 2005; vol 95. News release, Duke University Medical Center.