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Obese patients have a greater illness burden than other patients and usually are less satisfied with their health care

Obesity contributes to almost 300,000 deaths in the United States each year. Obese patients often believe that doctors have a more negative attitude toward them than other patients, a perception that previous studies have validated.

A new study suggests that the higher illness burden of obese patients compared with normal weight patients may largely explain their lower satisfaction with the primary care they receive. In fact, the strong association between patient health status and patient satisfaction may have masked a weaker relationship between obesity and lower satisfaction in the study, explains Christina C. Wee, M.D., M.P.H., of Beth Israel Deaconess Medical Center. The study was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award fellowship F32 HS00137).

Dr. Wee and her colleagues correlated patient weight with outpatient care satisfaction among 2,858 patients at 11 primary care practices in Boston. Compared with normal weight patients, whose body mass index (BMI, weight in kilograms divided by height in meters squared) was 19 to 24.9 kg/m2, overweight (BMI 25-29.9 kg/m2) and obese patients (BMI 30 kg/m2 or more) reported lower overall satisfaction at their most recent outpatient visit. The scores were 85.5, 85.0, and 82.6 out of a possible 100, respectively.

After adjusting for other factors, including illness burden (health status and coexisting illnesses), obese patients still reported lower satisfaction scores, but the difference was no longer significant. Overall patient satisfaction with the usual care provider and their practice did not vary by BMI group, even after adjusting for other factors. One of the strongest correlates of lower patient satisfaction was poor health status which, in turn, was highly correlated with obesity. The researchers caution, however, that their measures may not have been sensitive to quality of care issues related to patient weight. For example, patients were not asked if they thought their body weight affected the way they were treated by health providers or resulted in inferior care.

See "Influence of body weight on patients' satisfaction with ambulatory care," by Dr. Wee, Russell S. Phillips, M.D., E. Francis Cook, Sc.D., and others, in the February 2002 Journal of General Internal Medicine 17, pp. 155-159.

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