Obesity and the Use of Health Care Services

Objective: This study investigated differences in the use of health care services and associated costs between obese and nonobese patients. Research Methods and Procedures: New adult patients (N = 509) were randomly assigned to primary care physicians at a university medical center. Their use of medical services and related charges was monitored for 1 year. Data collected included sociodemographics, self‐reported health status using the Medical Outcomes Study Short Form‐36, evaluation for depression using the Beck Depression Index, and measured height and weight to calculate BMI. Results: Obese patients included a significantly higher percentage of women and had higher mean age, lower mean education, lower mean health status, and higher mean Beck Depression Index scores. Obese patients had a significantly higher mean number of visits to both primary care (p = 0.0005) and specialty care clinics (p = 0.0006), and a higher mean number of diagnostic services (p < 0.0001). Obese patients also had significantly higher primary care (p = 0.0058), specialty clinic (p = 0.0062), emergency department (p = 0.0484), hospitalization (p = 0.0485), diagnostic services (p = 0.0021), and total charges (p = 0.0033). Controlling for health status, depression, age, education, income, and sex, obesity was significantly related to the use of primary care (p = 0.0364) and diagnostic services (p = 0.0075). There was no statistically significant relationship between obesity and medical expenditures in any of the five categories or for total charges. Discussion: Obesity is a chronic condition requiring long‐term management, with an emphasis on prevention. If this critical health issue is not appropriately addressed, the prevalence of obesity and obesity‐related diseases will continue to grow, resulting in escalating use of health care services.     

The Impact of Obesity on Primary Care Visits

Objective: To investigate the influence of patient obesity on primary care physician practice style. Research Methods and Procedures: This was a randomized, prospective study of 509 patients assigned for care by 105 primary care resident physicians. Patient data collected included sociodemographic information, self‐reported health status (Medical Outcomes Study Short Form‐36), evaluation for depression (Beck Depression Index), and satisfaction. Height and weight were measured to calculate the BMI. Videotapes of the visits were analyzed using the Davis Observation Code (DOC). Results: Regression equations were estimated relating obesity to visit length, each of the 20 individual DOC codes, and the six DOC Physician Practice Behavior Clusters, controlling for patient health status and sociodemographics. Obesity was not significantly associated with the length of the visit, but influenced what happened during the visit. Physicians spent less time educating obese patients about their health (p = 0.0062) and more time discussing exercise (p = 0.0075). Obesity was not related to discussions regarding nutrition. Physicians spent a greater portion of the visit on technical tasks when the patient was obese (p = 0.0528). Mean pre‐visit general satisfaction for obese patients was significantly lower than for non‐obese patients (p = 0.0069); however, there was no difference in post‐visit patient satisfaction. Discussion: Patient obesity impacts the medical visit. Further research can promote a greater understanding of the relationships between obese patients and their physicians.     

Obesity among People with and without Mental Retardation across Adulthood

Objective: This study was designed to explore obesity during adulthood and the likelihood of moving out of obesity among 1809 adults without disability and 680 adults with mental retardation who received care at the same primary care practices during the period of 1990 to 2003. Research Method and Procedures: A retrospective observational design using medical records first identified patients with mental retardation (MR) and age‐matched controls without disabilities. Data on BMI collected during each primary care visit allowed exploration of obesity at three levels. Moving out of obesity was defined as having a BMI <25 kg/m². We also abstracted data on age, sex, race, and other medical conditions. Results: For adults 20 to 29 years of age, 33.1% of patients without disability and 21% of patients with MR had a BMI >30 kg/m². Between the ages of 50 and 59 years, 40.5% of the patients without disability and 35.2% of the patients with MR had a BMI >30 kg/m². Patients with mild MR had similar prevalence rates of obesity and patients with severe MR had significantly lower prevalence of obesity compared with the patients without disability through 50 years of age. Throughout the period from 20 to 60 years of age, between 15% and 40% of individuals with and without MR, who were previously obese, were not currently obese. Discussion: Throughout the adult years, an increasing proportion of individuals with and without MR are obese. However, obesity is not a chronic state; many people transition back to a normal body weight.     

Influence of body mass index on the choice of therapy for depression and follow‐up care

Objective: Overweight and obese patients commonly suffer from depression and choice of depression therapy may alter weight. We conducted a cohort study to investigate whether obesity is associated with treatment choices for depression; and whether obesity is associated with appropriate duration of depression treatment and receipt of follow‐up visits. Design and Methods: Adults with a diagnosis of depression between January 1, 2006 and March 31, 2010 who had 1+ new episodes of an antidepressant medication and/or psychotherapy were eligible. Medication use, encounters, diagnoses, height, and weight were collected from health plan databases. We modeled receipt of the different therapies (medication and psychotherapy) by BMI and BMI trajectory during the 9‐months prior to initiation of therapy using logistic regression models that accommodated correlation within provider and adjusted for covariates. We modeled BMI via a restricted cubic spline. Fluoxetine was the reference treatment option in the medication models. Results: Lower BMI was associated with greater use of mirtazapine, and a declining BMI prior to treatment was associated with greater odds of initiating mirtazapine and paroxetine. Higher BMI was associated with greater odds of initiating bupropion even after adjustment for smoking status. Obese patients were less likely to receive psychotherapy and less likely to receive appropriate duration (180‐days) of depression treatment compared to normal weight subjects. Conclusions: Our study provides evidence that BMI is considered when choosing therapy but associations were weak. Our results should prompt discussion about recommending and choosing depression treatment plans that optimize depression care and weight management concurrently. Differences in care and follow‐up by BMI warrant additional research.     

Lipid and insulin levels in obese children: changes with age and puberty

Objective: The goal was to describe the lipid profile and insulin changes seen in obese children and adolescents at different stages of puberty. Research Methods and Procedures: A cross‐sectional study was conducted by chart review of 181 obese (BMI > 95th) children and adolescents 5 to 17 years of age, who were referred to the Center for Atherosclerosis Prevention for cardiovascular risk reduction from January 2003 through December 2003. Results: Eighty (44.2%) subjects were <12 years of age, and 101 (55.8%) were ≥12 years. Severity of obesity as expressed by BMI standard deviation score did not differ between these age groups. A significant difference with lower serum levels of total cholesterol, non‐high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, and high‐density lipoprotein cholesterol was seen with older age and with advancing sexual maturity rating. Triglycerides, very‐low‐density lipoprotein cholesterol, and lipoprotein(a) levels remained elevated across age and pubertal stages. Insulin levels and insulin resistance as expressed by homeostasis model assessment were significantly higher with older age. Similar trends were observed both in obese boys and obese girls during puberty. Discussion: The most striking findings of this study are that in the 5‐ to 17‐year‐old obese population, the combination of elevated triglycerides and very‐low‐density lipoprotein cholesterol and low high‐density lipoprotein cholesterol levels place them at greater cardiovascular risk than their non‐obese peers, even when the changing patterns of lipids and lipoproteins seen during pubertal maturation are accounted for.     

Family Physicians' Practices and Attitudes Regarding Care of Extremely Obese Patients

Despite the growing epidemic of extreme obesity in the United States, weight management is not adequately addressed in primary care. This study assessed family physicians' practices and attitudes regarding care of extremely obese patients and factors associated with them. A cross‐sectional, self‐administered survey was mailed to 500 family physicians in New Jersey (NJ) during March–May 2008. Measures included knowledge, weight management approaches, attitudes toward managing obesity, challenges with examinations, availability of supplies, and strategies to improve care. Response rate was 53% (N = 255). Bariatric surgery and weight loss medications were infrequently recommended, particularly in physicians with higher volume of extremely obese patients (odds ratio (OR) 0.38; 95% confidence interval (CI) 0.23, 0.62 and OR 0.51; 95% CI 0.31, 0.85 for surgery and medications, respectively). Higher knowledge was associated with increased frequency of recommendations of weight loss medications (P < 0.0001) and bariatric surgery (P < 0.0001). There was a high prevalence of negative attitudes, particularly in younger physicians and those with lower patient volume. Increased knowledge of weight‐loss diets was associated with less dislike in discussing weight loss (P < 0.0001), less frustration (P = 0.0001), less belief that treatment is often ineffective (P < 0.0001), and less pessimism about patient success (P = 0.0002). Many providers encountered challenges performing examinations on extremely obese patients. More education of primary care physicians, particularly on bariatric surgery, specific examination techniques, and availability of community resources for obese persons is needed. Further research is needed to determine if interventions to increase knowledge of physicians will lead to less negative attitudes toward weight loss and extremely obese patients.     

Primary Care Physicians’ Attitudes about Obesity and Its Treatment

Objective: This study was designed to assess physicians’ attitudes toward obese patients and the causes and treatment of obesity. Research Methods and Procedures: A questionnaire assessed attitudes in 2 geographically representative national random samples of 5000 primary care physicians. In one sample (N = 2500), obesity was defined as a BMI of 30 to 40 kg/m², and in the other (N = 2500), obesity was defined as a BMI > 40. Results: Six hundred twenty physicians responded. They rated physical inactivity as significantly more important than any other cause of obesity (p < 0.0009). Two other behavioral factors—overeating and a high‐fat diet—received the next highest mean ratings. More than 50% of physicians viewed obese patients as awkward, unattractive, ugly, and noncompliant. The treatment of obesity was rated as significantly less effective (p < 0.001) than therapies for 9 of 10 chronic conditions. Most respondents (75%), however, agreed with the consensus recommendations that a 10% reduction in weight is sufficient to improve obesity‐related health complications and viewed a 14% weight loss (i.e., 78 ± 5 kg from an initial weight of 91 kg) as an acceptable treatment outcome. More than one‐half (54%) would spend more time working on weight management issues if their time was reimbursed appropriately. Discussion: Primary care physicians view obesity as largely a behavioral problem and share our broader society's negative stereotypes about the personal attributes of obese persons. Practitioners are realistic about treatment outcomes but view obesity treatment as less effective than treatment of most other chronic conditions.     

Prevalence of Uncomplicated Obesity in an Italian Obese Population

Objective: The existence of healthy obese subjects has been suggested but not clearly reported. We sought to address the prevalence of uncomplicated obesity and adverse risk factors in a large Italian obese population. Research Methods and Procedures: This was a cross‐sectional study of a population of consecutive Italian obese subjects. We studied 681 obese subjects (514 women and 167 men), with a mean age of 41.1 ± 13.9 years (range, 16 to 77 years), mean BMI of 40.2 ± 7.6 kg/m² (range, 30 to 89.8 kg/m²), and a history of obesity for 20.5 ± 7 years (range, 10.5 to 30 years). Anthropometric, metabolic, cardiac, and obesity‐related risk factors were evaluated. Results: The prevalence of uncomplicated subjects was 27.5%, independent of BMI and duration of obesity. The youngest group of obese subjects showed a higher, but not statistically significantly higher, prevalence of uncomplicated obesity. No statistical difference for the prevalence of impaired fasting glucose, glucose intolerance, high triglycerides, high total cholesterol, low‐density lipoprotein cholesterol, and high‐density lipoprotein cholesterol among BMI categories (from mild to extremely severe obesity degree) was found. Obese subjects with BMI >50 kg/m² showed a higher prevalence of high blood pressure only when they were compared with the group with a BMI of 30 to 35 kg/m² (p < 0.01). Obese subjects with BMI >40 kg/m² showed a higher prevalence of hyperinsulinemia than subjects with BMI 30 to 35 kg/m² (p < 0.01). Discussion: This study shows that a substantial part of an Italian obese population has uncomplicated obesity, and the prevalence of adverse risk factors in this sample is unexpectedly low and partially independent of obesity degree. Uncomplicated obesity could represent a well‐defined clinical entity.     

Obesity and Depression in US Women: Results From the 2005–2006 National Health and Nutritional Examination Survey

Research is needed to better elucidate the relationship between obesity and depression, which has been most consistently demonstrated for women, but not for men. We examined exclusively a population‐based sample of US women who participated in the 2005 or 2006 National Health and Nutritional Examination Survey. Current depression was defined as having a score of ≥10 (a conventional threshold for moderate symptoms of depression) or meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM‐IV) diagnostic criteria for major depression on the nine‐item Patient Health Questionnaire. Weight and height were measured and BMI was calculated. Waist circumference, a clinical measure of abdominal obesity, was also measured. BMI was positively associated with the probability of moderate/severe depressive symptoms (r = 0.49, P = 0.03) and major depression (r = 0.72, P < 0.0001). The probability curves increased progressively, beginning at BMI of 30. Degree of obesity was an independent risk factor for depression even within the obese population, and women in obesity class 3 (BMI ≥40) were at particular risk (odds ratio (OR) = 4.91, 95% confidence interval (CI): 1.17–20.57), compared to those in obesity class 1 (BMI 30 to <35). Abdominal obesity was positively associated with depressive symptoms, but not major depression, independent of general obesity (BMI). In addition to severe obesity, compromised physical health status, young or middle‐aged adulthood, low income, and relatively high education were also independently associated with greater odds of depressive symptoms among obese women. These characteristics may identify specific at‐risk subgroups of obese women in which hypothesized causal pathways and effective preventive and therapeutic interventions can be profitably investigated.     

Obesity Impacts on General Practice Appointments

Objective: To quantify the impact of obesity on the number of visits to both primary and secondary care teams. Research Methods and Procedures: The adult populations of 80 general practices throughout the United Kingdom were classified according to their BMI. We undertook a cross‐sectional survey of computer‐generated and handwritten records of 6150 obese people (BMI ≥ 30 kg/m²) and 1150 normal weight (BMI = 18.5 to 24.9 kg/m²) control subjects over an 18‐month retrospective period. Results: Obese patients made significantly more visits to the general practitioner (GP), practice nurse (PN), and hospital outpatient units than normal weight patients (all p < 0.001), and they were admitted to the hospital more often (p = 0.034). For both GP and PN visits, the relationship remained after adjusting for age, sex, social deprivation category, country, and number of comorbidities. Among obese patients, there was an increasing relationship between frequent GP visits (at least four appointments) and greater BMI, which remained significant after adjustment had been made for age, sex, deprivation, country, and number of comorbidities. Discussion: The human resource burden to general practice is significantly higher in the obese population than in the normal weight population, even when adjusted for confounding factors. The increase in prevalence of obesity will continue to put pressure on GP and PN time unless appropriate action is taken.     

Association between Serum Leptin Levels and 24‐Hour Blood Pressure in Obese Women

Objective: To assess the relationship between serum leptin and 24‐hour blood pressure (BP) in obese women, according to body fat distribution. Research Methods and Procedures: A cross‐sectional study was carried out in a population of 70 nondiabetic, normotensive, obese women (40 with android and 30 with gynoid type of obesity) and 20 nonobese healthy women as a control group. All subjects underwent 24‐hour ambulatory BP monitoring. Blood samples were collected for serum leptin and plasma insulin measurements. Total cholesterol and high‐density lipoprotein cholesterol were also measured. Results: Serum leptin levels were significantly higher in obese subjects than in controls, and they were more elevated in android obese women than in gynoid ones. Leptin levels were positively related to body mass index (BMI), insulin, and waist and hip circumferences in the android group. Among gynoid subjects, leptin levels showed positive associations with BMI and insulin. In women with android obesity, strong positive correlations (p < 0.001) were found between leptin levels and 24‐hour systolic BP (SBP), daytime SBP, nighttime SBP, 24‐hour diastolic BP (DBP), and daytime DBP. Multiple regression analyses, including age, insulin and leptin concentrations, BMI, and waist and hip circumferences on 24‐hour and daytime SBP and DBP, showed that only leptin levels contributed to the variability of BP. Conclusions: Our study shows that serum leptin levels are directly related to 24‐hour BP levels in normotensive women with android fat distribution, independently of BMI.     

Sustained Weight Loss in Obese Subjects Has Benefits That Are Independent of Attained Weight

Objective: To explore the hypothesis that sustained weight loss in severely obese patients may have benefits that are independent of their attained BMI. Research Methods and Procedures: We conducted a comparison of two weight‐stable groups with BMI in the 30 to 35 kg/m² range. Subjects (n = 79) were selected obese patients 3 years after laparoscopic adjustable gastric band surgery, and controls (n = 79) were obese patients seeking weight loss therapy. Subjects were selected in a de‐identified manner from our database to best match the control group. A range of clinical, biochemical, and questionnaire measures were obtained to assess obesity‐related health status Results: Subjects maintained a mean weight loss of 32.8 ± 18 kg after surgery. The weight loss subjects had significantly lower fasting plasma glucose, insulin, and triglyceride concentrations, along with higher high‐density lipoprotein‐cholesterol levels and better indirect measures of insulin sensitivity when compared with controls (p < 0.05 for all). In addition, aminotransferase levels, neutrophil counts, and globulin levels were also significantly lower in weight loss subjects. All differences in laboratory variables remained significant after controlling for BMI. The subjects also reported better health‐related quality of life, fewer symptoms of depression, and greater satisfaction with their appearance than controls. Discussion: These findings suggest that the post‐weight loss state conveys benefits that are greater than predicted by the attained BMI. These findings may have important implications regarding the expectations of weight loss therapy, and mechanisms for this effect should be carefully sought.     

BMI and waist circumference as indicators of health among Samoan women

Objective: High rates of obesity and chronic disease make establishment of effective indicators of risk for chronic disease important. The objective was to examine adequacy of anthropometric cut‐off points as indicators of risk for chronic disease among Samoan women in Hawaii. Research Methods and Procedures: A cross‐sectional survey of 55 Samoan women 18 to 28 years of age that included blood lipids, cholesterol, and glucose (including after a 2‐hour oral glucose test); anthropometry (weight, height, waist circumference); and DXA of body composition. Results: Using the Centers for Disease Control and Prevention (CDC)/World Health Organization (WHO) cut‐off points for BMI, 22% of women were overweight and 58% were obese. Cholesterol, lipid, and glucose values were all linearly related to DXA body fat, BMI, and waist circumference. BMI and waist circumference at WHO/NIH cut‐off points predicted levels of blood lipids and glucose that indicate elevated risk for disease. Discussion: WHO/NIH cut‐off points for BMI and waist circumference reflect risk indicators of chronic disease among young Samoan women in Hawaii.     

Nosocomial Infections and Obesity in Surgical Patients

Objective: There is an increased morbidity and mortality associated with surgery in the obese patient. This study was conducted to determine risk factors and compare the nosocomial infection rate in obese and nonobese surgical patients. Research Methods and Procedures: A total of 395 surgical patients were evaluated. BMI was calculated for each patient. Various conventional risk factors for nosocomial infections were recorded. Biochemical parameters with plasma total cholesterol and high‐density lipoprotein‐cholesterol levels were measured. The diagnosis of infection was made according to the Centers for Disease Control and Prevention criteria. Univariate and two‐step multivariate logistic regression methods were used for determination of nosocomial infection risk factors. Results: There were 117 nosocomial infections identified in 96 of 395 surgically operated patients. A significant increase in the total number of nosocomial infections was determined in obese patients compared with the normal‐weight patients (p < 0.05). High‐density lipoprotein‐cholesterol below the 10th percentile increased risk of surgical site infection. Discussion: Our results suggest that obesity is an important risk factor for postoperative nosocomial infection.     

Calcium and Magnesium ATPase Activities in Women with Varying BMIs

Objective: Intracellular calcium (Ca) is increased in obese humans, and magnesium (Mg)‐ATPase activity is increased in monosodium glutamate‐induced obese rats. The aims of this study were to test the hypotheses that Ca‐ATPase activity is negatively correlated with BMI, and that Mg‐ATPase activity is positively correlated with BMI and Ca‐ATPase activity in obese women. Research Methods and Procedures: Thirty healthy adult women, with BMIs of 20 to 40, donated a single sample of whole blood and were interviewed as to medical history and family history of obesity. Erythrocyte membranes were isolated and assayed for Ca‐ATPase and Mg‐ATPase. Weight and height were self‐reported. Regression analysis was used to determine relationship between BMI and enzyme activity. Family history of obesity served as a covariant. Results: Ca‐ATPase was negatively correlated with increasing BMI (r = ? 0.38, p = 0.02). The relationship between BMI and Ca‐ATPase remained valid after controlling for family history of obesity (r = ?0.36, p = 0.03). There was a positive correlation between Mg‐ATPase activity and Ca‐ATPase (r = 0.42, p = 0.024), and this relationship remained valid after controlling for BMI and family history of obesity (r = 0.41, p = 0.03). Discussion: Ca‐ATPase activity decreases as BMI increases. Decreased ATPase activity may contribute to increased intracellular calcium, previously reported in obese persons. Further studies are needed to determine whether a drop in Ca‐ATPase activity can serve as a marker for the development of obesity.     

Relationship of BMI,Waist Circumference,and Weight Change with Use of Health Services by Older Adults

Objective: To examine the relationship of BMI, waist circumference (WC), and weight change with use of health care services by older adults. Research Methods and Procedures: This was a prospective cohort study conducted from 2001 to 2003 among 2919 persons representative of the non‐institutionalized Spanish population ≥60 years of age. Analyses were performed using logistic regression, with adjustment for age, educational level, size of place of residence, tobacco use, alcohol consumption, and presence of chronic disease. Results: Obesity (BMI ≥ 30 kg/m²) and abdominal obesity (WC >102 cm in men and >88 cm in women) in 2001 were associated with greater use of certain health care services among men and women in the period 2001–2003. Compared with women with WC ≤ 88 cm, women with abdominal obesity were more likely to visit primary care physicians [odds ratio (OR): 1.36; 95% confidence limit (CL): 1.06–1.73] and receive influenza vaccination (OR: 1.30; 95% CL: 1.03–1.63). Weight gain was not associated with greater health service use by either sex, regardless of baseline BMI. Weight loss was associated with greater health service use by obese and non‐obese subjects of both sexes. In comparison with those who reported no important weight change, non‐obese women who lost weight were more likely to visit hospital specialists (OR: 1.45; 95% CL: 1.02–2.06), receive home medical visits (OR: 1.61; 95% CL: 1.06–2.45), be hospitalized (OR: 1.88; 95% CL: 1.29–2.74), and have more than one hospital admission (OR: 2.31; 95% CL: 1.19–4.47). Discussion: Obesity and weight loss are associated with greater health service use among the elderly.     

Subclinical Hypothyroidism in Obese Patients: Relation to Resting Energy Expenditure,Serum Leptin,Body Composition,and Lipid Profile

Objective: To evaluate whether subclinical hypothyroidism (SH) affects resting energy expenditure (REE) as well as body composition, lipid profile, and serum leptin in obese patients. Research Methods and Procedures: A total of 108 obese patients with SH defined as normal free thyroxine levels and thyroid‐stimulating hormone (TSH) values of >4.38 μU/ml (mean ± 2 SD of the values of our reference group of obese patients with normal thyroid function) were compared with a group of 131 obese patients matched for age, sex, and body mass index (BMI) but with normal TSH levels. We assessed estimated daily caloric intake by 7‐day recall, REE by indirect calorimetry, body composition by bioelectrical impedance analysis, serum leptin by radioimmunoassay, and lipid profile (i.e., total cholesterol, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, and triglycerides). Results: All of the variables measured were not different between the euthyroid obese patients and those with SH. In a multiple regression model with REE expressed for kilograms of fat free mass (REE/kgFFM) as a dependent variable and percentage of fat mass, BMI, waist‐to‐hip ratio, age, TSH, free thyroxine, serum leptin, and caloric intake as independent variables, only percentage of fat mass was significantly correlated with REE/kgFFM in both groups. In the SH group only, BMI, waist‐to‐hip ratio, age, and TSH were related to REE/kgFFM and explained 69.5% of its variability. After dividing the patients with SH using a cutoff TSH value of 5.7 μU/ml, which represents 3 SD above the mean of TSH levels of the group of obese patients with normal thyroid function, only REE/kgFFM was significantly different and lower in the group of more severely hypothyroid patients. Discussion: In patients with obesity, SH affects energy expenditure only when TSH is clearly above the normal range; it does not change body composition and lipid profile. We suggest that, at least in obese patients, evaluation of TSH levels may be useful to rule out a possible impairment of resting energy expenditure due to a reduced peripheral effect of thyroid hormones.     

Bariatric Surgery Patients’ Views of Their Physicians’ Weight‐Related Attitudes and Practices

Objective: A prior study found that nearly 80% of bariatric surgery patients felt that they were treated disrespectfully by members of the medical profession. This study assessed patient‐physician interactions in a group of bariatric surgery patients and in a group of less obese patients who sought weight loss by other means. Research Methods and Procedures: A total of 105 bariatric surgery candidates (mean BMI, 54.8 kg/m²) and 214 applicants to a randomized controlled trial of the effects of behavior modification and sibutramine (mean BMI, 37.8 kg/m²) completed a questionnaire that assessed patient‐physician interactions concerning weight. Results: Only 13% of bariatric surgery patients reported that they were usually or always treated disrespectfully by members of the medical profession, a percentage substantially lower than that found in the previous study. Surprisingly, surgery patients were significantly more satisfied than nonsurgery patients with the care they received for their obesity. Surgery patients also reported significantly more interactions with physicians concerning obesity and weight loss compared with nonsurgery patients. A substantial percentage of both groups, however, reported that their physician did not discuss weight control with them. Discussion: These and other findings suggest that doctor‐patient interactions concerning weight may have improved in the past decade; however, there is still much room for improvement. Increased efforts are needed to help physicians discuss, assess, and potentially treat obesity in primary care practice.     

Body Mass Index and the Prevalence of Hypertension and Dyslipidemia

Objective: To describe and evaluate relationships between body mass index (BMI) and blood pressure, cholesterol, high‐density lipoprotein‐cholesterol (HDL‐C), and hypertension and dyslipidemia. Research Methods and Procedures: A national survey of adults in the United States that included measurement of height, weight, blood pressure, and lipids (National Health and Nutrition Examination Survey III 1988–1994). Crude age‐adjusted, age‐specific means and proportions, and multivariate odds ratios that quantify the association between hypertension or dyslipidemia and BMI, controlling for race/ethnicity, education, and smoking habits are presented. Results: More than one‐half of the adult population is overweight (BMI of 25 to 29.9) or obese (BMI of ≥30). The prevalence of high blood pressure and mean levels of systolic and diastolic blood pressure increased as BMI increased at ages younger than 60 years. The prevalence of high blood cholesterol and mean levels of cholesterol were higher at BMI levels over 25 rather than below 25 but did not increase consistently with increasing BMI above 25. Rates of low HDL‐C increased and mean levels of HDL‐C decreased as levels of BMI increased. The associations of BMI with high blood pressure and abnormal lipids were statistically significant after controlling for age, race or ethnicity, education, and smoking; odds ratios were highest at ages 20 to 39 but most trends were apparent at older ages. Within BMI categories, hypertension was more prevalent and HDL‐C levels were higher in black than white or Mexican American men and women. Discussion: These data quantify the strong associations of BMI with hypertension and abnormal lipids. They are consistent with the national emphasis on prevention and control of overweight and obesity and indicate that blood pressure and cholesterol measurement and control are especially important for overweight and obese people.     

Raised CRP levels in obese patients: symptoms of depression have an independent positive association

Background: Depression and obesity, the two common ailments of modern society, are associated with increased risk of coronary artery disease and raised C‐reactive protein (CRP) levels. Are the effects of depression and obesity related or do they influence CRP levels independently? Objective: In 493 consecutive patients presenting for obesity surgery, we explored the relationship between symptoms of depression and raised CRP levels after controlling for confounding factors. Methods and Procedures: Depression was measured using the Beck Depression Inventory (BDI). Confounding variables were age, gender, BMI, waist and hip measures, smoking and alcohol habits, medications, biochemical measures of the metabolic syndrome, and indirect measures of insulin resistance. General linear regression sought variables independently associated with CRP levels. Results: These patients had a BMI range from 31 to 91 kg/m², participants age ranged from 14 to 71 years, and 76% were women. The median CRP concentration was 7.7 mg/l (interquartile range: 3.9–14), 40% had an abnormally raised concentration (>10 mg/l). The mean BDI score was 17.0 ± 9.0, indicating symptoms of moderate depression. We found five independent factors associated with raised CRP levels. In order of strength of association, these were: higher BMI (β = 0.36, P < 0.001), female gender (β = ?0.19, P < 0.001), estrogen therapy (β = 0.18, P < 0.001), higher BDI score (β = 0.11, P = 0.01), and insulin resistance index (β = 0.11, P = 0.01), and with a combined R ² = 0.24, (P < 0.001). Discussion: In obese patients, symptoms of depression were associated with raised CRP levels after controlling for confounding variables. Obese women on estrogen therapy are at risk of high CRP levels.