Underdiagnosis of Obesity at a Community Health Center

Celeste A. Lemay; Suzanne Cashman; Judith Savageau; Kenneth Fletcher; Rebecca Kinney; Ellen Long-Middleton

doi:10.3122/jabfm.16.1.14

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Figure 1.
Study sample patients with obesity diagnosed by body mass index (BMI) and by patient’s provider (n = 157).

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Table 1.

Demographic Characteristics of Study Sample (n = 465) and Community Health Center (CHC) Patient Population Overall.

Characteristic	Study Sample No. (%)	Percent of CHC Patient Population Overall^*
Sex
Male	136 (29)	42
Female	329 (71)	58
Insurance
Medicaid	259 (56)	45
Private	45 (10)	10
Race
American Indian	4 (1)	0
Asian	28 (6)	7
African American	45 (10)	12
White	159 (34)	32
Ethnicity
Hispanic	188 (41)	42

* Data obtained from Federal Government Uniform Data System Report for the reporting period January 1998 to December 1998.

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Table 2.

Underdiagnosis of Obesity by Provider Type Among Patients Determined to be Obese by Body Mass Index (BMI) Calculations.

Diagnosis of Obesity	Physician No. (%)	Nurse Practitioner No. (%)	Resident No. (%)	Total(s) No. (%)
Provider diagnosis	32 (46)	7 (33)	4 (17)	43 (37)
Omission of diagnosis by provider	38 (54)	14 (67)	20 (83)	72 (63)
Total	70 (61)	21 (18)	24 (21)	115^*

* Excluded 6 patients who had received primary care from a physician’s assistant.
χ² = 6.62, 2 df, P = .036.
Linear-by-linear association = 6.53, 1 df, P = .011.

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Table 3.

Comparison of Patients with Obesity Diagnosed by Primary Care Provider (PCP) and Patients Calculated to be Obese by Body Mass Index (BMI) Exclusively.

Patient Characteristics	PCP Diagnosis of Obesity (n = 83) No. (%)	Obese by BMI Calculation Exclusively (n = 74) No. (%)
Sex^*
Male	14 (17)	31 (42)
Female	69 (83)	43 (58)
Age, years
18–25	8 (10)	10 (14)
26–40	27 (32)	19 (26)
41–49	14 (17)	17 (23)
50–64	31 (37)	24 (37)
65+	3 (4)	4 (5)
Insurance
Medicaid	50 (60)	41 (55)
Free care	5 (6)	8 (11)
Private	6 (7)	8 (11)
Medicare	16 (19)	8 (11)
Self-paying	6 (7)	8 (11)
Race^†
American Indian	1 (1)	1 (1)
Asian	0	2 (3)
African American	10 (12)	9 (12)
White	38 (46)	20 (27)
Multiracial, other	6 (7)	7 (10)
Unknown	28 (34)	35 (47)
Ethnicity^†
Hispanic	28 (34)	33 (45)
Non-Hispanic	9 (11)	15 (20)
Unknown	46 (55)	26 (35)
Chronic conditions
Hypertension	29 (35)	24 (32)
Diabetes mellitus	20 (24)	11 (15)
Depression	28 (34)	23 (31)

* χ² = 11.98, 1 df, P = .001
† Did not test for significance because of missing data.

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Table 4.

Comparison of Patients with Obesity Determined by Primary Care Provider (PCP) or Body Mass Index (BMI) Calculation (n = 157) and Patients Overweight Determined by BMI Calculation (n = 83).

Characteristics	Obesity Determined by PCP or BMI No. (%)	Overweight Determined by BMI No. (%)
Sex
Male	45 (29)	32 (39)
Female	112 (71)	51 (61)
Age, years
18–25	18 (12)	13 (16)
26–40	46 (31)	29 (35)
41–49	31 (21)	19 (23)
50–64^*	55 (37)	19 (23)
65+	7 (4)	3 (3)
Insurance
Medicaid	91 (58)	44 (53)
Free care	13 (8)	11 (13)
Private	14 (9)	9 (11)
Medicare	24 (15)	6 (7)
Self-paying	14 (9)	11 (13)
Race^†
American Indian	2 (1)	2 (2)
Asian	2 (1)	8 (10)
African American	19 (12)	9 (11)
White	58 (37)	25 (30)
Multiracial, other	13 (8)	8 (10)
Unknown	63 (40)	31 (37)
Ethnicity^†
Hispanic	61 (39)	34 (41)
Non Hispanic	24 (15)	17 (20)
Unknown	72 (46)	32 (39)
Chronic conditions
Hypertension^†	53 (34)	17 (21)
Diabetes mellitus^§	31 (20)	3 (4)
Depression	51 (33)	34 (41)