Abstract
To determine whether overweight and obese adults with and without physical morbidity show an excess utilization of general practitioners in terms of consultation and, among users, number of consultations. In a general adult population survey in the Augsburg region, Germany (KORA Survey S4 1999/2001), body mass index (BMI in kg/m2) was assessed anthropometrically, physical morbidity via computer-aided personal interview with an adapted version of the Functional Comorbidity Index (Groll et al., J Clin Epidemiol 58:595–602, 2005) and consultations with general practitioners in three computer-aided telephone interviews over half a year. Analysis was performed using multiple logistic and zero-truncated negative binomial regressions (two-part model). Data were adjusted for gender, age, socio-economic status, marital status, health insurance and place of residence. Among healthy respondents, i.e. those with no morbidity, neither moderately nor severely obese respondents had significantly higher odds for GP use, or higher numbers of consultations among users, than those in the normal weight range. In contrast, among respondents with any physical morbidity, obese respondents showed excess utilization of GP in that moderately obese adults had significantly higher odds of any GP contact (odds ratio = 2.09, p < 0.01), and, among users, the severely obese group showed an excess number of consultations [incident rate ratio = 1.73, p < 0.05 (adjusted: 1.59, p < 0.10)]. Physical morbidity did not predict any GP use, but tended to be associated with number of consultations among users (incident rate ratio = 1.84, p < 0.10). Under the present conditions of utilization of general practitioners by obese adults in Germany, this group of physicians seems to have the most opportunities for secondary and tertiary prevention in this group of patients. With regard to obese adults who are as yet by and large healthy (and usually of relatively young age), primary prevention efforts may be viable not predominantly by primary care, but community-oriented policies. How far general practice can be an integrative part of primary disease prevention by obesity management is an issue for further investigation.
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References
Bowerman S, Bellman M, Saltsman P, Garvey D, Pimstone K, Skootsky S, Wang HJ, Elashoff R, Heber D (2001) Implementation of a primary care physician network obesity management program. Obes Res 9:321S–325S
Bramlage P, Pittrow D, Wittchen HU, Kirch W, Böhler S, Lehnert H, Höfler M, Unger T, Sharma AM (2004a) Hypertension in overweight and obese primary care patients is highly prevalent and poorly controlled. Am J Hypertens 17:904–910
Bramlage P, Wittchen HU, Pittrow D, Kirch W, Krause P, Lehnert H, Unger T, Hofler M, Kupper B, Dahm S, Bohler S, Sharma AM (2004b) Recognition and management of overweight and obesity in primary care in Germany. Int J Obes Relat Metab Disord 28:1299–1308
Bray GA (2004) Obesity is a chronic, relapsing neurochemical disease. Int J Obes Relat Metab Disord 28:34–38
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383
Cohen-Mansfield J, Pawlson G, Lipson S, Volpato S (2001) The measurement of health: a comparison of indices of disease severity. J Clin Epidemiol 54:1094–1102
de Groot V, Beckerman H, Lankhorst GJ, Bouter LM (2003) How to measure comorbidity: a critical review of available methods. J Clin Epidemiol 56:221–229
Diehr P, Yanez D, Ash A, Hornbrook M, Lin DY (1999) Methods for analyzing health care utilization and costs. Annu Rev Public Health 20:125–144
Fortin M, Hudon C, Dubois M-F, Almirall J, Lapointe L, Soubhi H (2005) Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life. Health Qual Life Outcomes 3:74
Foster GD, Wadden TA, Makris AP, Davidson D, Sanderson RS, Allison DB, Kessler A (2003) Primary care physicians’ attitudes about obesity and its treatment. Obes Res 11:1168–1177
German Obesity Association, German Diabetes Association, German Nutrition Association, & German Nutritional Medicine Association (2006) Evidenzbasierte Leitlinie: Prävention und Therapie der Adipositas-Version 2006 (in German). German Obesity Association, Hamburg. http://www.dge.de/pdf/ll/Adipositas-LL-2006.pdf (accessed July 03, 2006)
Groll DL, To T, Bombardier C, Wright JG (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58:595–602
Heusch G (2006) Obesity—a risk factor or a RISK factor for myocardial infarction? Br J Pharmacol 149:1–3
Hill JO, Wyatt H (2002) Outpatient management of obesity: a primary care perspective. Obes Res 10:124S–130S
Hoffmann W, Terschüren C, Holle R, Kamtsiuris P, Bergmann M, Kroke A, Sauer S, Stang A, Latza U (2004) The problem of response in epidemiologic studies in Germany (part II) (in German). Gesundheitswesen 66:482–491
Holle R, Happich M, Löwel H, Wichmann H-E, MONICA/KORA Study Group (2005) KORA—a research platform for population based health research. Gesundheitswesen 67:S19–S25
Hurley SF, Bond LM, Carlin JB, Evans DB, Kaldor JM (1995) A method for estimating baseline health care costs. J Epidemiol Community Health 49:525–531
Jöckel K-H, Babitsch B, Bellach B-M, Bloomfield K, Hoffmeyer-Zlotnik JHP, Winkler J, Wolf C (1998) Empfehlungen der Arbeitsgruppe “Epidemiologische Methoden” in der Deutschen Arbeitsgemeinschaft Epidemiologie der Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (GMDS) und der Deutschen Gesellschaft für Sozialmedizin und Prävention (DGSMP) zur Messung und Quantifizierung soziodemographischer Merkmale in epidemiologischen Studien (in German). In: Ahrens W, Bellach B-M, Jöckel K-H (eds) Messung soziodemographischer Merkmale in der Epidemiologie (RKI-Schriften 1/98). MMV-Verlag, Munich, pp 7–38
Lauterbach K, Westenhöfer J, Wirth A, Hauner H (1998) Adipositas Leitlinie: Evidenz-basierte Leitlinie zur Behandlung der Adipositas in Deutschland (in German). University of Cologne, Cologne. http://www.westenhoefer.de/infos/adipositasleitlinie_expertenversion.pdf (accessed October 17, 2006)
Löwel H, Döring A, Schneider A, Heier M, Thorand B, Meisinger C, MONICA/KORA Study Group (2005) The MONICA Augsburg Surveys—basis for prospective cohort studies. Gesundheitswesen 67:S13–S18
Mielck A (2000) Soziale Ungleichheit und Gesundheit (in German). Hans Huber, Bern
Padwal R, Li SK, Lau DC (2004) Long-term pharmacotherapy for obesity and overweight. Cochrane Database Syst Rev 3:CD004094
Rebhandl E, Rabady S, Mader F (eds) (2006) Evidence based medicine—Guidelines für Allgemeinmedizin (in German). Deutscher Ärzte-Verlag, Cologne
Sander B, Bergemann R (2003) Economic burden of obesity and its complications in Germany. Eur J Health Econ 4:248–253
Syme SL (2006) Preventing disease and promoting health: the need for some new thinking. Soz Praventivmed 51:247–248
van Dijk L, Otters HB, Schuit AJ (2006) Moderately overweight and obese patients in general practice: a population based survey. BMC Fam Pract 7:43
von Lengerke T, Happich M, Reitmeir P, John J, KORA Study Group (2005) Utilization of out- and inpatient health services by obese adults: a population based study in the Augsburg region, Germany. Gesundheitswesen 67:S150–S157
von Lengerke T, John J, KORA Study Group (2006) Use of medical doctors, physical therapists, and alternative practitioners by obese adults: does body weight dissatisfaction mediate extant associations? J Psychosom Res 61:553–560
Werner A, Reitmeir P, John J (2005) Switching sickness funds and risk compensation mechanisms in the statutory health insurance system in Germany—empirical results from the Cooperative Health Research in the Region of Augsburg (KORA) (in German). Gesundheitswesen 67:S158–S166
WHO (2000) Obesity: preventing and managing the global epidemic [Technical Report Series No. 894]. WHO, Geneva
Wiesemann A, Barlet J, Engeser P, Kuth N, Müller-Bühl U (2006) Obesity: behavior change promotion in primary care (in German). Z Allg Med 82:103–107
Acknowledgements
This study is part of the KORA Survey S4 1999/2001, a project conducted within the KORA research platform (Cooperative Health Research in the Region of Augsburg). This platform was initiated by the GSF-National Research Center for Environment and Health (Neuherberg, Germany), which is funded by the German Federal Ministry of Education and Research and the State of Bavaria. The authors wish to thank all present and former members of the KORA Study Group, especially Rolf Holle, Christian Janßen, Andreas Mielck, Hannelore Nagl, Peter Reitmeir, Walter Satzinger, and Andrea Wulff. Also, our sincere appreciation goes to the originator of the Functional Comorbidity Index (FCI), Dianne Groll (University of Ottawa, Canada), for her prompt, thorough and cooperative support of our adaptation of the instrument.
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The authors declare they have no relevant associations that might pose a conflict of interest.
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The KORA Study Group consists of H.-E. Wichmann (speaker), H. Löwel, C. Meisinger, T. Illig, R. Holle, J. John and co-workers who are responsible for the design and conduct of the KORA studies.
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von Lengerke, T., John, J. & KORA Study Group. General practitioners’ opportunities for preventing ill health in healthy vs morbid obese adults: a general population study on consultations. J Public Health 15, 71–80 (2007). https://doi.org/10.1007/s10389-006-0086-9
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DOI: https://doi.org/10.1007/s10389-006-0086-9