General practitioners’ opportunities for preventing ill health in healthy vs morbid obese adults: a general population study on consultations

摘要

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.