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      Physician Consultations According to Different BMI Levels of the Greek General Population

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          Abstract

          Obesity constitutes a global epidemic which is rapidly becoming a major public health problem in many parts of the world, threatening peoples’ health and quality of life. The aim of our study was to estimate the prevalence and impact of overweight and obesity on physician consultations and frequency of use and furthermore, to investigate whether physician consultations in each of the groups defined by BMI level correspond to the need for care implied by health risk level, using logistic regression models. The survey was carried out in Greece in 2006 and involved complete data from 645 individuals consulted by physicians. Overweight and obese users constituted 41.7% and 19% of the sample respectively. The findings showed firstly that the odds of obese individuals visiting a physician (OR 2.15) or making more than three visits (OR 2.12) was doubled compared to the odds of individuals with normal weight. Secondly, we conclude that physician consultations in overweight and obese subgroups as well as the frequency of visits were predicted by factors such as co-morbidities, low HRQL, low educational level which are associated directly or indirectly with obesity, and thus with a greater health need, assuming vertical equity in the utilization of such services.

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          The impact of obesity on health-related quality-of-life in the general adult US population.

          Haomiao Jia, Erica I Lubetkin (2005)
          The US Preventive Services Task Force recently recommended screening all adult patients for obesity due in part to the strong association between obesity and numerous chronic diseases. However, how obesity affects health-related quality-of-life (HRQL), particularly for persons without any chronic diseases, is less clear. The relationship between obesity and HRQL was examined using data from the 2000 Medical Expenditure Panel Survey. Respondents > or =18 years were classified as underweight, normal weight, overweight, class I obesity, and class II obesity based on their BMI. HRQL was measured by the 12-item Short Form physical and mental summary scores (PCS-12 and MCS-12, respectively) and EuroQol EQ-5D index and visual analogue scale (EQ VAS). The impact of obesity on HRQL was examined through multivariate regression, adjusting for sociodemographics and disease status. After adjustment, HRQL decreased with increasing level of obesity. Compared to normal weight respondents, persons with severe obesity had significantly lower scores with scores on the PCS-12, MCS-12, EQ-5D index, and EQ VAS being 4.0, 1.1, 0.073, and 4.8 points lower, respectively. Such decrements of HRQL for severe obesity were similar to the decrements seen for diabetes or hypertension. Persons with moderate obesity or who were overweight also had significantly lower HRQL scores, particularly on the PCS-12 and EQ-5D index. Underweight persons also had lower MCS-12 and EQ VAS scores. Persons with obesity had significantly lower HRQL than those who were normal weight and such lower scores were seen even for persons without chronic diseases known to be linked to obesity.
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            Moderate and severe obesity have large differences in health care costs.

            Jeanne Ringel, Roland Sturm, Tatiana Andreyeva (2004)
            To analyze health care use and expenditures associated with varying degrees of obesity for a nationally representative sample of individuals 54 to 69 years old. Data from the Health and Retirement Study, a nationwide biennial longitudinal survey of Americans in their 50s, were used to estimate multivariate regression models of the effect of weight class on health care use and costs. The main outcomes were total health care expenditures, the number of outpatient visits, the probability of any inpatient stay, and the number of inpatient days. The results indicated that there were large differences in obesity-related health care costs by degree of obesity. Overall, a BMI of 35 to 40 was associated with twice the increase in health care expenditures above normal weight (about a 50% increase) than a BMI of 30 to 35 (about a 25% increase); a BMI of over 40 doubled health care costs (approximately 100% higher costs above those of normal weight). There was a difference by gender in how health care use and costs changed with obesity class. The primary effect of increasing weight class on health care use appeared to be through elevated use of outpatient health care services. Obesity imposes an increasing burden on the health care system, and that burden grows disproportionately large for the most obese segment of the U.S. population. Because the prevalence of severe obesity is increasing much faster than that of moderate obesity, average estimates of obesity effects obscure real consequences for individuals, physician practices, hospitals, and health plans.
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              Validity of SF-12 summary scores in a Greek general population

              Nick Kontodimopoulos, Evelina Pappa, Dimitris Niakas … (2007)
              Background The 12-item Health Survey (SF-12) was developed as a shorter alternative to the SF-36 for use in large-scale studies, particularly when overall physical and mental health are the outcomes of interest instead of the typical eight-scale profile. The main purpose of this study was to assess the validity of the Greek version of the SF-12. Methods A stratified representative sample (N = 1005) of the Greek general population was interviewed. The survey included the SF-36, the EQ-5D and questions on socio-demographic and health-related characteristics. SF-12 summary scores were derived using the standard US algorithm. Factor analysis was used to confirm the hypothesized component structure of the SF-12 items. Construct validity was investigated with "known groups" validity testing and via convergent and divergent validity, which in turn were assessed by the correlations with the EQ-5D dimensions. Concurrent validity was assessed by comparisons with SF-36 summary scores. Results SF-12 summary scores distinguished well, and in the expected manner, between groups of respondents on the basis of gender, age, education, socio-economic status, self-reported health problems and health services utilization, thus providing evidence of construct validity. Effect size differences between SF-36 and SF-12 summary scores were generally small (<0.2), supporting concurrent (criterion) validity. Significantly lower mean PCS-12 and MCS-12 scores were observed for respondents reporting chronic conditions compared to those without (P < 0.001). Convergent and divergent validity were supported by expected relationships with the EQ-5D. Reporting a problem in an EQ dimension was associated with lower SF-12 summary scores, supporting concurrent validity. Sensitivity of the Greek SF-12 and replication of the original measurement and conceptual model were demonstrated. Conclusion The results provide evidence on the validity of the Greek SF-12 and, in conjunction to future studies addressing test-retest reliability and responsiveness, support its use in Greek health status studies as a brief, yet valid, alternative to the SF-36.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Environ Res Public Health
                Journal ID (publisher-id): 101238455
                Title: International Journal of Environmental Research and Public Health
                Publisher: Molecular Diversity Preservation International (MDPI)
                ISSN (Print): 1661-7827
                ISSN (Electronic): 1660-4601
                Publication date (Print): November 2011
                Publication date (Electronic): 14 November 2011
                Volume: 8
                Issue: 11
                Pages: 4300-4311
                Affiliations
                [1 ]Hellenic Open University, Faculty of Social Sciences, Riga Fereou 169 & Tsamadou, Patras 26222, Greece; E-Mails: nkontodi@ 123456otenet.gr (N.K.); docpapado@ 123456yahoo.gr (A.A.P.); niakas@ 123456eap.gr (D.N.)
                [2 ]“ATTIKON” University Hospital, Rimini 1, Athens 124 62, Greece
                [3 ]Center for Health Services Research, Department of Hygiene and Epidemiology, Medical School, Athens University, Alexandroupoleos 25, Athens 115 27, Greece; E-Mail: chsr@ 123456med.uoa.gr
                Author notes
                [* ]Author to whom correspondence should be addressed; E-Mail: evanpappa@ 123456gmail.com ; Tel.: +302610-367441; Fax: +302610-367442.
                Article
                Publisher ID: ijerph-08-04300
                DOI: 10.3390/ijerph8114300
                PMC ID: 3228572
                PubMed ID: 22163208
                SO-VID: aafb067d-9842-43c7-a147-6eff20e85610
                Copyright © © 2011 by the authors; licensee MDPI, Basel, Switzerland
                License:

                This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/3.0/).

                History
                Date received : 12 July 2011
                Date revision received : 04 October 2011
                Date accepted : 08 November 2011
                Categories
                Subject: Article

                ScienceOpen disciplines: Public health
                Keywords: greece,obesity,overweight,physician consultations,health needs
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: greece, obesity, overweight, physician consultations, health needs

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