Abstract
Background: Two-thirds of U.S. adults are overweight or obese. Obesity is a major risk factor for cardiovascular disease, type II diabetes, and certain cancers including prostate and colorectal. While overweight and obesity are associated with increased morbidity, mortality and health care costs, their association with health behaviors and use of preventive health services is unclear.
Methods: We examined lifestyle and screening exams in the past 5 years by categories of body mass index (BMI) in the California Men’s Health Study (n=84,170). The cohort includes Kaiser Permanente members 45–69 years of age in 2003–2004 with nearly 40% belonging to a minority racial/ ethnic group.
Results: 25% reported healthy weight (BMI=18.5–24.9); 45% overweight (BMI=25.0–29.9); and 19% and 7% obesity categories I or II+ (BMI=30.0–34.9, 35+). In multivariable analyses controlling for sociodemographics and health care characteristics, we found significant differences in health behaviors and use of preventive services by categories of BMI. Obese men reported lower levels of alcohol consumption and were less likely to be a current smoker. On the other hand, overweight and obese men were less likely to consume a diet with <30% of calories from fat [OR (CI), 0.71 (0.68–0.74); 0.49 (0.46–0.51); 0.38 (0.35–0.41)]. A similar trend was seen for physical activity. Overweight and obese men were less likely to participate in moderate activity [OR (CI), 0.81 (0.78–0.84); 0.51 (0.48–0.53); 0.31 (0.29–0.33)] or vigorous activity [OR (CI), 0.73 (0.70–0.76); 0.47 (0.44–0.50); 0.29 (0.26–0.32)]. An inverse trend was found for sedentary behavior. Men with a BMI of 35+ were twice as likely to report sedentary behavior for 6.5+ hours/day [OR (CI), 2.04 (1.90–2.18)]. For screening exams, overweight and obese men were more likely to report having had their glucose, cholesterol, and triglycerides tested, and among men with diabetes, their HgAlc. In contrast, obese men were less likely to report a PSA test [OR (CI), 0.84 (0.79–0.89); 0.74 (0.68–0.80)] or, among men at average risk for colorectal cancer, a screening sigmoidoscopy [OR (CI), 0.84 (0.79–0.90); 0.73 (0.67–0.81)].
Conclusions: Despite having more primary care visits, obese men may be at greater risk due to lower utilization of common screening exams. Results suggest targeted efforts are needed to increase cancer screening and physical activity, and lower consumption of dietary fat among patients with elevated BMIs.
- Received September 11, 2008.
