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Primary care access associated with lower obesity rates in US counties

An association between access to primary care at the county level and obesity may have significant implications for restructuring the physician workforce, in light of both the current primary care physician shortage and the implementation of the Affordable Care Act, according to data published in Journal of the American Board of Family Medicine.

According to the researchers, although the observed link between county-level primary care access and obesity may not be causal, more investigation is needed.

“Several recent studies support the effectiveness of a primary care-based model for treatment of obesity,” Anne H. Gaglioti, MD, of the department of family medicine, at the Morehouse School of Medicine National Center for Primary Care, in Atlanta, and colleagues wrote. “While it is effective, physicians do not practice weight-loss counseling with appropriate regularity, content, or frequency. Although the content and frequency of weight-loss counseling is not yet optimal based on the existing evidence, obese people who come in contact with the health care system are more likely to receive weight-loss counseling than those who do not have adequate access to care.”

To analyze the association between PCP access at the county level in the United States and local obesity rates, the researchers used a multivariate logistic regression model with data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS), a yearly, nationwide telephone survey of adults aged 18 years or older administered by the CDC and conducted by state health departments. Their sample included 392,535 noninstitutionalized civilians from 2,507 United States counties.

The researchers controlled for individual variables, including rurality and poverty. The primary outcome was the odds of an individual living in a county being obese, defined as having a BMI of 30 kg/m², calculated from participants’ reports in the BRFSS.

According to the researchers, participants living in counties with the most access to PCPs were about 20% less likely to be obese (P ≤ .01), compared with those with the lowest PCP supply. In all, 25.8% of adults were obese in counties with the most PCPs, compared with 30.8% in the counties with the fewest, which had more than 2,126 people per PCP.

“In this instance, the association relates to a public health epidemic that is a leading cause of preventable early mortality in the United States,” Gaglioti and colleagues wrote. “In the context of the Affordable Care Act, the projected shortage of PCPs in the United States, and the evolution of the patient-centered medical home that is underway in communities across the country, our findings warrant further studies to discern the mechanisms of action responsible for this ecologic association.” – by Jason Laday