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An Ounce of Prevention

Updated: Sep 28, 2022

Preventive and routine care is care that helps prevent health problems or finds them before they become serious. Examples of common preventive healthcare are:

  • Screenings such as blood pressure, diabetes, and cholesterol tests.

  • Many cancer screenings, including mammograms and colonoscopies.

  • Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression, and reducing alcohol use.

Many people have had a more difficult time accessing preventive care during the covid pandemic and that has extended to the present time, likely due to the “backlog” of screenings not done during that two year period and reduced healthcare staff and infrastructure. This almost certainly has led to delays in diagnoses, detection of conditions at more advanced stages of disease, and perhaps even delays in treatment, all of which may lead to worse outcomes. This is all very concerning, but did you know that disparities between people of normal weight compared to those with weight/height disproportion even before the pandemic? It is not known yet whether these disparities have worsened or not. Studies showed that people with overweight/obesity were less likely to get certain routine preventive care and more likely to receive counseling on nutrition and exercise, whether they asked for it or not.

In this article, preventive care practice patterns were studied among weight groups of people with normal, overweight, and obese weights. There was a “dose dependent” relationship with weight showing the least amount of preventive care in the group with the highest weight. People with obesity were significantly less likely to receive cancer screening, including breast exam, mammogram, pap smear, pelvic exam, or rectal exam. People with obesity also were less likely to receive counseling for tobacco cessation and injury prevention, but more education on diet, exercise, and weight reduction. Referral patterns differed, also. People with obesity were less likely to see a physician at their initial visit, more likely to be referred out to another physician, less likely to be referred to psychotherapy.

Overall, patients of normal weight received a significantly greater number of diagnoses or screening services compared to patients with overweight/obesity. These differences were the greatest for female patients with obesity. The total number of minutes spent with the patient was the same regardless of weight, indicating that time spend on education on weight reduction likely took the place of other preventive care services.

Why does this matter? This article estimates that forty percent of cancers in the United States are associated with obesity. This means that there is less cancer screening in the population at higher risk. It should be the opposite; the screenings should be the most diligent in the populations most at risk. Moreover, most physicians are not offering effective treatment for overweight/obesity according to the most up to date guidelines.

Here are cancer screening guidelines by the American Cancer Society.

Here are heart health screening guidelines by the American Heart Association:

The U.S. Preventive Services Task Force makes recommendations for other screening tests and procedures.

Keep in mind, screening is for an individual at average risk with no signs or symptoms, so make your appointment for your annual preventive visit with your primary care physician, because individual recommendations may vary. Screening is typically the minimum.

Here is an article on cancer deaths and missed cancer screenings.

Take Back Your Preventive Care,

Valerie Hope-Slocum Sutherland, MD

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