Obese white women and men are less likely to receive preventive services such as mammograms, Pap smears and flu shots from health care providers, according to an analysis by Duke University Medical Center researchers.

The Duke study showed that for a sample of white middle-aged women, as body mass index (BMI) went up, the odds of receiving mammograms and Pap smears went down. A white woman of normal weight was more than 50 percent more likely to receive a mammogram than a severely obese white woman in this 2000 study.

The researchers reported a similar inverse correlation between obesity and flu shots among elderly white women and men. However, they found no significant association between obesity and all three preventive services among black study participants.

"Despite knowing that obese women have a higher risk of breast and cervical cancer, and the obese elderly have a higher risk of complications from flu, obese people are less likely to receive clinical preventive services," said Dr. Truls Ostbye, lead researcher.

Ostbye said the researchers' analysis found that income, education and access to health care were not important reasons for the discrepancies in care. The researchers suggest that significant causes may include social stigma, avoidance of health care by patients and bias by health care providers.

The results of the Duke study will be published in the September 2005 issue of the American Journal of Public Health.

In 2000, more than 78 percent of women with a normal BMI (18.5-24.9) received mammograms, the researchers found. Only 71 percent of women with a BMI above 40 received mammograms.

The difference between study participants was greater for Pap smears. In 2000, 73 percent of women with normal weight BMI received Pap smears, compared to less than 54 percent of women with a BMI greater than 40.

The researchers also found a significant decrease in the proportion of study participants who received flu shots as their body mass increased. More than 78 percent of men and women with a normal BMI received flu shots in 2000, compared to only 57 percent of people with a BMI greater than 40, the researchers found.

Other sources: Duke University