Disparities in Healthcare Utilization Among Adults with Obesity in the United States, Findings from the NHIS: 2006–2015

  • Judith D. WeissmanEmail author
  • David Russell
  • Patricia Ansah
  • Melanie Jay
Original Research


Few studies of disparities consider logistical hurdles faced by adults with obesity in obtaining needed healthcare. This study compared adults with obesity to adults without obesity on self-reported practical aspects of receiving healthcare including ease of seeing a doctor and wait times for appointments. Serious psychological distress and chronic health conditions are prevalent in adults with obesity. Because serious psychological distress and number of chronic health conditions can act as confounders in any observed differences between the adults with and without obesity in their use of healthcare, we have examined these differences independent of serious psychological distress and chronic health conditions. Adults 18 to 64 years sampled from the 2006–2015 National Health Interview Survey (NHIS) (n = 74,598) were examined on five self-reported indicators: does not need a doctor, waited too long in the doctor’s office, and to get an appointment, year since having seen a doctor, and saw a doctor ten times or more in the last 12 months. Multivariable models adjusted for serious psychological distress, chronic health conditions, gender, age, race/ethnicity, income, health coverage, and survey year demonstrated that adults with obesity were more likely to wait too long to get an appointment, and in the waiting room. Adults with obesity report not needing doctors despite seeing doctors frequently. Greater attention is needed to understand barriers to health care utilization in adults with obesity.


Obesity Stigma Health care access Disparities 


Author Contributions

All authors provided (1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data for the article; (2) drafting of the article or reviewing it and revising it critically for important intellectual content; and (3) final approval of the version to be published.


The authors report no financial relationships with commercial interests.

Compliance with Ethical Standards

Conflict of interest

No authors had a conflict of interest in the production of this manuscript.


  1. Botman, S. L., Moore, T. F., Moriarity, C. L., & Parsons, V. (2000). Design and estimation for the National Health Interview Survey, 1995–2004. Hyattsville, MD: National Center for Health Statistics. Vital Health Statistics.Google Scholar
  2. Buchanan, N. D., King, J. B., Rodriguez, J. L., White, A., Trivers, K. F., Forsythe, L. P., et al. (1992). Changes among US cancer survivors: Comparing demographic, diagnostic, and health care findings from the 1992 and 2010 National Health Interview Surveys. International Scholarly Research Network Oncology, 2013, 1–9.Google Scholar
  3. Carr, D., & Friedman, M. A. (2005). Is Obesity stigmatizing? Body weight, perceived discrimination and psychological well-being. Journal of Health and Social Behavior, 46(3), 244–259.CrossRefGoogle Scholar
  4. Centers for Disease Control and Prevention, Defining Adults Overweight and Obesity. Retrieved from
  5. Chen, J., Vargas-Bustamante, A., Mortensen, K., & Ortega, A. N. (2016). Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Medical Care, 54(2), 140–146.CrossRefGoogle Scholar
  6. Drury, A., Aramburu, C., & Louis, M. (2002). Exploring the association between body weight, stigma of obesity, and health care avoidance. Journal of the American Association of Nurse Practitioners, 14(12), 554–561.CrossRefGoogle Scholar
  7. Fruh, S. M., Nadglowski, J., Hall, H., David, S. L., Crook, E. D., & Ziomeke, K. (2016). Obesity stigma and bias. The Journal for Nurse Practitioners, 12(7), 425–432.CrossRefGoogle Scholar
  8. Graham, G. (2016). Acute coronary syndromes in women: Recent treatment trends and outcomes. Clinical Medicine Insights: Cardiology, 10, 1–10.Google Scholar
  9. Henderson, E. (2015). Obesity in primary care: A qualitative synthesis of patient and practitioner perspectives on roles and responsibilities. British Journal of General Practice, 65(633), e240–247.CrossRefGoogle Scholar
  10. Herd, P., Goesling, B., & House, J. S. (2007). Socioeconomic position and health: The differential effects of education versus income on the onset versus progression of health. Journal of Health and Social Behavior, 48(3), 223–238.CrossRefGoogle Scholar
  11. Hilbert, A., Braehler, E., Haeuser, W., & Zenger, M. (2014). Weight bias internalization, core self-evaluation, and health in overweight and obese persons. Obesity Journal, 22, 79–85.CrossRefGoogle Scholar
  12. Hoff, R., & Rosenheck, R. (1998). Female veterans’ use of Department of Veterans Affairs Health Care Services. Medical Care, 36(7), 1114–1119.CrossRefGoogle Scholar
  13. Jung, F. U., Luck-Sikorski, C., Konig, H. H., & Riedel-Heller, S. G. (2016). Stigma and knowledge as determinants of recommendation and referral behavior of general practitioners and internists. Obesity Surgery, 10, 2393–2401.CrossRefGoogle Scholar
  14. Kent, J. A., Patel, V., & Varela, N. A. (2012). Gender disparities in health care. Mount Sinai Journal of Medicine, 79(5), 555–559.CrossRefGoogle Scholar
  15. Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., et al. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60, 184–189.CrossRefGoogle Scholar
  16. Locatelli, L., Boulnari, L., Pataky, Z., & Golay, A. (2017). When weight influences mental health and reciprocally. Revue Médicale Suisse, 13(5555), 643–646.Google Scholar
  17. Lofquist, D., Lugaila, T., O’Connell, M., & Feltz, S (2012). Households and Families: 2010 U.S. Census Bureau. pp. 1–21. Retrieved from
  18. Makara-Studzińska, M., Podstawka, D., & Goclon, K. (2013). Factors influencing self-perception of overweight people. Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego, 35(209), 313–315.Google Scholar
  19. Manuel, J. (2017). Racial/ethnic and gender disparities in health care use and access. Health Services Research. Scholar
  20. Materud, K., & Ulriksen, K. (2011). Obesity, stigma, and responsibility in health care: A synthesis of qualitative studies. International Journal of Qualitative Studies on Health and Well-being, 6, 8404.CrossRefGoogle Scholar
  21. Ogden, L., Carroll, M., Fryar, C.D., & Fiegal, K.M. (2015). Prevalene of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief. No.219.Google Scholar
  22. Parsons, V. L., Moriarity, C., Jonas, K., Moore, T. F., David, K. E., & Tompkins, L. (2014). Design and estimation for the national health interview survey, 2006–2015. Vital and Health Statistics. Series 2, Data evaluation and methods research. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  23. Patenburg, B., Sikorski, C., Luppa, A., Schomerus, G., Konig, H. H., Werner, P., et al. (2012). Medical students’ attitudes towards overweight and obesity. PLoS ONE, 7(11), e4811–4813.Google Scholar
  24. Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319–326.CrossRefGoogle Scholar
  25. Puhl, R., & Heuer, C. (2009). The stigma of obesity: A review and update. Obesity, 17(5), 941–964.CrossRefGoogle Scholar
  26. Ross, K. M., Shivy, V. A., & Mazzeo, S. E. (2009). Ambiguity and judgments of obese individuals: No news could be bad news. Eating Behaviors, 10, 152–156.CrossRefGoogle Scholar
  27. Schenker, N., Raghunathan, T.E., & Chiu, P. (2008). Multiple imputation of family income and personal earnings in the National Health Interview Survey: Methods and examples.Google Scholar
  28. SUDAAN (Release 10.0) [computer software]. Research Triangle Park, NC: RTI International, 2008Google Scholar
  29. Sutcliffe, K., Melendez-Torres, G. J., Burchett, H. E. D., Richardson, M., Ress, R., & Thomas, J. (2018). The importance of service-users’ perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programs. Health Expectations, 21(3), 563–573.CrossRefGoogle Scholar
  30. The Stigma, Discrimination, Reduction and Advancing Policy to Eliminate Discrimination Program, Funded by the Mental Health Services Act (Prop 63) administered by the California Mental Health Services (2015).Google Scholar
  31. Ward, B. W., Schiller, J. S., & Goodman, R. A. (2014). Multiple chronic health conditions among US respondents. Prevalent Chronic Disease, 11, 1303–1389.Google Scholar
  32. Weissman, J., Pratt, L., Miller, E., & Parker, J. D. (2015). Serious psychological distress among adults: United States, 2009–2013. NCHS data brief, No 203. Hyattsville, MD: National Center for Health Statistics, 2015.Google Scholar
  33. Wilson, E. R., Kyle, T. K., Nadglowski, J. F., & Stanford, F. C. (2017). Obesity coverage gap: Consumers perceive low coverage for obesity treatments even when workplace wellness programs target BMI. Obesity (Silver Spring), 25(2), 370–377.CrossRefGoogle Scholar
  34. Zeng, Y., Land, K. C., Gu, D., & Wang, Z. (2013). Household and living arrangement projections: The extended cohort-component method and applications to the US and China. New York: Springer Science & Business Media.Google Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Molecular Imaging and Neuropathology, New York State Psychiatric InstituteNew York, New YorkUSA
  2. 2.Department of SociologyAppalachian State UniversityBooneUSA
  3. 3.City University of New YorkBrooklyn CollegeKings CountyUSA
  4. 4.Department of Population Health and MedicineNew York UniversityNew York County, New York CityUSA
  5. 5.Veterans Health AffairsNew York HarborNew York County, New York CityUSA

Personalised recommendations