Setting

This project included patients whose usual source of medical care was the Deaconess Family Medicine Center (DFMC) in the metropolitan area of Buffalo, NY. This family medicine center is located in an underserved community in a highly urbanized area and provides medical care to a primarily minority population.

Study Design

We completed a cross-sectional survey among a total of 1,000 patients who presented to the (DFMC) for their care between 1998 and 2000. From this group of 1,000 patients, we focused on individuals ages 20-64 years, yielding a study population of 923 persons. Persons >65 years old were excluded from these analyses since: 1) they represent a limited sub set (8%) of all survey respondents, and 2) to avoid the possibility of confounding due to the increased likelihood of comorbid conditions being present with advancing age, which may impact on both body weight and body image.
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Measures

A structured, self-administered survey form was used to collect specific data elements from each participant after obtaining assent consistent with institutional review board approval. Independent variables assessed in this paper include age (20-39 years, 40-49 years and 50-64 years); gender (male, female); self-reported race (African-American, white); education (less than high school, high school diploma, some college, college graduate and beyond); employment (employed, unemployed); total household income during the year prior to survey completion (<$ 10,000, $10,000-$29,999 and >$30,000); comorbidity based on number of active medical problems reported by each respondent (none, 1-2, 3-5, >6 conditions); level of exercise (<1 time per week, 1-2 times per week, >3 times per week); and overall health rating (excellent, very good, good, fair, poor).

Main Outcomes

The primary dependent variables of interest for this study were: 1) BMI and 2) body image. BMI was assessed based on measured height and weight at the time the survey was completed. Height and weight measurements were converted into centimeters and kilograms, respectively, and used to calculate a BMI using a standardized formula. The values for BMI were then categorized into normal (BMI = 18.5-24.9), overweight (25.0-29.9) and obese (>30.0).

Respondents also provided a self-rating of their body image (overweight, underweight, just about right) on the survey. We examined both BMI and body image as dependent variables since data on BMI was available for 58% of respondents, while data on body image was available for nearly all survey respondents (98%). These proportions did not differ by race.

Analyses

Descriptive statistics were used to examine selected variables and to construct summary tables. For each variable, the percent of individuals in each category was examined. The statistical significance of observed patterns, stratified by selected outcome variables, was assessed using Chi-squared statistics for inferential analysis of categorical data. Odds ratios and 95% confidence intervals (CIs) are presented as summary measures of association across various strata.
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In addition, logistical regression models were used to explore: 1) the likelihood of obesity based on BMI measurements and 2) the likelihood of a body image rating of overweight based on self-reported assessment.

For logistic models examining the BMI variable, normal weight and overweight individuals (BMI values between 18.5 and 29.9) were collapsed and compared to that of obese individuals (BMI >30.0). In other words, the body image variable was dichotomized into one group containing individuals reporting themselves as either underweight or just about right versus another group of individuals who reported themselves as overweight. Dependent variables were examined while controlling for respondent age (20-39, 40-49, 50-64 years), gender (male, female), race (African-American, white), education (less than or equal to high-school diploma, some college, college graduate and beyond), employment (any employment, unemployed), household income (<$ 10,000, >$ 10,000), comorbidity (none, 1-2 conditions, >3 conditions), exercise (<1 time per week, 1-2 times per week, >3 times per week), and health rating (excellent/very good, good, fair/poor).