The impact of body size, prior care quality, and weight gain on health care utilization during the COVID-19 pandemic.

Abstract

The goal of this study was to ascertain the effect of patient body size on clinic- or patient-delayed health care during the COVID-19 pandemic and factors predicting delay. Primary survey data were collected in August 2021 from 3593 individuals living within the communities near Mayo Clinic facilities in Minnesota, Wisconsin, Arizona, and Florida. More people who identified with the higher-weight BMI categories reported having their care appointments cancelled (62.3%) compared to those who identified with normative weight (38.0%) or underweight (47.7%; p < .001) and reported more frequently delaying their own care (67.9%) relative to those who identified with normative weight (47.0%) or underweight (62.3%; p < .001). Higher-weight people were more likely than others to report delay was due to not knowing where to get care (UW: 5.6%, NW: 3.5%, HW: 7.0%, p_chi-square < .001), worrying about weight-based judgement (UW: 2.1%, NW: 2.1%, HW: 4.5%, p_chi-square < .001), and fearing discrimination (UW: 2.9%, NW: 2.4%, HW: 5.5%, p_chi-square < .001). There was no difference across groups in delay due to fear of COVID-19 exposure. Weight gain was associated with care delay in higher-weight and normative weight groups. Having experienced more patient-centred care pre-COVID was associated with less care delay in the normative weight group, but more care delay in other groups. Higher-weight people were more likely to have their care delayed by health care providers and to delay care themselves. Patient weight gain and concerns about discrimination and judgement about weight gain may have driven the delay of needed care during COVID-19.