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Health Equity/Community Health

Poster Session 1

(107) The Association of Body Mass Index with Engagement in a Perinatal Collaborative Care Model

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Individuals with a higher body mass index (BMI) are less likely to engage in routine healthcare due to the experience of weight stigma. Whether this applies to mental health care, and specifically, the collaborative care model of delivery, remains unknown. This study evaluated the association of BMI with engagement in a perinatal collaborative mental health care model (PCCM).

Study Design: This secondary analysis of a prospective cohort study included individuals referred to PCCM at a quaternary care hospital in Chicago, IL from 2017-2022. Individuals were grouped by pre-pregnancy BMI using the World Health Organization classification (class 1: 30-34.9kg/m2, class 2: 35-39.9kg/m2, class 3: ≥40kg/m2). The primary outcome, engagement, was defined as the completion of >2 mental health assessments within the PCCM. Maternal demographics, comorbidities, obstetric factors, and baseline Patient Health Questionnaire-9 (PHQ-9) scores were compared across BMI strata. Multivariable regression accounting for differences in race/ethnicity, parity, mental health history, and tobacco use was performed.

Results: Of the 2,614 individuals included, 1,921 (73.5%) had a BMI< 30, 362 (13.8%) class 1 obesity, 184 (7.0%) class 2 obesity, and 147 (5.6%) class 3 obesity. Myriad differences were observed in sociodemographic and clinical characteristics across BMI categories, aligning with prior literature. Compared to individuals with BMI< 30, individuals with BMI>30 had higher baseline PHQ-9 scores (median 8 [IQR 5,14], vs. median 7 [IQR 4,12], p=.025) but no difference in engagement (76.2% vs. 78.9%, p=.16). On multivariate regression, having a BMI > 40 kg/m2 was associated with higher engagement in PCCM (Table 1).

Conclusion: Although individuals with a pre-pregnancy BMI>30 had more baseline depressive symptoms, there was no difference in engagement in PCCM compared to those with BMI < 30. Those with the highest BMI category were found to have paradoxically increased engagement, suggesting that the equity-centered principles of the PCCM extend to the area of weight bias.