Table 2 Results of the logistic regression model with obesity as dependent variable Variables of the model Beta p OR 95%CI Antipsychotics use 0.421 0.0001 1.5 1.3 – 1.8 Age (years) 0.132 0.0001 1.2 1.1 – 1.3 Sex (male) −0.272 0.0001 0.8 0.7 – 0.8 Arterial hypertension 0.864 0.0001 2.4 2.2 – 2.5 Diabetes mellitus 0.323 0.0001 1.4 1.3 – 1.5 Dyslipidemia 0.272 0.0001 1.3 1.2 – 1.4 Abbreviations: OR, odds ratio; CI, 95% conﬁdence interval. The total direct costs in Primary Care of the attended patients were 27.7 million euros, with a distribution of 27.1% corresponding to ﬁxed or semi-ﬁxed costs, and the rest to variable costs. In this context, referrals to reference specialists stood out (8.0%), along with pharmaceutical prescription: 59.4% (Table 4). This table reports the total costs and the costs by components; uncorrected observed costs and differential costs corrected for morbidity burden, age and sex among the patients with obesity (versus the nonobese control population). The obese individuals were associated with signiﬁcantly greater corrected total costs of 811 (CI: 787–835) vs. 694 (CI: 679–709), respec- tively, p 0.001. All the components of the corrected costs were signiﬁcantly greater in the presence of obesity. Discussion The results of this study show obese patients seen in the Pri- mary Care setting to represent 27.3% of the total. Compared with the general population, this markedly high percentage can be explained in part by the fact that the attended patients are not representative of the general population, and because young individuals less commonly resort to health care services. Nevertheless, the lack of knowledge of the speciﬁc etiology of the disorder and the scant therapeutic resources available, lead to a limited percentage treatment success that is often followed by recovery of the initial body weight. The above suggests that treatment and preventive activities targeting obesity are inefﬁcient in the Primary Care setting. This in turn generates a certain relaxed approach to this risk factor, and a reluctance to dedicate major efforts to solve the problem – in contrast to other disorders which are more amenable to effective medical intervention. In the logistic model, obesity was associated with the use of APDs and the presence of hypertension, diabetes and dyslipidemia, and with patient age and sex. These results are similar to those reported in the consulted literature Neuropsychiatric Disease and Treatment 2008:4(1) Obesity and the use of antipsychotic drugs (Aranceta-Bartrina et al 2005; Gutiérrez-Fisac et al 2005; Haupt 2006; Mackin et al 2005; Tandon et al 2006), though the impact of obesity upon health requires the adoption of a preventive approach that can only be achieved through the generalization of educative and preventive activities (Haupt 2006). These data reﬂect the importance of preventing weight gain in such patients, with adequate treatment in each case, and posterior supervision of the patients that receive APD therapy – particularly among those presenting a high cardio- vascular risk or those who are already obese (Haupt 2006; Wu et al 2006). No differences were observed between the uses of conventional or atypical APDs in relation to obesity. This may be due to patient selection bias, a statistical artifact, or limited statistical power as a result of the small number of patients in each group (Flores-Meneses et al 2005). Likewise, the possibility that a modiﬁcation in APD treatment regimen may have altered our ﬁndings cannot be ruled out. Table 3 Overall characteristics and clinical parameters of the patients included in the study according to the use of antipsy- chotic drugs (APDs) General concepts No APDs APDs p (n = 41,886) (n = 551) Characteristics Sex (females) 54.5% 56.4% NS Mean age (SD), years 50.7 (18.4) 56.4 (19.5) 0.0001 Body Mass Index (SD), 27.3 (5.1) 28.8 (5.7) 0.0001 kg/m2 Mean visits/year (SD) 9.8 (8.9) 14.8 (11.3) 0.0001 Mean episodes/year (SD) 5.9 (3.8) 7.1 (4.3) 0.0001 Mean Charlson Index 0.3 (0.6) 0.5 (0.7) 0.0001 (SD) Clinical parameters Systolic blood pressure 129.6 (16.9) 128.2 (15.8) NS (SD), mmHg Diastolic blood pressure 76.5 (9.7) 75.9 (9.4) NS (SD), mmHg Baseline blood glucose 98.4 (28.3) 102.1 (35.0) 0.006 (SD), mg/dl Serum triglycerides (SD), 121.2 (81.1) 139.6 (90.5) 0.0001 mg/dl Total cholesterol (SD), 206.8 (41.5) 207.9 (42.2) NS mg/dl HDL-cholesterol (SD), 46.9 (13.3) 43.6 (12.6) 0.0001 mg/dl LDL-cholesterol (SD), 139.6 (35.6) 139.8 (34.5) NS mg/dl Notes: values are given as percentage or mean. Abbreviations: SD, standard deviation; NS, nonsigniﬁcant; HDL-cholesterol, high density lipoprotein cholesterol; LDL-cholesterol, low density lipoprotein cholesterol. 223