Purpose: The main focus of this study is to explore the relationship between body mass index (BMI) as a reflection of obesity, its association with chronic disease, health services utilization and its impact on direct costs to the health system, in the province of Newfoundland and Labrador. -- Methods: In a secondary analysis of the provincial component of the Canadian Community Health Survey version 1.1 (2000/01), survey records for respondents aged 20-64 (n=2345) were linked to provincial physician and hospitalization data in order to obtain objective measures of longitudinal health services utilization. Regression models were used to examine whether BMI level was an independent predictor of family physician (GP) visits, hospitalization and costs. -- Results: Of the study sample 37%, 39% and 17% and 6% were classified as normal, overweight, obese, and morbidly obese respectively. The obese (including morbidly obese) were more likely to report having serious chronic conditions after adjusting for age and gender. Analyses identified the morbidly obese group (BMI ≥ 35kg/m²) as having a significantly higher number of GP visits over a 5-year period when compared with the normal weight group (BMI 18.5-24.9kg/m²), [median 22.0 vs. 17.0, p<05], and as having significantly higher average costs of GP (p<.001) and specialist services (p<.05). Controlling for number of chronic conditions and other covariates, being morbidly obese remained a significant independent predictor of family physician visits (p< .001) and total physician costs (p < .01), but was not a predictor of hospitalization. -- Conclusions: Morbid obesity is independently associated with increased GP utilization and total physician costs but not with hospital utilization. Some future health promotion/education and weight loss interventions should be targeted at this high-risk group; however a population health approach must be developed in order to have an impact on the prevalence of obesity in this population
