Background and Aims Little is known about the association between obesity and bowel preparation. We investigated whether body-mass index (BMI) is an independent risk factor for inadequate bowel preparation in patients who receive split preparation regimens. Methods We performed a retrospective study of data from 2163 consecutive patients (mean age, 60.6 ± 10.5 y; 93.8% male) who received outpatient colonoscopies in 2009 at the Veterans Affairs Medical Center in Indianapolis, Indiana. All received a split preparation, categorized as adequate (excellent or good, based on the Aronchick scale) or inadequate. We performed multivariable analysis to identify factors independently associated with inadequate preparation. Results Bowel preparation quality was inadequate for 44.2% of patients; these patients had significantly higher mean BMIs than patients with adequate preparation (31.2±6.5 vs 29.8±5.9, respectively; P<.0001) and Charlson comorbidity scores (1.5±1.6 vs 1.1±1.4; P<.0001). Independent risk factors for inadequate preparation were BMI ≥ 30 kg/m2 (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.21–1.75; P <.0001), use of tobacco (OR, 1.28; 95% CI, 1.07–1.54; P=.0084) or narcotics (OR, 1.28; 95% CI, 1.04–1.57; P=.0179), hypertension (OR, 1.30; 95% CI, 1.07–1.57; P=.0085), diabetes (OR, 1.38; 95% CI, 1.12–1.69; P=.0021), and dementia (OR, 3.02; 95% CI, 1.22–7.49; P=.0169). Conclusions BMI is an independent factor associated with inadequate split bowel preparation for colonoscopy. Additional factors associated with quality of bowel preparation include diabetes, hypertension, dementia, and use of tobacco and narcotics. Patients with BMIs ≥ 30 kg/m2 should be considered for more intensive preparation regimens.

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