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Am Fam Physician. 2008;77(3):362

Background: Obesity management is often difficult for patients to achieve and is closely linked to lifestyle changes. Patients who receive counseling from their physicians about lifestyle changes tend to lose weight and keep it off, and increase physical activity levels.

Although Medicare has listed obesity and morbid obesity as billable under International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes since 2004, many health care professionals do not consider or treat obesity as a disease (or document it accordingly). Because obesity is a risk factor for many diseases and leads to poorer outcomes and increased health care expenditures, the risk of underdiagnosis and undertreatment is potentially significant. To assess whether primary care physicians document obesity as a diagnosis, Bardia and colleagues evaluated the rates of obesity diagnoses and documented management strategies.

The Study: This study used the Mayo Clinic prospective primary care database to identify patients who are obese, defined as those with a body mass index (BMI) of 30 kg per m2 or greater, who presented for a general medical examination (i.e., annual physical) between November 2004 and October 2005. Subsequently, the database, which comprises the electronic medical records for all patients seen in the Division of Primary Care Internal Medicine, was assessed for the documentation of obesity. Adequate documentation included the word “obesity” in the diagnosis or in the impressions and report plans section of the note.

Demographic data were collected and included comorbidities (e.g., hypertension, coronary artery disease, hyperlipidemia, diabetes, gallstones, osteoarthritis, obstructive sleep apnea). Multiple terms were assessed to capture obesity management plans even when obesity was not documented specifically.

Results: Of the almost 10,000 patients who received general examinations by residents and attending internal medicine physicians, approximately 2,500 had a BMI of at least 30 kg per m2. Only 505 had obesity documented as a diagnosis. Patients who were more likely to have obesity diagnosed were women; younger patients; patients with diabetes, obstructive sleep apnea, or a BMI greater than 35 kg per m2; and those evaluated by residents.

Almost 600 patients had an obesity management plan documented; those with documented obesity were significantly more likely to have a management plan documented as well. Younger patients, those with a BMI greater than 35 kg per m2, and those with diabetes were also more likely to have a documented plan.

Conclusion: This study reflects a significant disparity between clinical practice and optimal obesity management, and it shows that documenting obesity (ICD-9-CM: 278.00) or morbid obesity (ICD-9-CM: 278.01) is the strongest predictor of formulating an obesity management plan. The study did not address a link between documentation and subsequent weight loss, but it suggests that this may be an important first step in countering a prevalent disease.

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Copyright © 2008 by the American Academy of Family Physicians.

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