Prevalence and recognition of obesity and its associated comorbidities: cross-sectional analysis of electronic health record data from a large US integrated health system

Abstract

ObjectiveTo determine the prevalence of obesity and its related comorbidities among patients being actively managed at a US academic medical centre, and to examine the frequency of a formal diagnosis of obesity, via International Classification of Diseases, Ninth Revision (ICD-9) documentation among patients with body mass index (BMI) ≥30 kg/m2.DesignThe electronic health record system at Cleveland Clinic was used to create a cross-sectional summary of actively managed patients meeting minimum primary care physician visit frequency requirements. Eligible patients were stratified by BMI categories, based on most recent weight and median of all recorded heights obtained on or before the index date of 1July 2015. Relationships between patient characteristics and BMI categories were tested.SettingA large US integrated health system.ResultsA total of 324 199 active patients with a recorded BMI were identified. There were 121 287 (37.4%) patients found to be overweight (BMI ≥25 and <29.9), 75 199 (23.2%) had BMI 30–34.9, 34 152 (10.5%) had BMI 35–39.9 and 25 137 (7.8%) had BMI ≥40. There was a higher prevalence of type 2 diabetes, pre-diabetes, hypertension and cardiovascular disease (P value<0.0001) within higher BMI compared with lower BMI categories. In patients with a BMI >30 (n=134 488), only 48% (64 056) had documentation of an obesity ICD-9 code. In those patients with a BMI >40, only 75% had an obesity ICD-9 code.ConclusionsThis cross-sectional summary from a large US integrated health system found that three out of every four patients had overweight or obesity based on BMI. Patients within higher BMI categories had a higher prevalence of comorbidities. Less than half of patients who were identified as having obesity according to BMI received a formal diagnosis via ICD-9 documentation. The disease of obesity is very prevalent yet underdiagnosed in our clinics. The under diagnosing of obesity may serve as an important barrier to treatment initiation.

Determining patient attendance, access to interventions and clinical outcomes in a publicly funded obesity programme: Results from the Canberra Obesity Management Service

“…There was a higher prevalence of comorbidities observed in patients who continued to attend COMS following the initial medical review. This may be due to the fact that those with a higher BMI are likely to have more comorbidities than their lighter counterparts and that the burden of their health conditions motivates their attendance. There is growing evidence that those with comorbidities are more likely to seek help or to continue engaging with services if they perceive their health as poor .…”

Cognitive functioning following brain irradiation as part of cancer treatment: Characterizing better cognitive performance

“…Other unmeasured variables such as medical comorbidities may have also impacted cognitive performance. However, in our analyses, there were no significant group differences in BMI, suggesting that the number of medical comorbidities are unlikely to differ between the two groups . Lastly, the parent study was a clinical trial that sought to enhance cognitive functioning.…”

“…However, in our analyses, there were no significant group differences in BMI, suggesting that the number of medical comorbidities are unlikely to differ between the two groups. 36 Lastly, the parent study was a clinical trial that sought to enhance cognitive functioning. Thus, the percentage of survivors who were doing cognitively well may have been underrepresented in this study.…”

Family Influences on Patients’ Decisions to Undergo Bariatric Surgery

“…Bariatric clinical practice guidelines recommend bariatric surgery for patients with a BMI greater than or equal to 40 or a BMI of 35 or greater with two or more comorbidities . Health care personnel may associate obesity with type 2 diabetes and hypertension, but obese patients may have a variety of other comorbidities, including hyperlipidemia, obstructive sleep apnea, asthma, severe urinary incontinence, nonalcoholic fatty liver disease, pseudotumor cerebri, gastroesophageal reflux disease, venous stasis disease, and severe arthritis …”