Underdiagnosis of Obesity at a Community Health Center

Abstract

Background: Obesity is at epidemic proportions. This study examined the extent to which obesity is being diagnosed at a community health center residency-training site. Results were examined by provider type. Characteristics of patients with obesity diagnosed by primary care providers were compared with characteristics of patients determined to be obese by body mass index (BMI) calculation exclusively.Methods: A cross-sectional design was used. Medical records of 465 adult patients were audited. Data collected included diagnosis of obesity, height and weight, demographics, and comorbidity.Results: Of the 465 patients' charts audited, 83 contained a provider diagnosis of obesity, and 74 additional patients were determined to be obese by BMI calculation exclusively. Significant underdiagnosis occurred among all provider types (P ‫؍‬ .036). Patients with a diagnosis of obesity had significantly higher BMI scores (38.4 vs 34.4, P ‫؍‬ .002). Obesity was more likely to be diagnosed in female than in male patients (P ‫؍‬ .001). Differences related to age, insurance coverage, and comorbidity were not significant.Conclusions: Obesity was found to be an underdiagnosed condition among all provider types. As evidenced by significantly higher BMI scores for provider-diagnosed obesity, the data suggest that the obesity diagnosis is made by appearance. The importance of teaching and modeling the use of BMI to diagnose obesity is underscored.

BMI-based body size guides for women and men: development and validation of a novel pictorial method to assess weight-related concepts

“…[8][9][10] Physicians also have been found to misperceive their own weight status and that of their patients, 11,12 and to infrequently use BMI measurements in their practices. 13,14 Although the US Surgeon General has issued a 'call to action,' and the lay press and professional literatures are replete with articles discussing the health risks associated with obesity, these warnings may miss their intended targets if affected individuals fail to recognize the personal relevance of the warnings or health-care providers fail to appropriately identify and counsel the overweight patients they treat. 15,16 Assessing perceptions of the terms 'overweight' and 'obese' has been approached through a variety of methods.…”

Obesity Evaluation and Intervention During Family Medicine Well Visits

“…13 In a national study of 12,835 adults classified as obese, only 42% reported that their health care provider advised them to lose weight. 14 The purpose of this study was to determine the extent that primary care providers assess overweight and obesity and document treatment strategies in a family medicine setting during well visits. Review of medical records provided data to assess the use of BMI for adults and BMI-for-age for children and allowed examination of the documentation of patient education concerning body weight, diet, and exercise.…”

Availability and utility of body mass index for population-based cancer surveillance

“…Our overall results are similar to those from the Connecticut Cancer Registry, also a participant in the SEER program, which found 79% of a random sample (n=618) of invasive cancer patients to have height and weight recorded in hospital admissions records at cancer diagnosis (19). To our knowledge, no other studies have assessed the availability of this information in the medical records of cancer patients, however, in a study of non-cancer patients, 63% of adults (n=465) scheduled to receive care at a community health center over a one-week period had height, at any time, and weight, within the prior 6 months, recorded in the medical record (24).…”