Weight History in Clinical Practice: The State of the Science and Future Directions

Abstract

Eliciting a weight history can provide clinically important information to aid in treatment decision‐making. This view is consistent with the life course perspective of obesity and the aim of patient‐centered care, one of six domains of health care quality. However, thus far, the value and practicality of including a weight history in the clinical assessment and treatment of patients with obesity have not been systematically explored. For these reasons, the Clinical Committee of The Obesity Society established a task force to review and assess the available evidence to address five key questions. It is concluded that weight history is an essential component of the medical history for patients presenting with overweight or obesity, and there are strong and emerging data that demonstrate the importance of life stage, duration of exposure to obesity, maximum BMI, and group‐based trajectory modeling in predicting risk for increased morbidity and mortality. Consideration of these and other patient‐specific factors may improve risk stratification and clinical decision‐making for screening, counseling, and management. Recommendations are provided for the key elements that should be included in a weight history, and several needs for future clinical research are outlined.

8. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2021

“…Care should be taken to regard a patient's weight (and weight changes) and BMI as sensitive health information. Additionally, assessing weight gain pattern and trajectory can further inform risk stratification and treatment options (30). Providers should advise patients with overweight or obesity and those with increasing weight trajectories that, in general, higher BMIs increase the risk of diabetes, cardiovascular disease, and all-cause mortality, as well as other adverse health and quality of life outcomes.…”

Unsystematic Tracking of BMI Through Electronic Medical Records Hinders Weight Management Over the Life Course

“…Furthermore, International Classification of Diseases codes indicating children's weight status (i.e., underweight, healthy weight, overweight, obesity) were missing for 85.5% of children (4). Barriers to BMI documentation may be similar to those outlined by Kushner et al (1) for taking weight history, including limited time, competing demands, and lack of reimbursement. These potential barriers warrant further consideration.…”

“…In the January 2020 issue, Kushner and colleagues illustrate the importance of including a weight history to assist in clinical decision-making, and they outline several recommendations and needs for future research (1). Kushner et al (1) demonstrate the value of taking a weight history, including capturing information to better understand the sequential development of weight gain and underlying issues as well as to aid in shared decision-making and patient-centered care. However, the authors' comments about the documentation of weight history and BMI in electronic medical records (EMR) require further scrutiny.…”

Controlled obesity status: a rarely used concept, but with particular importance in the COVID-19 pandemic and beyond

“…Nonetheless, we believe that attaining self-reported maximal weight would be a relevant clinical information to be considered in future studies with Covid-19 and beyond [ 17 ]. If we demonstrate, even with case–control studies, that those who voluntarily lost weight in the past have a better prognosis in Covid-19, we can start providing a simple and achievable message for those with obesity.…”