Obesity rarely listed as cause of death for obesity-related illness
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Obesity is rarely recorded as a cause of death at a United Kingdom teaching hospital, even though nearly half of people with a BMI of 30 kg/m² or greater died from an obesity-related illness, according to study data.
“This project has highlighted that obesity is frequently and inappropriately excluded from the Medical Certificate of Cause of Death,” Niloofar Tavangar Ranjbar, MBBS, MSc, of York Teaching Hospital NHS Foundations Trust in the U.K., and colleagues told Healio. “Medical Certificate of Cause of Death are legal documents that must remain accurate. Omissions on these documents could have significant public health ramifications — if hospitals are failing to correctly record those who are dying from the consequences of obesity, then we lack the appropriate evidence to inform us of how many people are dying from it.”
Tavangar Ranjbar and colleagues analyzed all of the available death certificates at York Teaching Hospital over a 4-week period (n = 112; average age of death, 80 years; 55% women). Researchers reviewed demographic details, weight, comorbidities and cause of death as stated in the medical certificate.
Among the cohort, there were 28 people with overweight and 22 people with obesity. Of the 50 people with either overweight or obesity, 32% died of an obesity-related illness. Of the 22 people with obesity, 45% died of an obesity-related illness. However, only two people had obesity listed as the cause of death on the Medical Certificate of Cause of Death. Tavangar Ranjbar said the researchers found this low number surprising.
“Obesity was inappropriately omitted from death certificates in the majority of cases reviewed,” Tavangar Ranjbar said. “We believe this research draws parallels with the historical omission of alcohol from death certificates many years ago. The appropriate inclusion of alcohol into death certificates has since allowed change in public health policies as it became apparent the enormous and deadly impact this substance was causing.”
Obesity-related comorbidities were present in most of the cohort, with hypertension (67%) the most common. Other obesity-related comorbidities at the time of death were ischemic heart disease (46%), hypercholesterolemia (41%), cerebrovascular disease (37%), type 2 diabetes (25%), peripheral arterial disease (17%), vascular dementia (13%) and non-alcoholic fatty liver disease (6%). The mean age of death for people with obesity (73.1 years) was lower than for people with overweight (mean age, 84.1 years; P < .01).
“Readers may find it surprising the numbers of patients who succumbed to obesity-related illnesses and how many died of obesity-related disease,” Tavangar Ranjbar said. “Although these causes of death were multifactorial, obesity is believed to be a strongly associated modifiable risk factor in many causes of death, and it should be included in the cause of death where appropriate.”
Tavangar Ranjbar said a larger scale study examining this issue is needed to confirm the findings and look for ways to improve reporting. Researchers suggested more data could help influence medical examiners who want to improve the accuracy of their cause of death certification.
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Tavangar Ranjbar N, et al. Obesity – the deadly disease no one dies of. Presented at: European and International Congress on Obesity Annual Meeting; Sept. 1-4, 2020; (virtual meeting).
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