Documented obesity diagnosis independent predictor of weight loss
A formal diagnosis of obesity on the same day as an initial recorded weight is independently associated with weight loss 9 to 15 months later, according to a large analysis of electronic health care records.
“In a large sample of patients drawn from the electronic medical records of 15 diverse health care systems, just the recorded diagnosis of obesity is associated with greater weight loss and the likelihood of losing at least 5% weight loss, compared with patients with high BMI who do not have the diagnosis,” W. Timothy Garvey, MD, FACE, professor of medicine at the University of Alabama at Birmingham, told Healio. “This is independent of demographics, insurance, obesity medications and other factors.”
In an observational study, Garvey and colleagues analyzed the relationship between weight loss and documentation of an obesity diagnosis, examining EHR data from 688,878 adults with a BMI of at least 30 kg/m² from 15 health systems. Researchers used logistic regression models using a stepwise backward elimination procedure to identify potential predictors of weight loss.
Within the cohort, 44.9% of patients had an obesity diagnosis on a claim or EHR problem list, whereas 16.9% lost at least 5% of body weight and 5.9% lost at least 10% of body weight.
“Regrettably, the overall rate for documentation of obesity as a disease remains low,” the researchers wrote.
Researchers found that a diagnosis of obesity on the same day as the initial weight was a predictor of 5% weight loss in 9 to 15 months, with an OR of 1.3 (95% CI, 1.2-1.3). Other significant predictors included an obesity medication prescription, female sex, diagnosis of type 2 diabetes, having Medicare or Medicaid insurance, and number of ambulatory visits.
“Primary care professionals are first-line in the delivery of health care and need to be aware of obesity as a disease and to diagnose the disease when present,” Garvey said. “This alone is associated with improved health in their patients. Perhaps there are two reasons: The diagnosis implies that the health care professional raised the issue of excess weight with their patient and how it might be affecting their health, and having the recorded diagnosis would predispose to the development of a therapeutic plan.”
Garvey said it was noteworthy that a prescription for obesity medication on the day of diagnosis was associated with the highest likelihood of losing more than 5% (OR = 2.2; 95% CI, 2-2.4) and 10% of body weight (OR = 2.3; 95% CI, 2-2.7).
“We must learn how we can better target the tools of obesity medicine to lessen the suffering and social costs of obesity in a manner that optimizes benefit-risk ratio and cost-effectiveness, based on risk assessment and disease severity,” Garvey said.
For more information:
W. Timothy Garvey, MD, FACE, can be reached at garveyt@uab.edu.
Perspective
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The results of the excellent study by Ciemins and colleagues are both captivating and self-evident. As challenging as it can be to counsel patients about obesity, that simply making the diagnosis independently increases the odds of successful weight loss by 30% is fascinating. However, isn’t this outcome self-evident? After all, no one would expect diabetes — or arthritis, or melanoma, or cataracts — to magically improve on its own without proper diagnosis and subsequent management.
Several studies have suggested similar outcomes; however, prior studies were based on self-reported data from patients. Here, the authors combed through electronic health record problem lists and insurance claims of nearly 700,000 adults across 15 health systems, extending and reinforcing the outcomes of prior published research.
While only 45% of patients with BMI of at least 30kg/m² in this study had documented obesity diagnoses — a paltry number, to be sure — this actually suggests an improvement over time, as previous research has suggested the frequency of obesity diagnosis and documentation to be far lower. In one large review of more than 2 million patient records, up to 90% of patients with BMI between 30 kg/m² and 35 kg/m² did not have a documented diagnosis. (Kahan S. Mayo Clin Proc. 2018; doi:10.1016/j.mayocp.2018.01.006.; Crawford AG, et al. Popul Health Manag. 2010; doi:10.1089/pop.2009.0039.)
These findings are especially timely, as obesity appears to be a significant risk factor for more severe COVID-19 disease and worsened outcomes. (Popkin BM, et al. Obes Rev. 2020; doi:10.1111/obr.13128.)
Healthcare providers and health systems should pay close attention. While so much of weight management and obesity counseling is complex, costly, and challenging, we would do well to continue to identify and systematically implement those strategies that seem to be “low-hanging fruit.”
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