Obesity remains underdiagnosed: discordant documentation of obesity body mass index and obesity diagnosis in patients' electronic medical record
Fink J, Morris GL, Singh M, Nelson D, Walker R, Cisler R. Obesity remains underdiagnosed: discordant documentation of obesity body mass index and obesity diagnosis in patients' electronic medical record. J Patient-Centered Res Rev. 2014;1:142.
Presented at 2014 Aurora Scientific Day, Milwaukee, WI.
Background: Obesity remains a public health crisis in the United States with 64% of adults in the U.S. being overweight or obese with its corresponding economic impacts.
Purpose: This study examined concordance between obesity body mass index (BMI > 30) in the patient’s electronic medical record (EMR) and a documented diagnosis of obesity in the EMR.
Methods: We conducted a retrospective record review of a large health care system EMR for the period of one year (2012). A total of 397,313 patients met criteria including having at least one physician visit, at least 18 years of age and not being pregnant. Of those patients, 158,372 had a BMI > 30 (39.86%). We examined BMI obesity and obesity diagnosis on the EMR concordance as well as demographics and comorbid diagnoses for their ability to predict obesity diagnosis.
Results: Obesity was on the problem list for only 35% of patients with a BMI > 30. Obesity was documented more frequently in women, more frequently in middle-aged patients, and more frequently for blacks/African Americans. Obesity on the problem list was greater for some comorbidities (e.g. sleep apnea, hypertension, diabetes) and less for others (e.g. coronary artery disease, osteoarthritis); there was a significant positive association between the number of comorbid diagnoses and obesity diagnosis on the problem list.
Conclusion: Obesity remains underdiagnosed despite the presence of obesity BMI in the patient’s EMR. Patient demographics and comorbidities should be considered when identifying new best practices for screening, diagnosing, documenting, intervening and monitoring weight management. New practices should be patient-centered and consider cultural context and social and physical resources available to patients – all crucial for enacting systems change in a true accountable care environment.