Less than half of patients with obesity are diagnosed in the medical setting
Mollie Turner, The Obesity Society, firstname.lastname@example.org
Carolina Auger, Cleveland Clinic, AUGERC@ccf.org
For Immediate Release: November 3, 2016
NEW ORLEANS, LA:Improving health insurance coverage for weight loss services could help people struggling with obesity lose weight, according to a new survey of non-physician health professionals (HPs). This is the first study to examine HPs perspectives of insurance coverage as a facilitator or barrier for weight loss. In addition to current insurance coverage being perceived as a barrier, a second study found that three out of four patients are affected by obesity or overweight, yet less than half (48%) of these patients with a BMI higher than 30 received a formal diagnosis of obesity.
“These two barriers to care – no insurance for medical weight loss support and lack of initial diagnosis – can negatively impact people with obesity or overweight as they seek support from those most adept, trained weight-loss professionals,” said Scott Kahan, MD, MPH spokesperson for The Obesity Society (TOS) and director at the National Center for Weight and Wellness. “While self-management strategies, such as following a commercial diet or increasing exercise, can help in some individuals, most people with obesity, especially those with severe obesity, can benefit from a comprehensive approach that includes healthcare professional support.”
Research results from these two studies will be shared today atThe Obesity Society Annual meeting at ObesityWeek℠ in New Orleans, Louisiana. Ruchi Doshi, MPH at the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health will provide an oral presentation on her health insurance coverage survey, and Bartolome Burguera, MD, PhD, of Cleveland Clinic’s Endocrinology and Bariatric Institutes and Director of Obesity Programs at Cleveland Clinic will present a poster regarding study findings on the initial diagnosis of obesity.
“More than half, 57%, of the 450 health professionals we surveyed believe that improved health insurance coverage for weight loss is a solution to greater access to care, and this finding cuts across all patient income levels,” said Ms. Doshi. “Furthermore, we found that a quarter of health professionals perceive current insurance coverage to be a weight-loss challenge.”
The most recent treatment guidelines for obesity strongly recommend counseling by health professionals to help people with diet, physical activity and changing behavior, yet few people have access to these services. Studies of physicians have previously documented lack of reimbursement as a barrier to providing weight loss services, and now this first-of-its-kind survey adds the input of non-physician health providers engaged in weight-loss services.
In the second study, funded by Novo Nordisk, Dr. Burguera and his colleagues reviewed nearly 325,000 electronic health records from the Cleveland Clinic to see if patients with obesity or overweight as identified via BMI received a formal diagnosis using ICD-9 documentation. This cross-sectional summary from a large U.S. integrated health system found that of all patients with a BMI > 30, only 48% had documentation of an ICD-9 code for obesity. In those patients with a BMI > 40 (considered severe obesity), only 75 percent had an ICD-9 code for obesity.
“The disease of obesity is very prevalent yet too often underdiagnosed, which could be an important barrier to getting initial care,” said Dr. Burguera. “By providing a formal diagnosis, we may be able to help people get the treatment they need to lose weight and get healthy.”
It’s unclear why doctors aren’t providing a formal diagnosis for obesity. However, Dr. Kahan says, “This could go hand-in-hand with coverage: if doctors aren’t being paid to treat obesity, they may not see any benefit in making a formal diagnosis. Regardless, there is a clear need to advance the understanding of medical diagnosis and treatment of obesity across the spectrum, from providers to policymakers.”
In an effort to increase that understanding, TOS has joined with nearly 30 of its partners to help advocate for a change in the way obesity is treated in the medical setting. This week, during the second annual National Obesity Care Week, Oct. 30 – Nov. 6, campaign partners are asking physicians and other care providers to “Take 5” – that’s five minutes to have a productive conversation with patients about their weight.
Abstract and author contact information are available below.
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Scott Kahan, MD, MPH spokesperson for The Obesity Society (TOS) and director at the National Center for Weight and Wellness
Ruchi Doshi, MPH, MD Candidate 2017, Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health
Contact: email@example.com, 408-858-7234
Health Professionals’ Perceptions of Insurance Coverage for Weight Loss Services
Current guidelines suggest obese patients attend intensive, multi-disciplinary weight loss programs. Such interventions are often delivered by non-physician health professionals (HPs). Past studies show physicians report lack of insurance coverage as a barrier to care. Our first objective was to determine whether HPs perceptions of insurance coverage-related challenges and solutions. Our secondary objective was to examine whether these perceptions varied by patient panel income level.
In 2014, we conducted a cross-sectional, web-based survey of HPs in nutrition, nursing, behavioral/mental health, exercise, and pharmacy. Our outcomes were HPs’ identification of insurance coverage as a top three (1) “challenge” or (2) “solution” for obesity management and weight loss. Our independent variable was “patient panel income,” dichotomized as “mostly low-income” versus “evenly distributed/mostly not low-income.” We performed logistic regression with survey weights to calculated predicted probabilities, adjusted for HP profession, age, gender, and race.
Among 450 weight management HPs, mean age was 44.9 years; 86% were women; 44% had low-income panels. Overall, 23% of HPs endorsed current insurance coverage as a challenge and 57% viewed improved coverage as a solution. Relative to HPs with non low-income panels, HPs with low-income panels had similar predicted probabilities of identifying insurance coverage as a challenge to care (28% vs 20%, p=0.33) and viewing future benefits expansions as a solution to improve outcomes (47% vs 64%, p=0.08).
Regardless of panel income level, most HPs perceive insurance coverage of their services as an important factor in facilitating weight loss. While the Affordable Care Act potentially expands coverage of obesity care to low-income patients, there is no legislation regarding benefits for non-governmental insurers; yet health professionals perceive that all patients may benefit from expanded coverage.
Doshi R. Johns Hopkins University School of Medicine. Oral abstract presentation at: The Obesity Society Annual Meeting at ObesityWeekSM 2016; October 31 – November 4, 2016. www.obesityweek.com.
Bartolome Burguera, MD, PhD, Cleveland Clinic’s Endocrinology and Bariatric Institutes and Director of Obesity Programs at Cleveland Clinic
Contact: Caroline Auger, AUGERC@ccf.org, 216-636-5874
The Prevalence and Recognition of Obesity and its Associated Comorbidities in a Large U.S. Integrated Health System
Obesity is a chronic disease that is underdiagnosed in clinical practice, and it is estimated that among adults with obesity, less than 30% receive this diagnosis during their primary care visit. The objective of our study was to determine the prevalence of obesity and its related comorbidities among patients being actively managed at a U.S. academic medical center, and to examine the frequency of a formal diagnosis of obesity, via ICD-9 documentation among patients with BMI > 30.
The electronic health record system at Cleveland Clinic was used to create a cross-sectional summary of patients. The cohort was characterized and stratified by BMI category.
As of July 1, 2015, 324,199 active patients with a recorded BMI were identified. There were 121,287 (37.4%) %) patients found to have overweight (BMI ≥25 and < 29.9), 75,199 (23.2%) had obesity class 1 (BMI 30-34.9), 34,152 (10.5%) had obesity class 2 (BMI 35-39.9) and 25,137 (7.8%) had obesity class 3 (BMI ≥40). There was a higher prevalence of T2D, prediabetes, hypertension and cardiovascular disease (P-value <0.0001) within higher BMI compared to lower categories. Of all the patients with a BMI > 30 (N = 134,488), only 48% (64,056) had documentation of an ICD9 code for obesity. In those patients with a BMI > 40, only 75% had an ICD9 code for obesity.
This cross-sectional summary from a large U.S. integrated health system, found that 3 out of every 4 patients had overweight or obesity. Less than ½ of patients who were identified as having obesity according to BMI, received a formal diagnosis via ICD-9 documentation. The disease of obesity is very prevalent yet underdiagnosed in our clinics. The under diagnosing of obesity may serve as an important barrier to treatment initiation.
Burguera B. Cleveland Clinic’s Bariatric and Metabolic Institute. Poster abstract presentation at: The Obesity Society Annual Meeting at ObesityWeek 2016; October 31 – November 4, 2016. www.obesityweek.com.
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