Proposal for a Scientifically Correct and Medically Actionable Disease Classification System (ICD) for Obesity

Abstract

Objective Obesity is responsible for a huge burden of suffering and social costs, and yet many patients lack access to evidence‐based therapies. The diagnostic term “obesity” and inadequate International Classification of Diseases(ICD) codes contribute to suboptimal efforts to prevent and treat obesity as a chronic disease. The goal of this review is to develop a medically actionable classification system based on the diagnostic term “adiposity‐based chronic disease” (ABCD) that reflects disease pathophysiology and specific complications causing morbidity and mortality. Methods A coding system based on the diagnosis of ABCD with four domains is proposed: A codes reflect pathophysiology, B codes indicate BMI classification, C codes specify specific biomechanical and cardiovascular complications remediable by weight loss, and D codes indicate the degree of the severity of complications. Supplemental codes identify aggravating factors that complicate care and that are relevant to a personalized therapeutic plan. Results The coding system addresses pathophysiology and therapeutic goals and differential risk, presence, and severity of specific complications that are integral to ABCD as a chronic disease. Conclusions The scientifically correct and medically actionable approach to diagnosis and disease coding will lead to greater acknowledgement of ABCD as a disease and accessibility to evidence‐based therapies on behalf of patients across the life cycle.

Obesity in adults: a clinical practice guideline

“…rise in the prevalence of obesity. 18,19 A better understanding of the biological underpinnings of this disease has emerged in recent years. 19 The brain plays a central role in energy homeostasis by regulating food intake and energy expenditure (Box 2).…”

“…18,19 A better understanding of the biological underpinnings of this disease has emerged in recent years. 19 The brain plays a central role in energy homeostasis by regulating food intake and energy expenditure (Box 2). 24 Decreased food intake and increased physical activity lead to a negative energy balance and trigger a cascade of metabolic and neurohormonal adaptive mechanisms.…”

“…27 Novel approaches to diagnose and assess obesity in clinical practice have been proposed. 11,18,19,28 Although BMI is widely used to assess and classify obesity (adiposity), it is not an accurate tool for identifying adiposity-related complications. 19 Waist circumference has been independently associated with an increase in cardiovascular risk, but it is not a good predictor of visceral adipose tissue on an individual basis.…”

Response to “The Future of Obesity Diagnostic Coding”

“…Our proposed coding system based on the diagnostic term "adiposity-based chronic disease" (ABCD) (3) has four domains: "A" codes specify pathophysiology, "B" codes BMI classification, "C" codes biomechanical and cardiometabolic complications remediable by weight loss, and "D" codes the degree of the severity of complications (2). Novel aspects include distinct codes linking obesity to specific complications as well as supplemental codes identifying aggravating factors that complicate care, including psychological conditions and social and environmental determinants of health.…”

The Future of Obesity Diagnostic Coding

“…One discrepancy of note is that, within the proposed ICD coding system for ABCD (Table 2 from Garvey and Mechanick [5]), which includes "normal" BMI, "overweight" BMI, and BMI Classes I through III (B.0, B.1, and B.2), WC is notably absent despite being a critical component of adiposity classification for risk of cardiometabolic disease (7). In theory, it could be encompassed within the C.2.2 domain of metabolic syndrome but should likely be included in the "B" classification domain for clarification of abdominal obesity regardless of BMI classification.…”