Recognizing Obesity in Adult Hospitalized Patients: A Retrospective Cohort Study Assessing Rates of Documentation and Prevalence of Obesity

Abstract

Background: While obesity is a chronic condition that predisposes patients to other more serious disorders, the prevalence and the documentation of obesity as diagnosis has not been extensively studied in hospitalized patients. We conducted a retrospective chart review to investigate the prevalence and documentation of obesity as a diagnosis among patients admitted to our medical center. Method: IRB approval was obtained for this retrospective study. Body mass index (BMI) as per CDC, admission and discharge diagnosis of obesity and common comorbidities (hypertension, diabetes, hyperlipidemia, coronary artery disease, congestive heart disease, chronic kidney disease and chronic obstructive pulmonary disease) were recorded. The length of stay in the hospital was also calculated. We also investigated whether counselling was provided to the obese patients for weight loss. Results: A total of 540 consecutive patients were reviewed with a mean age was 66 ± 6 years. Out of 540 patients only 182 (34%) had normal weight, 188 (35%) of the patients were overweight and 170 (31%) patients were obese. Of the obese group, 55% were female and 45% were male.100 (59%) had class I obesity, 43 (25%) had class II obesity and 27 (16%) class III obesity. Of the obese patients 40/170 (23.5%) patients had obesity documented on the admission problem list and only 21 (12%) had obesity documented as a discharge diagnosis. Only 3 (2%) patients were given appropriate counseling and referral for obesity management during the hospitalization. Comorbidities and their prevalence included, hypertension (68%), diabetes mellitus (35%), hyperlipidemia (36%), coronary artery disease (18%), chronic kidney disease (17%), congestive heart failure (18%) and COPD (24%). The average length of stay in normal weight, overweight and obese patients was similar for all three groups (4.5 ± 0.5 days). Conclusion: A significant number of hospitalized patients were overweight and obese. An overwhelming percentage never had weight status documented. Hospitalization offers health care providers a window of opportunity to identify obesity, communicate risks, and initiate weight management interventions.

Non-Surgical Interventions for Hospitalized Adults with Class II or Class III Obesity: A Scoping Review

“… 47–49 , 51 , 55 , 56 , 58 However, these aspects of medical evaluation are commonly missed in the patient with Class II or III obesity. 70 , 71 Unless a patient’s weight immediately affects the management of their acute illness it is often not considered an important factor within their management care plan. 71 , 72 Smoking and alcohol 73 usage are routinely assessed on admission and interventions implemented; however, weight is not considered in the context of the same behaviours.…”

“… 70 , 71 Unless a patient’s weight immediately affects the management of their acute illness it is often not considered an important factor within their management care plan. 71 , 72 Smoking and alcohol 73 usage are routinely assessed on admission and interventions implemented; however, weight is not considered in the context of the same behaviours. 71 Given the consequences of obesity rivalling health issues such as smoking and excessive alcohol usage the health professionals’ holistic assessment of the patients care needs is incomplete without nutrition and weight related health assessments.…”

In‐patient obesity diagnosis, use of surgical treatment and associated costs by payer type in the United States: Analysis of the National Inpatient Sample, 2011 through 2014

“…We identified hospitalization cases for bariatric surgery among patients with an obesity diagnosis using a large number of ICD‐9‐CM codes a (see Appendix Table A1 for the complete list). Some studies report an under‐diagnosis of obesity in community health centres; however, our research is based on the hospitalized patient, and it has been found that hospitalization offers healthcare providers a chance to identify obesity and initiate weight management interventions 26,27 . Finally, we stratified the sample by age, sex, race and payer type.…”

Direct oral anticoagulant therapy in patients with morbid obesity after intermediate- or high-risk pulmonary emboli

“…Obesity is not only an independent risk factor for VTE [11][12][13] but is also associated with an increased risk for recurrent VTE 14 . Morbid obesity is even more prevalent among hospitalized patients (one estimate of 16% 15 ), many of whom are likely to require some anticoagulation therapy during hospitalization. Therefore, an effective and easy to manage anticoagulation strategy in this population is critical to decrease their risk for long-term complications, including recurrent VTE.…”