The Future of Obesity Diagnostic Coding

Abstract

Obesity is a complex disease defined by abnormal or excessive adiposity that impairs health and involves a broad spectrum of pathophysiology and severity (1). The diagnosis of obesity as a disease has been plagued by an unfortunately inappropriate emphasis on BMI, which estimates adiposity well for populations and research but falls severely short for personalized evaluation of obesity in a given individual. In response to this, the American Association of Clinical Endocrinologists (AACE) published guidelines recommending a more nuanced diagnosis based on exam and clinical evaluation to classify and stage the severity of disease (2). Advancing the clinical evaluation and therapy of obesity beyond just a disease of weight based on BMI, the AACE recommended utilizing BMI for screening and anthropometric classification while confirming that BMI represents excess adiposity on exam along with utilization of waist circumference (WC) or more advanced tools if necessary. Additionally, staging the clinical severity of the disease in a "complication-centric" manner was recommended in that guideline to define the adverse impact of adiposity on patient health. It is critical to match the intensity of therapy to the severity of disease and pathophysiology of disease; thus, the AACE followed its guidelines with a position statement proposing "adiposity-based chronic disease" (ABCD) as a new diagnostic term for obesity (3), providing a more accurate conceptualization of obesity as a chronic disease of excess abnormal adiposity. This terminology was also recently embraced by the European Association for the Study of Obesity (EASO) in a position statement (4) citing the relevance of ABCD since it is in line with their proposal to improve the International Classification of Diseases, Eleventh Revision (ICD-11) diagnostic criteria for obesity based on etiology, degree of adiposity, and adverse health complications.