Obesity continues to be perceived as a lifestyle choice rather than a chronic disease. But evidence suggests that talking to patients about their weight increases their desire to lose weight and enhances perceptions of weight issues. Yet, very few patients with a BMI ≥ 30 have discussed weight with a health care provider.
A 5-year observational study of 688,878 adult patients with a BMI ≥ 30 and a visit in 2019Q1 examined the relationship between weight loss and several potential predictors, including documentation of an obesity diagnosis and prescribing anti-obesity medications (AOMs). Weight was documented at a primary care visit at 15 health care organizations. Pregnant and bariatric surgery patients were excluded.
Of patients with BMI ≥ 30, 46.5% had an obesity diagnosis on a claim or EHR problem list, and 5% had a prescription for an AOM in the past 5 years. Multivariable logistic regression models revealed predictors of ≥ 5% weight loss in 9–12 months: an AOM Rx 0–7 days prior to initial weight (OR = 2.2; CI: 2.0–2.5; p < 0.001) and diagnosis of obesity 0–7 days prior to initial weight (OR = 1.2; CI: 1.2-1.3; p < 0.001). Other significant predictors included female sex, diagnosis of type 2 diabetes or osteoarthritis, Medicare or Medicaid insurance, and ambulatory visit number.
While controlling for patient demographics, insurance status, health care utilization, and prescribing anti-obesity medication, documentation of an obesity diagnosis remained independently predictive of at least 5% weight loss. This suggests that making the diagnosis of obesity may be an important step toward engaging patients to lose weight.