In May 2013, the American Medical Association (AMA) formally recognized obesity as a “disease state”. Current guidelines recommend screening all adults for obesity via body mass index and offering lifestyle, pharmacotherapy, and/or surgical interventions as appropriate. This study aimed to determine if the AMA’s classification of obesity as a disease had an effect on the diagnosis and management of obesity in the primary care practice at an academic center.
A retrospective chart review was conducted to compare obesity diagnosis and management before and after the AMA obesity statement. The time periods compared were pre-2013 (January 2010-December 2012) and post-2013 (January 2014-December 2016). All patients seen at the primary care practice for an initial visit plus at least one follow-up visit over a 6-month period were identified by Epic query. 102 charts from each time period were randomly selected for detailed review.
The prevalence of type 2 diabetes, hypertension, dyslipidemia, and coronary artery disease was similar in the two groups. There was a trend towards more patients in the post-2013 group being overweight/obese (55.6% vs 67% p=0.09). The proportion of all patients with documented height and weight was higher in the post-2013 group (76% vs 91% p=0.003). However, the proportion of patients with overweight/obesity who received an obesity diagnosis (chart documentation or ICD code) (38.2% vs 40.3%); obesity counseling (36.4% vs 31.3%); referral to nutritionist (18.1% vs 14.9%) or specialist physician (1.8% vs 3%); or targeted pharmacotherapy (0% vs 1.5%) was similar in the two time periods (p>0.05).
Despite the AMA’s recognition of obesity as a disease state in 2013, this study suggests that practice patterns in the primary care setting have not significantly changed. This is consistent with prior research that has found that despite rising national prevalence, the rates of obesity diagnosis and management in the primary care setting remain low.