Experts pitch obesity diagnosis overhaul, could alter CDI and coding work

By Brian Murphy
There’s a new international effort afoot to revise the way physicians diagnose obesity.
A clinical study published in The Lancet Diabetes & Endocrinology Journal, “Definition and Diagnostic Criteria of Clinical Obesity,” posits that obesity should be more than just high BMI, and recommends other measures including waist circumference, direct fat measurement, and signs of symptoms of ill health at the individual level.
And yes, I am aware that changes in diagnostic criteria take a LONG time to permeate clinical practice. This is just a general heads up—though I am interested to hear your takes on the change, and your current thinking of BMI as a marker of health.
The study delineates obesity into “clinical obesity” and “preclinical obesity,” defined as follows:
- Clinical obesity: A chronic, systemic illness characterised by alterations in the function of tissues, organs, the entire individual, or a combination thereof, due to excess adiposity. Clinical obesity can lead to severe end-organ damage, causing life-altering and potentially life-threatening complications (eg, heart attack, stroke, and renal failure).
- Preclinical obesity: A state of excess adiposity with preserved function of other tissues and organs and a varying, but generally increased, risk of developing clinical obesity and several other non-communicable diseases (eg, type 2 diabetes, cardiovascular disease, certain types of cancer, and mental disorders).
Finally, the study recommends that “BMI should be used only as a surrogate measure of health risk at a population level, for epidemiological studies, or for screening purposes, rather than as an individual measure of health.”
From my non-clinical perspective, this makes sense. We all know people who are classified as obese due to BMI, but are otherwise quite healthy (raises hand). And we also know people who have lived with obesity for many years and suffering from its effects.
I see this as refinement, along the lines of what happened with malnutrition. Which used to be measured with markers like serum albumin but later evolved to other factors including grip strength and Insufficient energy intake.
Given clinical acceptance, I could see a case where clinical obesity is classified as a CC or an MCC, but preclinical obesity is neither and has no additional payment ramification (but might influence risk scoring).
Note: This is not so far afield from what we do today. The ACDIS Pocket Guide reminds providers that morbid obesity can be considered in patients with a BMI greater than 35 AND with one or more related comorbid conditions (e.g., DM, hypertension, GERD, cardiovascular disease), and reminds providers that documentation should link the condition(s) to the patient’s BMI.
Today, coders require both a morbid/severe obesity diagnosis and a sufficiently high BMI score to code morbid obesity, a CC. That remains true, but based on the work of the international commission may change.
Links to the articles below. Thanks to Medpage Today for breaking the news.
References
Medpage Today, “Experts Pitch Major Overhaul to How Obesity Is Diagnosed — Global commission makes the case to move beyond BMI, incorporate other measures of body fat”: https://www.medpagetoday.com/primarycare/obesity/113783
The Lancet, Diabetes and Endocrinology Commission, “Definition and diagnostic criteria of clinical obesity”: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00316-4/abstract
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