If a GLP-1 drops your BMI under 35, is morbid obesity off the table?

By Brian Murphy

At the ACDIS conference last week, an interesting obesity coding question posed during a Q&A session at the Outpatient Symposium:

Should we continue to code morbid obesity for patients who were previously morbidly obese (BMI greater than 35 with obesity-related comorbidities), but because they are on an active GLP-1 their BMI is now under 35?

With the reasoning that, without the drug, their obesity will return? And therefore is an active disease being treated (MEAT criteria met)?

The person raised an interesting, analogous(ish) example of a patient with hypertension and on ACE inhibitors or the like. You still code hypertension in that scenario.

If a patient has a diagnosis of hypertension and is being treated with medication, the condition is considered chronic and ongoing, even if it’s currently well-controlled.

• “Controlled” ≠ “resolved”
• The patient is still under treatment (antihypertensive meds)
• It remains a reportable condition that affects care and risk adjustment

BUT, regarding obesity, the answer to the symposium question seems to be no. According to the official coding guidelines morbid obesity diagnosis + BMI must be present. BMI under 35 does not rise to morbid obesity reportability.

AND, the obesity is NOT guaranteed to return.

Though it may.

Major health organizations like the AMA and WHO classify obesity as a chronic, relapsing, multi-factorial, neurobehavioral disease. A Lancet article defines it as clinical obesity as “a systemic, chronic illness directly and specifically caused by excess adiposity.”

Without the GLP-1, would it come back?

It sparked some thoughtful commentary and debate. Which is why I like going to these events. GLP-1s are a new wonder drug for the treatment of obesity and these types of questions are bound to arise. Especially given the costs of these drugs.

Have you had this debate in your organization? What do you think?

There does not seem to be a Coding Clinic out there on this issue.

As I always caveat I’m not a coder.

Note: This was in the context of risk adjustment/HCC coding.

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In other obesity news…

I also heard several attendees lament continued issues with providers not wanting to document morbid obesity because of stigma/patient labelling concerns.

I wondered whether new obesity definitions (clinical and pre-clinical) published in the Lancet Commission in 2025 might be a good way around that thorny problem. But as the below Medscape article shows these new definitions are still not fully accepted in the medical community.

Class 3 obesity is another potential way around the problem although it is not entirely analogous to morbid obesity. See Norwood article below.

References

• Medscape, Concerns Continue Over Proposed New Obesity Definitions: https://www.medscape.com/viewarticle/concerns-continue-over-proposed-new-obesity-definitions-2026a1000ak5
• Norwood, Morbid obesity vs. Class 3 obesity for medical coding: Which to use—and which is accepted? https://www.norwood.com/morbid-obesity-vs-class-3-obesity-for-medical-coding-which-to-use-and-which-is-accepted/