What Shall We Do About Diagnosing Obesity?

We hear lots of arguments about diagnosing obesity. Some people say it’s all about BMI. Sometimes they use this as a straw man argument for saying that BMI has flaws, so obesity isn’t really a thing. But other people are putting forward thoughtful proposals for diagnosing and staging the chronic disease of obesity. One such proposal comes from Tim Garvey and Jeffrey Mechanick, complete with a new acronym – ABCD. That stands for adiposity-based chronic disease and they explain it all in the new issue of Obesity.

Language and Logic

Language is that indispensable tool for describing what we see in the world around us. And unfortunately we see obesity through the lens of a lot of cultural bias. So we’ve loaded that word – the O-word – with a ton of baggage. Nobody really wants to claim it. People living with obesity get offended when they see that on the patient record, especially if they haven’t had a thoughtful conversation with their provider about it. And, of course, thoughtful conversations about obesity are devilishly hard to have. Just because that word is so fraught.

On top of that, we have the whole issue of obesity being such a broad and nonspecific diagnosis. Medically, it means an accumulation of fat tissue that impairs health. On health records, it often means merely that the patient has a BMI of 30 or higher. But to most health insurers, it means that they can deny coverage for any treatment related to that diagnosis.

Garvey tells us that calling it ABCD can solve all of that:

The coding reflects what we are treating and why we are treating it, and hopefully will provide impetus for greater access of patients to evidence-based treatments.

Herding the Cats

Naturally, bringing the whole world into line around the language of obesity is no small task. Garvey and Mechanick have the American Association of Clinical Endocrinologists on board with their proposal. The European Association for the Study of Obesity is on board, too. Gema Frühbeck authored their position on this subject and says:

It is time for obesity to enter the era of precision medicine, with novel classification systems based on functionally established endpoints

However, part of this proposal involves changing the diagnosis (ICD) codes for obesity to fall in line with these new language specs. That’s no small task, says Jamy Ard:

This more advanced approach will require a significant amount of education and outreach to change providers’ behaviors. However, if better reimbursement is tied to this type of coding system as the authors aspire, it may help to drive broader adoption and implementation.

Net, this is a fine idea. The concept might serve to break up some misperceptions about obesity and help people think more clearly about the medical issues at hand. But people are very cantankerous about singing in unison on this subject.

We will watch with great interest.

Click here for the paper by Garvey and Mechanick, here for a commentary, and here for further reporting on the subject.

Alphabet, illustrations courtesy of patricia m / flickr

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February 26, 2020