Meir Medical Center, Clalit Health Services, Kfar Saba, Israel.
Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Int J Obes (Lond). 2024 Jul;48(7):1003-1010. doi: 10.1038/s41366-024-01514-6. Epub 2024 Apr 22.
To investigate whether individuals with an elevated BMI measurement, for whom a diagnosis of overweight or obesity (OW/OB) is not recorded, are less likely to be offered clinical care for obesity compared to those with a recorded diagnosis.
A retrospective cohort study using the electronic medical record database of Maccabi Healthcare Services (MHS) in Israel. Included were 200,000 adults with BMI ≥ 25 kg/m measurement recorded during a primary care visit between 2014 and 2020, and no prior diagnosis of OW/OB or related co-morbidities.
The relationships between a recorded diagnosis of OW/OB and two composite outcomes: 1. A composite of referrals to screening tests for metabolic complications; 2. A composite of weight loss intervention and follow up, were analyzed using multivariate logistic regression models.
In only 18% of individuals, a diagnosis of OW/OB was recorded. After adjusting for multiple potential confounding factors, individuals who received a recorded diagnosis were 18% more likely to be offered an evaluation for obesity-related metabolic complication, (OR 1.18, 95% CI 1.15-1.21, p < 0.001), and almost twice as likely to be offered intervention and follow up for their excess body weight (OR 1.84, 95% CI 1.76-1.94, p < 0.001) compared to individuals with missed diagnosis. These results persisted after adjusting for inter-physician variability. In addition, male sex, older age, and Arab sector were all associated with lower rates of weight loss intervention and follow up, while young individuals were less likely to be screened for metabolic complications.
Beyond BMI measurement, a recorded diagnosis of OW/OB is associated with statistically and clinically significant higher rates of performance of obesity care and intervention. Undiagnosed OW/OB presents a significant clinical opportunity, as recording a diagnosis of OW/OB would predict improved patient access to obesity healthcare and improved clinical outcomes.
研究对于那些体重指数（BMI）升高但未记录超重或肥胖（OW/OB）诊断的个体，与那些有记录诊断的个体相比，他们是否不太可能获得肥胖临床治疗。
本研究为以色列 Maccabi 医疗保健服务（MHS）电子病历数据库的回顾性队列研究。纳入了 2014 年至 2020 年期间在初级保健就诊时 BMI≥25kg/m²且无 OW/OB 或相关合并症既往诊断记录的 20 万名成年人。
使用多变量逻辑回归模型分析记录的 OW/OB 诊断与以下两个综合结果之间的关系：1. 代谢并发症筛查测试的转诊综合结果；2. 体重减轻干预和随访的综合结果。
仅有 18%的个体记录了 OW/OB 诊断。在调整了多种潜在混杂因素后，接受记录诊断的个体发生肥胖相关代谢并发症评估的可能性增加 18%（OR 1.18，95%CI 1.15-1.21，p<0.001），且接受超重干预和随访的可能性几乎增加了一倍（OR 1.84，95%CI 1.76-1.94，p<0.001）与漏诊个体相比。这些结果在调整了医生间差异后仍然存在。此外，男性、年龄较大和阿拉伯地区与体重减轻干预和随访的较低发生率相关，而年轻人更不可能接受代谢并发症筛查。
除 BMI 测量外，OW/OB 的记录诊断与肥胖管理和干预的统计学和临床显著更高的实施率相关。未诊断的 OW/OB 提供了一个重要的临床机会，因为记录 OW/OB 诊断可以预测肥胖患者获得医疗保健和改善临床结局的机会增加。
