Chronic Disease and Obesity: How We Can Help Patients

In 2013 the American Medical Association declared obesity a disease. And though it has been more than three years since obesity was classified with a disease code, many patients remain undiagnosed today.

As the obesity epidemic intensifies and physicians are challenged to help a growing number of patients fight chronic disease, Bartolome Burguera, MD, PhD, would like to see more effort focused on helping patients with the primary problem of being overweight.

In 2016, Dr. Burguera and his team at Cleveland Clinic conducted a study to dig deeper into the issue of undiagnosed obesity. The objective of the study was to determine the prevalence of obesity and its related comorbidities among more than 300,000 patients being actively managed at a U.S. academic medical center, and to examine the frequency of a formal diagnosis of obesity, via ICD-9 documentation, among patients with a body mass index of greater than 30 kg/m2.

The electronic health record system at Cleveland Clinic was used to create a cross-sectional summary of non-pregnant patients, 20 years of age or older, as of July 1, 2015. The cohort was characterized and stratified by BMI category (<25, 25-30, 30-35, 35-40, >40).

The study found that nearly one third of the patients had obesity, and that one in four patients with morbid obesity did not have a formal diagnosis.

“Obesity is very prevalent and yet underdiagnosed, which is one of the top barriers to patients getting the best care,” says Dr. Burguera. He notes that without a formal diagnosis, there is often a lack of insurance coverage for obesity treatments. Instead, these patients are only treated for the conditions that happen as a result of being overweight, including type 2 diabetes and cardiovascular disease, orthopaedic issues, sleep apnea and cancers.

Dr. Burguera says it is time for the healthcare system to look at first line therapies for weight and obesity. “When patients lose just 5 to 10 percent of their weight, the symptoms of these chronic conditions improve,” says Dr. Burguera. “It’s important that we work to motivate people to lose weight and help them to keep the weight off.”

Dr. Burguera says getting to the diagnosis of obesity takes time and includes getting a good history of the patient to help pinpoint the cause of the weight gain. Then the goal is to act on the cause, be it diet, stress, depression, family history, sleep issues, medications and/or lack of physical activity.

This multifactorial issue means that all healthcare providers need to spend some time talking to patients about diet and exercise and, when necessary, provide patients with additional weight management resources. For many patients this may include dietitians, sleep specialists, health coordinators and/or physical therapists and others. And when patients are diagnosed with obesity, prescription medications also are available to help lower the set point of appetite.

Providing care in a multidisciplinary system can make this easier. At Cleveland Clinic Dr. Burguera is the director of Obesity Programs in the Endocrinology & Metabolic Institute, where he and his team work with overweight patients to achieve a healthier lifestyle.

Dr. Burguera underlines the importance of identifying obesity as a chronic health problem during clinic encounters, so physicians can develop an appropriate therapeutic plan to optimally manage patients with this very prevalent disease. These measures could have a positive impact improving the general health and sense of well-being of their chronically ill patients.

Dr. Burguera’s specialty interests include medical management of obesity, diabetes and insulin resistance. He can be reached at 216.444.6568 or burgueb@ccf.org.