Factors Associated with the Accurate Diagnosis of Obesity.
Obesity is a growing epidemic, yet few patients with obesity receive a clinical diagnosis of obesity or appropriate counseling. We examined the socioeconomic and demographic factors associated with the accurate diagnosis of obesity during ambulatory care visits. We used data from the National Hospital Ambulatory and National Ambulatory Medical Care Surveys (NHAMCS and NAMCS) to determine if a patient with obesity had been clinically diagnosed with obesity during the visit by either of the following: (1) a diagnosis listed in the patient's record; or (2) the provider's answer to the question "despite the diagnoses listed, does this patient have obesity?" We used multivariate models to examine the association between the accurate diagnosis of obesity and socioeconomic and demographic factors. We examined 885,291,770 weighted office visits involving individuals 5 years of age and older between 2006 and 2010. Providers were less likely to diagnose obesity at office visits involving children (5-12 years) with obesity (23.4 %) than at visits for adolescents (13-21 years; 39.7 %), young adults (22-34 years; 45.4 %), adults (35-64 years; 43.9 %) or elderly adults (≥65 years; 39.6 %; P < 0.001 for all). Individuals with obesity residing in more highly educated areas were more likely to be diagnosed than those living in less highly educated areas (44.2 vs. 40.9 %; AOR 1.4; 95 % CI 1.2-1.6). Males with obesity were less likely to be diagnosed than females with obesity (36.1 vs. 45.8 %; AOR 0.7; 95 % CI 0.6-0.8). After controlling for socioeconomic-status we did not find a consistent difference in the diagnosis of obesity by race. The diagnosis of obesity was made at less than half of all office visits involving patients with obesity. Children, adolescents, elderly, males, and those living in less educated areas were less likely to be accurately diagnosed with obesity.
Division of Cardiology, Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 679A, Rochester, NY, 14642, USA. Erica_Miller@urmc.rochester.edu.
Erica O
EO
Miller
Departments of Internal Medicine and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Bryan
B
Stanistreet
Departments of Internal Medicine and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Emily
E
Ruckdeschel
Departments of Internal Medicine and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.|Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Karen
K
Nead
Departments of Internal Medicine and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.|Center for Primary Care, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Robert J
RJ
Fortuna
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis*; D009819:Office Visits; D012680:Sensitivity and Specificity; D012923:Social Class; D055815:Young Adult
Ambulatory care; Demographics; Obesity; Socioeconomics; Under diagnosis