title: The prevalence of obesity documentation in Primary Care Electronic Medical Records. Are we acknowledging the problem?
abstract: BACKGROUND
  Although obesity is a growing problem, primary care physicians often inadequately address it. The objective of this study is to examine the prevalence of obesity documentation in the patient's problem list for patients with eligible body mass indexes (BMI) as contained in the patients' electronic medical record (EMR). Additionally, we examined the prevalence of selected chronic conditions across BMI levels.
  
  
  METHODS
  This study is a retrospective study using EMR data for adult patients visiting an outpatient clinic between June 2012 and June 2015. International Classification of Diseases, Ninth Revision, (ICD-9) codes were used to identify obesity documentation in the EMR problem list. Univariate and multivariate logistic regression analyses were used.
  
  
  RESULTS
  Out of 10,540, a total of 3,868 patients were included in the study. 2,003 (52%) patients met the criteria for obesity (BMI ≥ 30.0); however, only 112 (5.6%) patient records included obesity in the problem list. Moreover, in a multivariate analysis, in addition to age and gender, morbid obesity and cumulative number of comorbidities were significantly associated with obesity documentation, OR=1.6 and OR=1.3, respectively, with 95% CI [1.4, 1.9] and [1.0, 1.7], respectively. For those with obesity documentation, exercise counseling was provided more often than diet counselling.
  
  
  CONCLUSIONS
  Based on EHR documentation, obesity is under coded and generally not identified as a significant problem in primary care. Physicians are more likely to document obesity in the patient record for those with higher BMI scores who are morbidly obese. Moreover, physicians more frequently provide exercise than diet counseling for the documented obese.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mattar
authors.forename: David
authors.initials: D
authors.lastname: Carlston
authors.forename: Glen
authors.initials: G
authors.lastname: Sariol
authors.forename: Tongle
authors.initials: T
authors.lastname: Yu
authors.forename: Ahmad
authors.initials: A
authors.lastname: Almustafa
authors.forename: Genevieve B
authors.initials: GB
authors.lastname: Melton
authors.affiliation: Adil Ahmed, 1301 Third Street, Suite 200, Wichita Falls, TX 76301, E-Mail: doola2002@gmail.com, Phone: 507-269-1799.
authors.forename: Adil
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002908:Chronic Disease / Q000453:epidemiology; D004282:Documentation; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D011320:Primary Health Care; D012189:Retrospective Studies
keywords: Primary care; body mass index; electronic medical records documentation; obesity prevalence; service utilization