Obesity: under-diagnosed and under-treated in hospital outpatient departments

Abstract

Objective: This study investigated whether medically significant obesity (body mass index > 30 kg/m2) is recognised effectively in hospital outpatient departments and how those identified as obese are subsequently managed.

Design: A retrospective analysis of patients' hospital records (rheumatology n = 108, cardiology n = 257, orthopaedic n = 250) established the reported prevalence of obesity and subsequent referral patterns. In addition, BMI was measured prospectively on a separate cohort (rheumatology n = 188, cardiology n = 203, orthopaedic n = 179) to determine the true prevalence.

Results: Generally, obesity management appeared minimal and inconsistent. Retrospective analysis revealed an apparently low rate of obesity (4% cardiology, 5% rheumatology and 3% orthopaedics), whilst the true prevalence was found to be 30% for cardiology, 25.1% for orthopaedics and 20.2% for rheumatology. Although this appears to show a large disparity between the apparent and the true prevalence, it is impossible to establish precisely the degree of under-estimation, as the lack of height measurements (14% only) in the retrospective sample affects the reliability of the apparent prevalence. Further comparison with the general population showed obesity to be particularly common in men attending cardiology clinics.

Conclusion: An outpatient clinic consultation could be a useful starting point for integrating obesity and disease management, by helping to identify obesity, initiate appropriate referrals and assist in obesity education.