BMI documentation often lacking in primary care patient EHRs

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More than two-thirds of U.S. adults are overweight or obese, but many primary care physicians are failing to record body mass index (BMI) in their electronic health records or include these conditions in their electronic patient problem lists, according to a research letter published July 8, in JAMA Internal Medicine.

For the study, the researchers, from Brigham & Women's' Hospital and other Boston-area institutions, examined the EHRs of 219,356 patients in a large network. They found that diagnoses and documentation of obesity sorely lacking, even though recording of vital signs such as body mass index are a requirement of the Meaningful Use incentive program.

Fully, one-third of the patients had no BMI listed. Of the patients who had at least one BMI included in their EHRs, 68.3 percent had a BMI of at least 25 (overweight) and 34.4 percent had a BMI of 30, signifying obesity. However, only 17.1 percent of the known overweight patients and 30.1 percent of the obese patients were diagnosed by their physicians as being overweight or obese. The findings indicate that patients with these conditions are not being adequately identified and treated.

"Further research should focus on interventions to improve documentation of BMI and diagnosis and management of overweight and obesity in the primary care setting," the researchers stated.

They did note that the study was limited to only coded fields, and speculate that some physicians may have documented the issue in the EHR's free text.  

While the research letter did not address why obesity tends to be neglected in EHRs, other studies have found that physicians may not raise the issue for fear of offending patients, or due to having little empathy toward them.

The recent recognition by the American Medical Association of obesity as a disease may prompt more attention to and treatment of the condition.   

To learn more:
- read the research letter

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