ICD-9 278

Yesterday, I chaired a round table organised by the Canadian Obesity Network on behalf of the Public Health Agency of Canada on the development of tools and aids that would help Canadian primary care physicians and other health professionals improve their ability to prevent and treat obesity.

Among the many topics discussed, one of the suggestions that found the most support was to encourage physicians to actually note the diagnosis of “obesity” in their charts. As many readers may know, obesity has long been considered a disease by the World Health Organisation and in fact has its own code in the International Classification of Diseases 9 system (ICD9): 278.

(Just to confuse things, the numbers for obesity in ICD 10 are E65-E68)

The idea here is that unless physicians actually begin recording the diagnosis of “obesity” in their notes, charts and other records, they will not address obesity with the attention it deserves.

Thus, as one attendee commented, “No doctor would ever dream of leaving out a mention of diabetes, hypertension, COPD or any other disease in their notes, but hardly any physcian ever records the diagnosis of obesity in their charts”.

Simply put, when physicians examine a patient who has obesity and fail to put down “obesity” in their medical chart, they are in fact committing an important breach in their obligations to correctly document their patient’s health status. This would in no way be different from failing to note the presence of diabetes, hypertension, or any other medical diagnosis in their records.

By failing to routinely document the medical diagnosis “obesity” in their records, the physicians are not only commiting an important error of ommission, they are, by the same token, actively ignoring one of the most important and common medical health problems in their patients.

Encouraging, or in fact, requiring physicians to actually note the diagnosis of “obesity” (ICD 278) in their medical records for all patients who meet the WHO criteria for obesity, would not only ensure a proper documentation of their patient’s medical problems, it would also (hopefully) increase the likelihood that they will address this issue with their patients.

I wonder how many of my health professional readers routinely note the diagnosis of “obesity” (ICD-9 278) in their charts when they see it in their patients and I wonder how many patients with excess weight have actually seen their physician record this diagnosis in their chart.

I am often reminded by patients when I ocassionally fail to list one of their many medical conditions in my notes or letters – interestingly, no patient has ever pointed out that I have missed the mention of their diagnosis “obesity” in my letters – I wonder why!

Edmonton, Alberta