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

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.

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.

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.

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.