Underdiagnosed and Undertreated: Obesity and Its Cardiometabolic Burden in Swedish Clinical Practice-Insights From...

To quantify real-world diagnosis and treatment of obesity in Sweden, describe cardiometabolic comorbidity burden across obesity classes, and compare long-term cardiovascular outcomes with the general population.

This population-based cohort study used the AROS (Analysis of Real-world data of patients with Obesity in Sweden) database to identify adults with a recorded BMI ≥ 30 kg/m² between January 2013 and June 2023. Individuals were stratified by obesity class. Baseline demographics, comorbidities, medications and laboratory values were described. Outcomes included recorded obesity prevalence, obesity diagnosis (ICD-10: E66), healthcare setting at first BMI ≥ 30 kg/m², cardiometabolic comorbidity profiles, treatment patterns and long-term cardiovascular outcomes. Cardiovascular outcomes were compared with a matched general population.

In 2022, recorded obesity prevalence was 13.6%. Amongst 328 094 individuals with obesity (mean age 53.5 years; 55.0% women), 67.6% had at least one cardiometabolic comorbidity. At the first observed BMI ≥ 30 kg/m² (index), 28.8% had a recorded obesity diagnosis, increasing to 48.0% 5 years later. Index BMI was most often recorded in primary care (39.7%). Within 5 years after index, 7.8% had received obesity-management medication and 4.2% had undergone bariatric surgery. Compared with matched population representatives, the obesity cohort had higher cumulative incidence across all cardiovascular outcomes, with the largest relative difference for heart failure hospitalisation (HR 2.34, 95% CI 2.29-2.40).

Obesity remains underdiagnosed and undertreated in Swedish healthcare, despite a high burden of cardiometabolic comorbidities and substantially higher long-term cardiovascular risk compared with the general population.