Abstracts / Posters
Under-diagnosis of obesity and obesity-related co-morbidities for cardiovascular risk, in primary health care
Presented as poster at British Dietetic Association National Conference 2002
The Counterweight Project Team
Introduction: While efforts are being made globally to reduce Coronary Heart Disease (CHD) morbidity and mortality, the prevalence of obesity continues to grow. Obesity is associated with, and exacerbates a number of comorbidities, several of which impact on CHD risk. The Counterweight Programme is a multi-centre UK obesity initiative in primary health care where an obesity-related audit is being conducted, prior to an intervention programme which aims to improve the management of weight in high-risk patients.
Methods: The obesity audit conducted in the first 5 general practices is reported. One hundred patients aged 18-75 years with a Body Mass Index (BMI) >30 were randomly selected from each practice (n=500). All general practice medical records were retrospectively reviewed over the previous 18 months for weight history, the prevalence of obesity-related comorbidities, co-morbidity care patterns, and resource utilisation (including consultation rates, secondary care referrals, hospital admissions, length of hospital stay and medication use). We report here weight screening rates and prevalences of obesity and obesity-related comorbidites, if ever recorded, for the total practice population aged 18-75 years (n = 32 980) and the subset of obese individuals.
Results: Of all patients, 71.1% had a weight recorded (66.0 % male; 77.1% female, chi square, p<0.0001). The recorded prevalences of overweight and obesity were less than expected with 19.9 % and 8.0 % of patients having a BMI between 25-29.9 and >30 respectively. Prevalence of diabetes was higher in the obese subset compared to the total population (11.4%; 2.2 %; p<0.0001) as were the prevalences of hypertension (36.0 %; 6.7%; p<0.0001), total cholesterol >5.5 mmol/L (23.8; 6.2%; p<0.0001) and CHD (6.6%, 2.7%; p<0.0001). However, prevalences of diabetes and elevated lipids will be under-diagnosed, for only 25.6% and 43.6% of obese patients had ever had fasting or random blood glucose or lipids measured. Screening for hypertension was considerably higher with 98% of obese patients having had blood pressure measured on at least one life-time occasion.
Conclusion: The prevalence of obesity in these primary care practices is under recorded. The prevalence of obesity-related co-morbidities is extremely high, but is not adequately screened for, nor sought for, despite their high association.