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Clothier N, Marvel K, Cruickshank C. Does presenting patients’ BMI
increase documentation of obesity?
Med Educ Online [serial online] 2002;7:6. Available from URL
http://www.med-ed-online.org
Does Presenting Patients’ BMI Increase Documentation of Obesity?
Norm Clothier, MD*, M. Kim Marvel, PhDζ Courtney S. Cruickshank, MS^
*Family Healthcare Associates, Garland, TX
'⅛ort Collins Family Medicine Residency Program, Fort Collins, CO
Abstract - Purpose: Despite the associated health consequences, obesity is infrequently docu-
mented as a problem in medical charts. The purpose of this study is to determine whether a simple
intervention (routine listing of the BMI on the medical chart) will increase physician documenta-
tion of obesity in the medical record.
Methods: Participants were resident physicians in a family medicine residency program. Partici-
pants were randomly assigned to either an experimental group or a control group. For experimental
group physicians, the Body Mass Index was listed alongside other vital signs of patients seen in an
ambulatory setting. Physician documentation of patient obesity was assessed by chart review after
patient visits. Documentation was defined as inclusion of obesity on the problem list or in the pro-
gress note.
Results: The intervention did not significantly increase the rate of documentation of obesity in the
medical chart. Several reasons for the lack of change are explored, including the difficulty of
treating obesity successfully.
Key Words: BMI, documentation of obesity, medical record, documentation of vital signs
Obesity and overweight have reached epidemic
proportions. 1 A major health threat, obesity has been
shown to increase the severity of some medical
illnesses and to cause disease, such as hypertension,
depression, diabetes, and degenerative joint disease.2
Recognition of obesity in patients by physicians
should be increased so that it may be better addressed
as a medical problem.3 Currently there is a lack of
physician counseling for overweight and obese
patients.4,5 Additionally, obesity is infrequently
documented in medical charts. Documentation may
occur infrequently because obesity is often not the
presenting complaint of the patient. An additional
reason for poor documentation may be that obesity is
not often quantified, although most patient charts
have height and weight entered for each patient as
part of the nursing documentation of vital signs.
Therefore, the physician must base a diagnosis of
obesity on a rough estimate of the patient’s weight
for height as compared to a rough calculation of the
ideal weight for height.
The difficulty of quantifying obesity is addressed
by using the Body Mass Index (BMI).2 The BMI
quantifies obesity using height and weight
measurements which already are present in most
patient charts. The index is calculated by dividing
weight in kilograms by the height in meters squared.
The calculation has been converted to use for weight
in pounds and height in inches, and is easily read by
lining up these values on a nomogram, resulting in a
set number for the BMI. Interpretation reveals that a
person is “overweight” with a BMI of 25-28
(women) and 26-29 (men), and “obese” with a BMI
29 and above (women) and 30 and above (men). 2
Thus, the BMI not only quantifies patients with
current obesity, but may identify those “at risk” for
obesity by quantifying patient’s overweight status.
The purpose of this study is to determine
whether the simple intervention of routinely listing
the BMI on the medical chart will increase physician
documentation of obesity in the medical record.
Methods
Participants: Fourteen resident physicians in a
family medicine residency program participated in
the study. Informed consent was obtained from each
participant.