TOPLINE

A study involving more than 6.7 million adults with elevated BMI in the US and Japan found that obesity remained significantly underdiagnosed, with 70.1% of eligible patients in the US and just 2.3% of those in Japan having a recorded diagnosis — despite high rates of obesity-related conditions such as type 2 diabetes (T2D), chronic kidney disease (CKD), and heart failure (HF). Those with a recorded obesity diagnosis carried a heavier burden of comorbidities than those without.

METHODOLOGY

• A paradigm shift has occurred toward recognizing obesity as a complex chronic disease linked to multiple interrelated conditions, requiring comprehensive, patient-centered care free from stigma and bias. Recent advances in awareness, diagnosis, and treatment warrant evaluating current diagnosis patterns and disease burden.
• Researchers conducted an observational study using claims data from the US and Japan to characterize adults with elevated BMIs by the presence or absence of an obesity diagnosis and to evaluate trends in diagnosing obesity over time.
• They analyzed 3,584,120 US adults with BMI ≥ 30 and 3,140,900 Japanese adults with BMI ≥ 25, with data collected between 2016 and 2024. All participants had at least 1 year of look-back data before the index date, defined as the most recent record of a qualifying BMI or an obesity diagnosis.
• The occurrence of obesity-related diseases — including dyslipidemia, hypertension, T2D, CKD, HF, metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis (MASLD/MASH), obstructive sleep apnea (OSA), and others — was compared between adults with and without an obesity diagnosis.
• Among those with an obesity diagnosis, the researchers further compared characteristics at the first diagnosis of obesity between “past” (first diagnosed during 2016-2020) and “contemporary” (first diagnosed during 2024) cohorts; the comparison aimed to reflect temporal changes around GLP-1 approval and evolving care patterns.

TAKEAWAY

• Overall, 70.1% of adults with an elevated BMI in the US and only 2.3% in Japan had a recorded diagnosis of obesity; the majority of adults with elevated BMI in the US and Japan had at least one obesity-related condition.
• In the US, the burden of interrelated diseases was substantially higher among adults with vs without an obesity diagnosis: dyslipidemia (84.9% vs 70.0%), hypertension (83.6% vs 67.4%), osteoarthritis (60.5% vs 39.5%), T2D (49.3% vs 29.9%), OSA (39.1% vs 15.4%), CKD (32.9% vs 18.8%), and HF (23.3% vs 9.8%).
• In Japan, adults diagnosed with obesity had higher rates of dyslipidemia (43.2% vs 30.6%), T2D (42.2% vs 25.9%), OSA (11.9% vs 2.8%), CKD (14.3% vs 8.6%), and MASLD/MASH (14.5% vs 3.9%) than those undiagnosed.
• In the US, adults with a contemporary diagnosis of obesity (2024) had a higher burden of interrelated diseases than those with a past diagnosis (2016-2020). In contrast, in Japan, the burden of interrelated diseases among those recently diagnosed was similar to or somewhat lower than that among those previously diagnosed.

IN PRACTICE

“This finding may indicate that those without an obesity diagnosis are not receiving optimal care that identifies interrelated diseases, or that obesity is not diagnosed until a more progressed disease state, when interrelated diseases have already developed,” the authors of the study wrote.

“Understanding the range and prevalence of diseases interrelated to obesity may encourage HCPs [healthcare providers] and healthcare systems to systematically diagnose and better manage obesity and these interrelated diseases in individuals with elevated BMI, as well as to understand the risk of diseases interrelated to obesity in individuals who do not have them,” they added.

SOURCE

The study was led by Deborah B. Horn, Center for Obesity Medicine and Metabolic Performance, UT McGovern Medical School, Houston. It was published online in Obesity.

LIMITATIONS

The study used BMI as a surrogate marker, which could misclassify true adiposity. The results cannot prove cause and effect between obesity and related diseases. The study used routine medical and insurance records that weren’t collected for research, so some diagnoses may be missing or recorded inaccurately.

DISCLOSURES

The study was funded by AstraZeneca. Three authors declared being employees and potential shareholders of AstraZeneca. Some authors reported receiving consulting fees, research funding, or honoraria from various pharmaceutical companies, including the funding agency.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.