Hospitalist Recognition and Treatment of Obesity in Inpatients: A Quality Improvement Cohort Study

Abstract

Background: Obesity is primarily managed in the outpatient setting, however its impact on the frequency and course of hospitalizations is well-established. Considering the rising prevalence of obesity and the broad implications on population health when untreated, hospitalizations may represent an untapped opportunity to address obesity management. Methods: We performed a retrospective cohort study comparing the frequency of inpatient obesity documentation to initiation of obesity-targeted therapy, including weight management clinic referral and weight management medication prescription on discharge from hospitalization by hospitalists for patients with class 2 and 3 obesity. We also queried the frequency of weight management clinic referrals and weight management medication prescriptions prior to hospitalization for these cohorts. Results: The cohorts included 1531 patients with class 2 (49.2%) or class 3 (50.8%) obesity. During hospitalization, obesity was frequently documented as a medical problem in patients with both class 2 (48.4%) and class 3 (75%) obesity. Patients with class 3 obesity were more likely to be referred on discharge to a weight management clinic and initiated on weight management medications, however the overall absolute number of referrals and prescriptions were low. Conclusions: We observed that hospitalists documented the presence of obesity in over 60% of patients, yet rarely implemented targeted treatment on discharge. Our results suggest a gap exists between awareness of obesity and subsequent intervention. This highlights an opportunity to generate an inpatient workflow to bridge a gap in care for patients with obesity.