Posts tagged ‘ICD’

The Obesity Non-Epidemic

It seems of late that obesity is the new sky-is-falling health care issue I see in papers all the time.  One of the easiest ways to create a "trend" is to steadily change the standards**, which is in fact what has been happening with obesity in the US.  Every year or two, government officials or whoever does this stuff expand the range of weights that constitute "obese".  By doing this, even if the average weights are not changing (and I don't know if they are or are not) you can create a trend in increasing obesity just from changing the standards.  In fact, I argued here:

By the way, I am willing to make a bet with anyone that no where near
40% of our healthcare charges in Arizona are due to obesity.  I am
positive some advocate made up this number, or created it using some
ridiculously broad assumptions, and it has now been swallowed by the
credulous and scientifically-illiterate press. 

Sandy Szwarc who runs the new Junkfood Science blog, writes of a similar effect in hospital statistics.

The HCUP report
is not actually reporting hospital stays of obese people. It is a tally
of the numbers of times "obesity" was checked off on the billing codes
on the hospital records. These codes are currently known as ICD-9
codes, taken from the International Classification of Diseases, Ninth Revision.
This is an enormous, complicated and continually changing system which
gives a number to every disease and medical procedure, and currently
has about 12,000 codes. The medical literature is filled with
documentations of their inaccuracies in reflecting actual patient
disease rates. But over recent years, healthcare providers are being
increasingly educated on using these codes in order to receive
reimbursements ... including coding for obesity. The weight loss and
bariatric industry has been especially intense in marketing the usage of the obesity code, in particular.     

Not surprisingly, more providers are.    

So that 112% increase in hospitalizations for "obesity"since 1996 actually reflects increased usage of
the coding, but whether or not it means there are actually more obese
patients is arguable. But with the heightened stringency and
surveillance by third party payers in compelling providers to
accurately note ICD-9 codes in order to receive reimbursements, the
current figures are certainly more complete than in past years.

She concludes by questioning whether there really is an epidemic of hospital admissions for obesity.  Remember that this is important because it is this obesity epidemic that is used as justification for nanny-state interventions like the NY trans-fat bans as well as potential tobacco-clone litigations against fast food companies. 

This report is being
presented as proof that ""╦ťobesity' has become a major public health
problem." That was even its opening sentence. But the media's failure
to give us the full story is demonstrated in the most significant fact
in the report: 94.3% of all hospitalizations made no mention of obesity!    

Fat people are not flooding into hospitals with health problems more than anyone else.   

"Obesity" is the primary diagnosis in only 0.4% of all hospitalizations and
virtually all of those (95%) were for bariatric surgery! Not the result
of fat people succumbing to life-threatening health problems, but a
profit-making elective surgery targeting them.

My sense is that the obesity issue is the next phase of what I call the health care trojan horse (and here and here).  This is the practice of using government funded health care expenditures as an excuse to micro-regulate our eating and other personal practices.  As I said then:

When health care is paid for by public funds, politicians only need to
argue that some behavior affects health, and therefore increases the
state's health care costs, to justify regulating the crap out of that
behavior.  Already, states have essentially nationalized the cigarette
industry based on this argument.

** As an aside, a fantastic example of this game is in the movie "An Inconvenient Truth."  The filmmakers try to make the argument that global warming is making weather more volatile.  As "proof", they show the number of reported tornadoes in the US rising dramatically since the 1950's.  But here is the rub:  In the 1950's, we had no good way of detecting smaller class 1 and 2 tornadoes that we now detect using Doppler radar and the like.  This means that we do not necessarily experience more tornadoes, we just can detect more.  In fact, if you look only at larger class 3-5 tornadoes that we could detect through the whole period, the tornado frequency has NOT gone up.  I leave it to the reader to decide if the filmmakers are terrible at interpreting scientific data, or if they are disingenuous.  Neither reflects well on the rest of the film.