Factors associated with receiving an obesity diagnosis and obesity-related treatment for patients with obesity class II and III within a single integrated health system

•This cross-sectional study characterized diagnostic and prescribing trends within a single health system by evaluating the rates of obesity diagnoses (per HCC coding) and obesity-specific treatments for patients with the physiological features of class II and III obesity.•Of over 67,000 patients with the clinical characteristics of class II or III obesity, only 40.7% were clinically diagnosed with obesity, and 23.5% received an obesity-related intervention.•Patients with BMI≥40 kg/m2 were significantly more likely to be diagnosed with severe obesity than those with BMI 35–39.9 kg/m2.•Patients with a diagnosis of severe obesity and Black and female patients were significantly more likely to be offered obesity-related treatment. The prevalence and associated adverse effects of obesity on health and healthcare cost make it a primary public health concern. However, individuals with the physiological features of obesity may be underdiagnosed and undertreated. We aimed to determine the prevalence of obesity diagnoses and obesity-related treatments in an integrated health system and determine the factors associated with receiving an obesity diagnosis and treatment for this indication. This retrospective cross-sectional study of data from the Henry Ford Health electronic health record included adult patients with a body mass index (BMI) indicating clinical evidence of class II and III (severe) obesity in 2017 and who received treatment through 2019. The primary outcome was prevalence of obesity diagnosis and obesity-related treatment. Logistic regression evaluated the patient-level factors associated with odds of having obesity diagnosis and treatment. Among 64,741 patients meeting the clinical definition of definition of severe obesity, only 40.7 % were clinically diagnosed with obesity, and 23.5 % received an obesity-related intervention. Patients with BMI≥40 kg/m2 (class III) were more likely to be diagnosed with obesity than those with BMI 35–39.9 kg/m2 (class II) (odds ratio [OR] 5.84; 95 % CI, 5.62–6.07). Patients with a diagnosis of obesity (OR 2.92; 95 % CI, 2.80–3.05), Black patients (OR 1.46; 95 % CI, 1.40–1.53), and female patients (OR 1.47; 95 % CI, 1.41–1.54) were more likely to be offered obesity-related treatment. Severe obesity may be underdiagnosed in patients who have BMI 35–39.9 kg/m2 and 1 comorbidity.