Fat people burdens on healthcare? Not so fast!

If we believe the news, “Hospital stays of obese Americans have doubled in the past decade, according to new federal data.”

This story and its corresponding press release are from a new report from the Healthcare Cost and Utilization Project (HCUP): Statistical Brief #20: Obese Patients n U.S. Hospitals, 2004. It is sponsored by the Agency for Healthcare Research and Quality (AHRQ), whose role it is to support government public health initiatives, including the war on obesity. [See The Scientific Evidence…]

According to its website, “HCUP databases bring together the data collection efforts of State data organizations, hospital associations, private data organizations, and the Federal government...[and] includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information beginning in 1988.”

First off, a note of caution. 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.

This report is being presented as proof that “‘obesity’ 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.

Interestingly, while fatness for women is especially benign, 82% of patients hospitalized for “obesity” and receiving bariatric surgeries were women, and most of those as healthy young adults (ages 18-44).

Concerning the rest of the story about hospitalized patients with “secondary diagnoses” of “obesity,” it goes without saying. With 30% of the population now labeled “obese,” considering all medical care done them as related to their weight is, frankly, nonsense.

© Sandy Szwarc 2006