RE: Super Obese --> RE: language question

[Guest guest]

How new is new? We have been using the V85.___ codes for over a year to indicate BMI on all patients. There is also the obesity code that is supposed to be billed with the V codes. 278.00 is obese and 278.01 is morbid obesity which according to the ICD-9 manual indicates a BMI >30.1 These codes came into being with the ICD-9 changes in October 2006.

Dr. Beth Sullivan, DORidgeway Family Practice, PCCommerce, GA

language question

I am finding myself without a good descriptive term to use in my exams. How do you guys describe obesity that is "beyond morbid"? For body habitus, I usually choose from lean, muscular, well developed and well nourished, overweight (applied to BMI 26-30), obese (BMI 31-33) and morbidly obese (BMI > 33)Problem is, I have more and more patients with BMIs that are A LOT more than 33....like 46 to 56...and I haven't been able to think of a term that sounds nonjudgmental and still conveys the reality.Any suggestions?-- Annie SkaggsLexington, KY

[Guest guest]

I don’t know Beth, it was in this year’s FPM Short

List. I didn’t go through last year’s very well so it’s

new to me.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Beth

Sullivan, DO

Sent: Sunday, December 07, 2008 9:56 AM

To:

Subject: Re: Super Obese --> RE: language

question

How

new is new? We have been using the V85.___ codes for over a year to

indicate BMI on all patients. There is also the obesity code that is

supposed to be billed with the V codes. 278.00 is obese and 278.01 is

morbid obesity which according to the ICD-9 manual indicates a BMI

>30.1 These codes came into being with the ICD-9 changes in October

2006.

Dr.

Beth Sullivan, DO

Ridgeway Family Practice, PC

Commerce, GA

-----

Original Message -----

From: Kathy Saradarian

To:

Sent: Wednesday, December

03, 2008 8:12 AM

Subject: RE: Super Obese

--> RE: language question

There is also a new ICD-9 code for BMI

> 40. As well as BMI codes for pediatric patients that are overweight

or underweight.

Kathy

Saradarian, MD

Branchville,

NJ

www.qualityfamilypractice.com

Solo 4/03,

Practicing since 9/90

Practice

Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Locke

Sent: Wednesday, December 03, 2008 1:02 AM

To:

Subject: Super Obese --> RE: language question

I

agree with megan.

Once

they are Morbidly Obese -- you could differentiate w/ Mild, Moderate, and

Severe Morbid Obesity.

Although

the argument could be made -- Are there varying degrees of Morbidly?

Or

is that like -- Mild, Moderate, and Severe Death?

There

really is not gradation for some problems.

If

nothing else, as long as the phrasing makes sense to you, it probably doesn't

matter whether it is " correct " or not -- it just reminds you of the

patient's situation.

Did

stumble on this...

Technically,

I guess there is a classification for the BMI > 50 - super obese.

Some

sites suggested that those w/ BMI >60 are -- super super obese.

http://www.asbs.org/Newsite07/media/fact-sheet4_morbid-obesity.pdf

Weight classifications for adults:

o Super obese: A person with a BMI

of 50 or more

50,000

adults are super obese in the U.S.

o Morbidly obese: A person with a

BMI of 40 or more, or a BMI of 35 or more with an obesity-related

disease, such as type 2 diabetes, heart disease or sleep apnea

15

million adults are morbidly obese in the U.S.

o Obese: A person with a BMI of 30

– 39.9

64

million adults are obese in the U.S.

o Overweight: A person with a BMI of

25 – 29.9

134

million adults are overweight or obese in the U.S.

http://www.asbs.org/html/pdf/2004_ASBS_Consensus_Conference_Statement.pdf

Between 1986 and 2000, prevalence of obesity (BMI > 30 kg/m2)

doubled, morbid obesity (BMI > 40 kg/m2) quadrupled, and super obesity

(BMI > 50 kg/m2) increased fivefold in US adults.

http://www.drmartin-duce.com/html_en/obesity_frame.html

Classification of obesity according to BMI and severity of risk

factors:

Categories

BMI Values

A: Normal weight

< 25

B: Overweight

25-27

C:

Overweight +

27-30

D:

Obese

(Class 1)

30-35

E: Obese

(Class 2)

35-40

F: Morbid Obesity

40-50

G:

Super Obesity

50-60

H:

Super-Super Obesity

> 60

Advisory Committee: American Society for Bariatric

Surgery.

Obes. Surg. 7:523, 1997.

===========================

Here

is an interesting related story.

http://news.yahoo.com/s/afp/healthchinausoffbeat;_ylt=AuE.fKD4K1xxqEI_v1UHi1wDW7oF

To shed pounds, three Americans head to China

by

nne Barriaux nne Barriaux –

Tue Dec 2, 3:14 pm ET

Play

Video AFP – Americans losing weight

the Chinese way

Slideshow:

Americans try living in China to lose weight

AFP/File – R-L:

Three American men - Alonzo Bland and brothers Walt and

- walk in the Chinese …

TIANJIN, China (AFP) – Three American men have taken the unusual step

of moving to China in an extreme attempt to shed

huge amounts of weight at a fat reduction clinic -- and have become surprise

local celebrities.

Alonzo Bland, 33, and brothers Walt and

, 56 and 50, have lived in the northern Chinese city of Tianjin since the middle of this year as part of an effort

to break away from their unhealthy lifestyles

back home.

Together, they have lost a combined 192 kilogrammes (427 pounds) and are

aiming to shed over 100 more.

snip/snip

Locke, MD

From:

[mailto: ]

On Behalf Of Skaggs

Sent: Tuesday, December 02, 2008 7:38 PM

To: practiceimprovement1

Subject: language question

I am finding myself without a good descriptive term to use in my

exams. How do you guys describe obesity that is " beyond

morbid " ? For body habitus, I usually choose from lean, muscular, well

developed and well nourished, overweight (applied to BMI 26-30), obese (BMI

31-33) and morbidly obese (BMI > 33)

Problem is, I have more and more patients with BMIs that are A LOT more than

33....like 46 to 56...and I haven't been able to think of a term that sounds

nonjudgmental and still conveys the reality.

Any suggestions?

--

Annie Skaggs

Lexington, KY