Recognition, diagnosis and management of obesity after myocardial infarction

doi:doi:10.1038/sj.ijo.0802831

International Journal of Obesity homepage

International Journal of Obesity (2005) 29, 137–141. doi:10.1038/sj.ijo.0802831 Published online 2 November 2004

Recognition, diagnosis and management of obesity after myocardial infarction

F Lopez-Jimenez¹, M Malinski², M Gutt³, J Sierra-Johnson¹, Y Wady Aude⁴, A A Rimawi⁴, P A Mego⁴, R J Thomas¹, T G Allison¹, B Kirby¹, B Hughes-Borst¹ and V K Somers¹

¹Mayo Clinic and Mayo Foundation, Rochester, MN, USA
²St Vincent Hospital, University of Massachusetts Medical School, Worcester, MA, USA
³University of Miami School of Medicine, Miami, FL, USA
⁴University of Arkansas for Medical Sciences, Little Rock, AR, USA

Correspondence: Dr F Lopez-Jimenez, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, USA. E-mail: lopezjimenez.francisco@mayo.edu

Received 4 April 2004; Revised 19 August 2004; Accepted 26 August 2004; Published online 2 November 2004.

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Abstract

OBJECTIVE:

We investigated the documentation of obesity as a medical problem, and subsequent management recommendations, in patients after myocardial infarction (MI).

DESIGN:

We performed a cross-sectional analysis of a randomly selected sample of 627 patients discharged after an MI, from five US teaching hospitals between 1/1/01 and 12/31/02. Information was extracted from clinical notes using standardized definitions.

RESULTS:

Mean body mass index (BMI) was 31 plusminus 13 kg/m², which was documented in only 14% of patients and had to be calculated post hoc in the rest. Waist circumference and waist/hip ratio were not documented at all; 83% of patients were overweight, 55% obese, and 8% morbidly obese. In only 20% of patients with BMI greater than or equal to 30 kg/m² was the diagnosis of obesity documented either as a current medical problem, as part of past medical history or as a final diagnosis. A dietary counseling was carried out in 61% of patients with BMI25 kg/m² and in 61% of patients with BMI<25 kg/m², P=0.96. Weight loss was described as part of the goals/plan at discharge in 7% of overweight and 9% of obese patients. There was no change in either the level of recognition of obesity (22 vs 19%, P=0.3) or in the proportion of obese patients for whom weight loss was described as part of the goals/plan at discharge (8 vs 10%, P=0.7) before (n=301) compared to after (n=326) the Call to Action in Obesity by the Surgeon General in December 2001.