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W. Timothy Garvey Part 8, Classifying Obesity as a Disease

In part 8, the conclusion of this Exclusive Interview, Dr. W. Timothy Garvey talks with Diabetes in Control Publisher Steve Freed during the AACE 2018 convention in Boston, MA about correcting the current coding for obesity, which can impact terminology, stigmatization, insurance approvals, etc.

W. Timothy Garvey, MD, FACE is a professor and Director of the University of Alabama Diabetes Research Center in Birmingham.


Transcript of this video segment:

Freed: You had mentioned before that obesity is now a disease. But when it comes to coding for physicians it’s still in the primordial stage and they haven’t addressed that yet.

Garvey: Yes, this is a sad situation. The most common code for obesity, E66, says obesity due to excess calorie intake. And you translate that and what it means is that you are fat because you eat too much. If you were an employer and you had a thousand employees and you were negotiating benefit coverage plans for your employees and you had to pay a little more to cover them for obesity medicine and the code was, you’re fat because you eat too much, you’re not going to be too inclined to pay extra money to cover your employees there. It’s not scientifically based, it’s antiquated notions about obesity. Patients aren’t obese because they want to be – they don’t say I’m going to eat food until I have a BMI of 35 and I’ll just stop there. That’s just not how it works. They have a disease process that creates that excess adiposity and how that impacts their health. So, I think we need a more kind of scientifically-based disease-based coding system for the disease. I think AACE is developing a positioning statement right now based on their new diagnostic term for obesity – adiposity based chronic disease. Not going to replace the term obesity, we got that, but obesity means so many different things to different people – it’s heavily stigmatized, its use in social media and is usually negatively used and insulting. So we need a medical term that says what the disease is and why we’re treating it. It’s adiposity based because it involves various degrees of abnormalities in adipose tissue mass, distribution and function. It’s a chronic disease because it offers opportunities for primary, secondary and tertiary treatment and prevention like any other chronic disease. It’s also associated with complications that lead to the morbidity and mortality of disease. So, adiposity based chronic disease says what’s causing the disease and why we need to treat it. So, we’re envisioning building a coding system around this term so you can have uncomplicated disease or you can have adiposity based chronic disease; unfortunately the acronym is ABCD. But you could have ABCD with osteoarthritis, ok, so that’s why we’re engaging the patient in weight loss therapy or with diabetes or with obstructive sleep apnea. It could be due to monogenetic or syndromic cases of obesity. So, I think we’re trying to reform that coding system. Hopefully in the end, we hope to enhance the access to evidence-based therapies for our patients.

Freed: Well, I want to thank you for your time, enjoy the rest of your stay here in Boston and again, thank you, I thought it was very informative.

Garvey: Always fun talking to you guys so thank you.   

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