Opinion: Weight Bias in Clinical Diagnosis Code

Perspective piece “E66.01 and Our Culture of Shame” was recently published in the New England Journal of Medicine by Dr. Scott Hagan, assistant professor (General Internal Medicine).

E66.01, the ICD-10 code for “morbid (severe) obesity due to excess calories”, is often the diagnosis code for patients seen clinically for weight related medical care. In the piece, Hagan describes how the language of this particular code carries an implied sense of personal blame, an effect attributable only to personal choices without respect for larger social context or additional physiological mechanisms associated with obesity.

While many providers acknowledge and counsel patients based on these additional factors, the general clinical diagnosis still reads as a singular, or personal, cause. The resulting side effect of such a label is often, inherently, shame.

“What was the ’due to’ modifier adding? If an explanation was needed, why not ‘severe obesity, due to long-term exposure to an environment full of nutrient-poor foods, along with activity-sparing technology, leading to reduced daily energy expenditure, with resultant permanent dysregulation of the part of the neuroendocrine system controlling energy balance?’”

Practicing compassionate patient care centers around removing shame from medical encounters. “If clinicians, the weight-loss industry, and the public continuously suggest to motivated patients that there’s an easy solution to obesity — and that failure therefore means they didn’t try hard enough — what feeling are we promoting, other than shame?” With regard to weight management, this particularly rings true when “diet and exercise interventions alone consistently fail to help most people with obesity maintain substantial weight loss.” . The question then becomes not how hard the patient may be trying, but is the patient’s effort alone even enough to achieve the desired outcome?

“Changing the language of a problematic ICD-10 code description is one step, but broader efforts targeting shortcomings in our medical education systems are needed to address the pervasive misconception that obesity is primarily a lifestyle-related condition.”