Proposal for a Scientifically Correct and Medically Actionable Disease Classification System (ICD) for Obesity

Objective: Obesity is responsible for a huge burden of suffering and social costs, and yet many patients lack access to evidence-based therapies. The diagnostic term “obesity” and inadequate International Classification of Diseases(ICD) codes contribute to suboptimal efforts to prevent and treat obesity as a chronic disease. The goal of this review is to develop a medically actionable classification system based on the diagnostic term “adiposity-based chronic disease” (ABCD) that reflects disease pathophysiology and specific complications causing morbidity and mortality. Methods: A coding system based on the diagnosis of ABCD with four domains is proposed: A codes reflect pathophysiology, B codes indicate BMI classification, C codes specify specific biomechanical and cardiovascular complications remediable by weight loss, and D codes indicate the degree of the severity of complications. Supplemental codes identify aggravating factors that complicate care and that are relevant to a personalized therapeutic plan. Results: The coding system addresses pathophysiology and therapeutic goals and differential risk, presence, and severity of specific complications that are integral to ABCD as a chronic disease. Conclusions: The scientifically correct and medically actionable approach to diagnosis and disease coding will lead to greater acknowledgement of ABCD as a disease and accessibility to evidence-based therapies on behalf of patients across the life cycle.