4.19.2023 Board Book

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November 14, 2022 Donna Pickett, MPH, RHIA Co-Chair, ICD-10-CM Coordination and Maintenance Committee National Center for Health Statistics 3311 Toledo Road, Room 2402 Hyattsville, Maryland 20782 Dear Ms. Pickett,

On behalf of the more than 4,000 members of the Obesity Medicine Association (OMA), we are pleased to provide the following comments on the “Obesity in Children, Adolescents, and Adults” proposal considered at the September 2022 ICD-10 Coordination and Maintenance (C&M) meeting. The mission of the OMA is to empower our clinicians to provide compassionate, evidence-based obesity care through sustainable care models and we are confident that alterations to the ICD coding methodology for these patient groups will assist us in realizing this mission. Obesity in Children, Adolescents, and Adults The OMA is pleased to be a cosigner of the November 9, 2022, comments of the Obesity Care Advocacy Network (OCAN) and we support the coalition’s efforts to ensure that current and future ICD coding for childhood and adult obesity encompass the specificity needed for categorizing elevated BMI in children/adults. In addition, the OMA believes that the current codes are stigmatizing and reflect outdated scientific understanding of the disease processes underlying obesity. Therefore, we strongly support the proposal to update the ICD obesity codes as presented by the CDC’s Division of Nutrition, Physical Activity, and Obesity during the National Center for Health Statistics (NCHS) annual ICD-10 C&M meeting. It is imperative that the ICD-10 codes surrounding overweight and obesity are updated to capture the nature of the disease process according to the current scientific understanding. We must move away from simplistic rationales for diagnosing obesity such as “due to excess calories” and instead consider the complex dysregulation in cellular homeostasis that contributes to obesity. Therefore, using the term “energy imbalance” would be more appropriate. We are also troubled that the current codes do not encompass the full spectrum of comorbidities associated with obesity. There are more than 200 other chronic conditions associated with obesity-- including but not limited to: hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea, non alcoholic fatty liver disease, and depression. Secondly, the current codes do not accurately reflect the classification of obesity in either children or adults. The classification of obesity clinically begins with overweight and progresses through severe obesity. Accurate classification is important because the risk of morbidity and mortality increases as excess weight increases. Finally, we must move away from further stigmatizing individuals affected by overweight or obesity. Use of person-first language is critical--referencing these individuals as overweight or obese results in patients feeling that they are defined by their disease. Using terms such as “morbid” and “due to excess