JAMA: Public Health Body Weight Changes During Pandemic-Related Shelter-in-Place in a Longitudinal Cohort Study

A recent study was published in the Journal of the American Medical Association (JAMA) on March 22, 2021 titled, “Body Weight Changes During Pandemic-Related Shelter-in-Place in a Longitudinal Cohort Study”. This study takes a look at the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 public health emergency (PHE) regarding “Shelter-in-Place”(SIP) on body weight changes across four regions in the United States (West, Midwest, Northeast and South). The authors of this study were: Anthony L. Lin, MD; Eric Vittinghoff, PhD; Jeffrey E. Olgin, MD; Mark J. Pletcher, MD, MPH; Gregory M. Marcus, MD, MAS.

This particular study focused on the timeframe of March 19, 2020 to April 6, 2020 which was when the initial COVID-19 SIP took place compared to the post-SIP timeframe. Interesting, data was obtained from the Health eHeart Study participants who volunteered to report weight measurements from their Bluetooth-connected smart scale (Fitbit [Fitbit Inc] or iHealth [iHealth Labs Inc]). The collected data timeframe was from February 1st, 2020 to June 1st, 2020, however.

A decrease in physical activity during the initial SIP and after occurred across populations, demographics, and geographic locations here in the United States. Understandably it was found that weight did increase approximately 1.5 pounds per month after the SIP irrespective of the study participant demographics and comorbidities. Because being overweight and/or obese can have a wide range of health consequences and even contribute to mortality these findings are especially important for us all to learn from. Having a regular physical activity program, even if we have to stay indoors, and having the States encourage activity during a PHE is a best practice to put in place.

For more details see: JAMA Network Open. 2021;4(3):e212536.doi:10.1001/jamanetworkopen.2021.2536

As we think about the above study, we then connect this to our coding classification system and the capture of important data. In ICD-10-CM Chapter 4, Endocrine, Nutritional and Metabolic Diseases contains the codes to capture Overweight and Obesity. There is a total of seven valid ICD-10-CM codes at code category E66 Overweight and Obesity. Here you will find an instructional note stating, Code first obesity complicating pregnancy, childbirth, and the puerperium , if applicable (099.21-). There is a “Use additional code” instruction, to identify body mass index (BMI), if known (Z68.-)

There also is an “Excludes I” note:

  • adiposogenital dystrophy (E23.6)
  • lipomatosis NOS (E88.2)
  • lipomatosis dolorosa [Dercum] (E88.2)
  • Prader-Willi syndrome (Q87.11)   

Here is the listing of the ICD-10-CM Chapter 4 codes for overweight and obesity:

  • E66.0 Obesity due to excess calories
    • E66.01 Morbid (severe) obesity due to excess calories
    • E66.09 Other obesity due to excess calories
  • E66.1 Drug-induced obesity
  • E66.2 Morbid (severe) obesity with alveolar hypoventilation
  • E66.3 Overweight
  • E66.8 Other obesity
  • E66.9 Obesity, unspecified

You will locate the codes for BMI in ICD-10-CM Chapter 21 in the code range of Z68.1 – Z68.54. Review the documentation carefully and look for the associated condition, which must meet the guideline definition of a reportable diagnosis. Remember not to assign a code for the BMI when a patient is pregnancy and the documentation states “overweight or obese”.

Thorough and complete clinical documentation is essential to accurate clinical coding and data integrity. Keep a focus on clinical documentation and coding for Overweight/Obesity and BMI, as March is National Nutrition Month!

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