S719 Underdiagnosis of Obesity in Patients at Risk for MASH

Introduction: According to the World Obesity Federation’s 2025 Atlas, the projected obesity rate for adults in the United States for 2025 is estimated to be 40.3%. The estimated rate of metabolic dysfunction-associated steatotic liver disease (MASLD) for adults in the United States is 33.7% and is expected to increase to 41.4% by 2050. American Association for the Study of Liver Diseases (AASLD) guidelines from 2022 recommend screening for liver fibrosis of all patients at risk for or with established MASLD, i.e. with features of metabolic syndrome including obesity, prediabetes and diabetes. Screening by calculation of the fibrosis-4 (FIB-4) score is recommended in the primary care setting and patients at intermediate or high risk should be referred to a hepatologist for further evaluation. However, most people at risk are not evaluated for MASLD. Methods: We assessed documentation of overweight and obesity in all adult patients up to age 75 who were seen at a primary care or internal medicine subspecialty office at Northwell Health, the largest health system on the east coast of the United States, between July and December 2024. Demographics, height, weight, body mass index (BMI), basic laboratory values, and diagnostic codes of overweight, obesity, several metabolic disorders, and liver diseases were recorded. Fib-4 values were calculated where available. Medications relevant to metabolic diseases were gathered. Results: Overall, 230,761 adult patients between age 18 and 75 had at least 1 office visit; 37.1% were obese, 34.6% were overweight, 25.8% had a normal BMI, and 2.5% were underweight. Of the 85,605 patients who were obese, only 51.7% had an International Classifications of Diseases, Tenth Revision (ICD-10) diagnosis of obesity, and 4.2% had a diagnosis code overweight, or both. Of the 79,933 patients with overweight, only 8.2% had a correct ICD code, 9.2% had an ICD code of obesity, or both; 44.2% and 82.5% of the obese and overweight patients, respectively, had neither coding. Hypertension was diagnosed in 58.9%, dyslipidemia in 56.5%, diabetes mellitus (DM) type 2 in 17.5%, and fatty liver disease in 0.3%. Most patients with obesity or DM type 2 were not on weight loss medications, and most diabetic patients were on medications that promote weight gain, namely insulin and sulfonylureas. FIB-4 scores suggested intermediate or high risk of liver fibrosis in 22.75% of obese patients, in 28.36% of overweight patients. Conclusion: Overweight and obesity were underdiagnosed judging by the lack of ICD-10 coding. Most patients with obesity or diabetes were not on weight-loss medications. Fatty liver disease was diagnosed in only 0.3% off all patients. Recognition of recent guidelines needs to vastly improved.