Prevalence and paradox: obesity and its comorbid conditions in the modern treatment era

Prevalence and paradox: obesity and its comorbid conditions in the modern treatment era O rtiz and colleagues present a study that highlights a major difficulty of interpreting epidemiological data in the modern treatment era. 1 This update of a previously published cohort compares the prevalence of obesity and related comorbidities in a single academic internal medicine clinic in West Texas, revealing important trends in the ongoing battle against obesity and its complications.In the years since their first study, undeniable changes have occurred in the healthcare landscape, namely, a worldwide pandemic and a revolution in how obesity is treated.Obesity prevalence in West Texas increased in the cohort from 46% in 2016-2018 to 51% in 2020-2022, continuing a worrisome trend in a rural and often underserved population.The importance of obesity as a risk factor is highlighted by the increased prevalence of COVID-19 among the obese compared to the normal weight group.However, other trends presented appear counterintuitive.The prevalence of diabetes, hyperlipidemia, and coronary artery disease decreased among the obese.This apparent paradox necessitates a careful review of how the healthcare landscape has changed since 2016.A major challenge in interpreting prevalence data lies in how we document and code diagnoses that are used both as risk factors and treated as chronic diseases.The authors acknowledge that the "presence of a code indicated a diagnosis was documented in the patient's chart at some point in their medical history but did not indicate that the condition was active at the time of data collection."Body mass index (BMI) classification was determined based on the most recent BMI found in the medical record.Fortunately, a major focus of current clinical practice is aggressive cardiovascular risk reduction, aided by GLP-1s, statins, and antihypertensives.Patients who carry a diagnosis of hyperlipidemia, hypertension, and diabetes may have well-controlled biomarkers that decrease their risk of future morbidity and mortality.However, the electronic health record fails to capture the reduction in that risk.Recent data have also suggested