Inequalities in Routine BMI Recording in English Primary Care: A Cross‐Sectional Study of 628 546 Adults With Implications for Diabetes and Obesity Care

Obesity is a major cause of ill health in the United Kingdom, and access to diabetes prevention and weight-management pathways depends on BMI recording. To quantify the completeness of adult BMI recording in primary care and to determine whether recording is socially and clinically patterned. We conducted a cross-sectional analysis of anonymised primary care records from an integrated care board in England. Adults aged ≥ 18 years (n = 628 546) were included. The outcome was ever having a recorded BMI, with no defined time window. Associations with age, sex, ethnicity, deprivation, T2D and CVD were estimated using modified Poisson regression and reported as adjusted prevalence ratios. Overall, 279 585 adults (44.5%) had a recorded BMI. Recording rose with age (31.0% at 18-39 to 60.7% at ≥ 60 years) and was higher in women than men (51.5% vs. 37.5%; 14.0 pp). Recording was highest in adults with T2D (88.2%) and CVD (78.0%) and lowest in adults with no recorded ethnicity (19.5%), White other (32.7%) and mixed (36.8%) groups. Adjusted analyses showed higher recording in adults with T2D (aPR: 1.79, 95% CI: 1.78-1.80), CVD (1.30, 1.29-1.31), female sex (1.37, 1.37-1.38) and older age, but lower recording in the most deprived quintile (aPR: 0.95, 0.94-0.96) and all non-White British ethnic groups. BMI was recorded in fewer than half of adults and was concentrated among those with chronic disease. Recording was less common in younger adults, men and deprived and minority ethnic groups, highlighting the importance of universal BMI recording as an equity metric.