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Obesity as a Cause of Death Recorded on Death Certificates

Posted Feb 23 2010 12:00am
The idea has not previously occurred to me but recording obesity as the primary or contributing cause of death on death certificates could be a way to cast greater light on the profound effects of this disease/condition on the U.S. population. A recent article suggested this idea to me (see: Obesity rise on death certificates, researchers say). Below is an excerpt from it

There has been a "dramatic rise" in deaths in England in which obesity was a contributory factor, researchers say. They said death certificates showed there were 757 obesity related deaths in 2009, compared with 358 in 2000. There were likely to be many more such deaths where obesity was not recorded, the University of Oxford team said in the European Journal of Public Health. It comes as the Scottish government warned of a "ticking time bomb", saying 40% of Scots could be obese by 2030. One public health expert said people often did not rea-lise obesity was linked with many serious conditions. This shows doctors are increasingly recognising obesity as a cause of death. The researchers said as obesity was rarely listed as the main cause of death, a simple snapshot of death certificates would not have picked up the rise. The marked increase was apparent when they included contributing causes of death in the analysis. Other figures recently released by ministers showed more than 190 people under 65 died as a direct result of obesity in 2009 compared with 88 in 2000. When contributing factors were included, there were 757 obesity related deaths in 2009 compared with 358 in 2000....Study leader Professor Michael Goldacre said although the death certificate figures tallied with rises in levels of obesity in the population over the same period, they did not know before the study whether doctors would be recording obesity on death certificates.

This article touches on a number of key points in the relationship of obesity to autopsy findings and the cause of death as recorded by clinicians on death certificates. The following questions come to my mind as I consider this general topic: (1) should obesity be viewed as a disease or medical condition; (2) at the time of death, should morbid obesity be considered as a primary or a contributing cause of death; (3) what criteria should be used to determine whether obesity is a primary or contributing cause of death. In order to explore these questions in greater depth, I Googled the terms obesity and cause of death. I first discovered a 2004 article quoting the CDC and indicating that obesity was a common underlying and preventable cause of death (see: Obesity approaching tobacco as top preventable cause of death). No surprise here.

I next encountered an on-line discussion forum focusing on the question of whether obesity is a disease or condition. I personally believe that some forms of obesity are due to genetic predisposition to an altered body metabolism, which would qualify some percentage of these cases as a disease in my mind. However, I am also mindful of economic pressure to "medicalize" various conditions in order to both destigmatize them and also allow the cost of treatment to be covered by health insurance. In a previous note, I used the term "disease mongering" as being akin to medicalization (see: Medical Device Mongering, a Variant of Disease Mongering). In the case of morbid obesity, I suspect that there will be little opposition, at least in medical and public health circles, to referring to it for some patients as a disease because of its growing characterization as an epidemic.

I am sure that both pathologists and clinicians have strong opinions about whether obesity, when present, should be recorded as the primary or contributing cause of death. For my part, this question may be less important than the the importance of reporting it somewhere in the death certificate so that the broad public health effects of it can be better understood.

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