The Opportunity

In 2015-2016, obesity affected 39.8% of adults and 18.5% of children in the United States.¹ It is associated with increased risk of hypertension, diabetes, heart disease, stroke, some cancers, and premature death.² Obesity-related illness costs an estimated $190.2 billion annually³ and is expected to increase to $860 billion by 2030.⁴ To combat this epidemic, both the American Medical Association and the Centers for Disease Control and Prevention have recommended multifaceted, multistakeholder approaches to obesity prevention and treatment.^5,6 Yet, obesity remains an underdiagnosed condition,⁷ and quality of care varies substantially. Despite existing weight assessment and obesity quality measures, there remain substantial opportunities to improve obesity care and fill meaningful measurement gaps for this condition.

About the Project

In 2016, National Quality Forum (NQF), in collaboration with the STOP Obesity Alliance, convened a roundtable discussion on system-level accountability in treating individuals with obesity. Following this meeting, an NQF Measure Incubator® strategy session was held in early 2017 to further refine the measure concepts proposed in the initial discussion. Participants included experts in obesity care, population health, and measure development and implementation, along with patients and patient advocates. Key recommendations included a greater focus on the clinical treatment of obesity, coupled with population- and community-based approaches to address the obesity epidemic. The Expert Panel prioritized two measure concepts for further development: 1) an outcome measure focused on serial body mass index (BMI) reduction or maintenance; and, 2) a shared decision-making (SDM) measure that focuses on patient-centered communication and clinician action to guide obesity care.

Initial development and testing of these measures began in 2018 as part of a broader subset of obesity measures used in the AMGA Obesity Care Model Collaborative, a 3-year collaborative to define, pilot, and evaluate a framework and necessary components to address obesity in multispecialty medical groups and integrated health systems. Discern Health is the lead developer for four obesity quality measures for the adult population:

1. Documentation of obesity diagnosis;
2. Weight change over time;*
3. Evidence-based treatment for obesity; and,
4. Obesity quality of life patient-reported outcome performance measure (PRO-PM).^*,#

^* Modified version of prioritized measure concept from the NQF-convened 2017 strategy session.

^# Initial measure testing focused on early feasibility assessment only.

Public Feedback Opportunity

NQF is soliciting public comments on the four obesity quality measures (PDF) listed above, including:

• General comments on measures under development;
• Input on critical components of the proposed measures, such as feasibility, importance, data availability, and alternative approaches;
• Measure-specific feedback (see public comment page for more details); and,
• Feedback on potential data and implementation barriers and proposed solutions.

Comments are due by July 12, 2019 at 6pm ET. Please see measure background (PDF) for more details.

NQF Process

NQF will compile all individual public comments received in a document to be shared with Discern Health, AMGA Obesity Care Model Collaborative, expert panelists, and other collaborators to inform potential modifications and future development work for the obesity quality measures listed above.

Funding

This NQF Measure Incubator® project is supported by NovoNordisk.

Contact Information

For more information, contact the project team via email at incubator@qualityforum.org.

¹Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS data brief, no 288. Hyattsville, MD: National Center for Health Statistics. 2017. Available at: https://www.cdc.gov/nchs/products/databriefs/db288.htm. Last accessed June 2019.

²National Heart, Lung, and Blood Institute (NHLBI). Managing Overweight and Obesity in Adults: Systematic Evidence Review from the Obesity Expert Panel. Available at: https://www.nhlbi.nih.gov/health-topics/managing-overweight-obesity-in-adults. Last accessed June 2019.

³Institute of Medicine (IOM). Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation, Institute of Medicine. Washington, DC: The National Academies Press 2012. Available at: https://www.nap.edu/catalog/13275/accelerating-progress-in-obesity-prevention-solving-the-weight-of-the. Last accessed June 2019.

⁴Wang Y, Beydoun MA, Liang L, et al. Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity. 2008; 16(10):2323‐2330.

⁵American Medical Association House of Delegates. Recognition of Obesity as a Disease. Resolution: 420, May 16, 2013. Available at: http://www.npr.org/documents/2013/jun/ama-resolution-obesity.pdf. Last accessed June 2019.

⁶National Center for Health Statistics. Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities. Hyattsville, MD. 2016. Available at: https://www.cdc.gov/nchs/data/hus/hus15.pdf. Last accessed June 2019.

⁷Baer HJ, Karson AS, Soukup JR. Documentation and Diagnosis of Overweight and Obesity in Electronic Health Records of adult Primary Care Patients. JAMA. 2013; 173(17):1648-1652.