Losing weights: Failure to recognise and act on weight loss documented in an electronic health record

Abstract

Background Involuntary weight loss is associated with higher mortality. When this weight loss is unrecognised, opportunities for timely diagnosis of significant conditions may be missed. Objective To use electronic health record (EHR) data to estimate the frequency of unrecognised involuntary weight loss and its implications. Methods We performed a retrospective analysis of the weights recorded in an EHR of 100,000 adult patients seen in outpatient clinics over a 5-year period using a novel data visualisation and review tool. We reviewed charts of a random sample of 170 patients experiencing weight loss periods. Our outcomes included 1) determination of whether weight loss was voluntary versus involuntary; 2) determination of whether weight loss was recognised and documented and 3) possible explanations identifiable at the index visit or within the subsequent 2 years. Results Of 170 randomly selected weight loss periods reviewed, 22 (13%) were involuntary, 36 (21%) were voluntary and 112 (66%) were indeterminate. Sixty- six (39%) weight loss periods were recognised by clinicians at the index visits and an additional 3 (1%) at the next PCP visits. Possible explanations for weight loss emerged in the subsequent 2 years including medical conditions in 60 (45%), psychosocial conditions in 19 (14%), erroneous data entry in 9 (7%), voluntary weight loss in 8 (6%) and postpartum weight loss in 6 (4%). No possible explanations were found in 32 (24%). Conclusions Periods of weight loss were common, often involuntary and frequently not recognised or documented. Many patients with involuntary weight loss had potential explanations that emerged within the subsequent 2 years.