Prevalence of Pre-Clinical Obesity Among US Adults Receiving Medical and Surgical Obesity Treatment

Abstract

Objective: We sought to determine how the proportion of adults historically receiving obesity interventions would be classified under the recently proposed “pre-clinical” and “clinical” obesity classifications and the impact of this change on safety and outcomes. Methods: A retrospective analysis of adults with BMI ≥ 35 who received bariatric surgery (BS) or antiobesity medications (AOMs) between 2017 and 2023 was conducted using the Merative MarketScan database. Patients had ≥ 6-month continuous enrollment before treatment. Clinical obesity was defined as presence of ≥ 1 obesity-related condition and pre-clinical obesity defined as absence of such. Treatment-related complications were identified within 90 days of treatment initiation. Multivariable logistic regression was used to compare the odds of treatment-related complications by obesity classification. Results: A total of 120,499 individuals (46.1%) underwent BS and 140,909 (53.9%) received AOMs. Among BS patients, 12.7% (n = 15,334) had pre-clinical obesity. Of AOM users, 38.1% (n = 53,633) had pre-clinical obesity. Clinical obesity patients were older with a higher comorbidity burden compared to pre-clinical obesity. Clinical obesity was associated with higher odds of post-treatment complications (AOM: aOR 1.10, BS: aOR 1.39, both p < 0.001). Conclusions: This novel framework would reclassify a significant proportion of patients as having pre-clinical obesity. Use of these definitions to determine treatment eligibility could potentially delay intervention and shift care to older, sicker populations.