New research presented at the European and International Conference on Obesity (ECO ICO 2020), held online this year (1-4 September), reveals that obesity and the illnesses it causes rarely appear as an official cause of death on the UK Medical Certificate of Cause of Death (MCCD).
Obesity is known to be a significant risk factor for many common causes of death, but it is rarely identified on the MCCD, despite the process of certifying a death becoming increasingly rigorous. Medical professionals not only have a moral duty to correctly record the reasons for a death; doing so is also vitally important to ensure the accuracy of public health data on mortality.
The study was conducted by Dr Niloofar Tavangar Ranjbar, Dr Charles Millson, and colleagues at York Teaching Hospital NHS Foundations Trust, York, UK. The team aimed to evaluate whether obesity was being included on the MCCD in cases of obesity-related death (ORD).
The researchers identified all 121 available death certificates recorded at York Teaching Hospital over a 4-week period in October 2019. Of these, 112 had sufficient information in their electronic notes to establish demographic details, weight, and comorbidities alongside the cause of death, as stated on the MCCD.
The average age of death was 80 years (range 28-99 years) and 55% of the deceased were female. The study identified several obesity-related comorbidities among the sample group: hypertension (67% of cases), ischemic heart disease (46%), high cholesterol (41%), cerebrovascular disease (37%), type 2 diabetes (25%), peripheral arterial disease (17%), vascular dementia (13%), and non-alcoholic fatty liver disease (6%). Average body mass index (BMI) was 25.4 kg/m2 which falls into the overweight category, just above the 'healthy' range of 18.5-25.0.
The authors found that among the subjects who had obesity (BMI of above 30) (n=22), the mean age of death was 73.1 years, compared to 84.1 years for subjects who were merely overweight (BMI 25-30) (n=28). Of the 50 individuals who had overweight or obesity, 32% died of an obesity-related illness, and when looking at just those who had obesity, the proportion dying of an obesity-related illness rose to 45%. Despite this, only 2 of the 22 people (9%) who were classed as obese had obesity recorded as a cause of death on their MCCD.
The researchers say: "Obesity-related diseases were commonplace in our cohort. In people with a BMI over 30, and thus classed as obese, close to half died from an obesity related illness, and yet obesity rarely appeared as a cause of death on the medical cause of death certificate."
They add: "It appears obesity is not being appropriately recorded on the medical cause of death certificate in cases of obesity related deaths. Further larger studies are warranted to determine the breadth of this issue, so that public health policy may be directed accordingly."