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Hagan, "E66.01 and Our My Culture of Shame," 11 Dec
The request for a nonformulary drug required an associated International Classification of Diseases, 10th Revision (ICD-10) diagnosis. Groaning as I typed "obesity," I knew the search result I would select: "morbid (severe) obesity due to excess calories" (E66.01). Although "other obesity" (E66.8) and "obesity, unspecified" (E66.9) were also options, they lacked a more precise obesity classification, and I worried that they might not be convincing enough to justify an authorization for an expensive drug ["an injectable glucagon-like peptide 1 (GLP-1) analogue"]. Resigning myself to choose E66.01, I could almost see the contempt for the patient dripping off the screen. What was the "due to" modifier adding? If an explanation was needed, why not
diabetes mellitus?
"severe obesity, due to long-term exposure to an environment full of nutrient-poor and calorie-dense foods, along with activity-sparing technology, leading to reduced daily energy expenditure, with resultant permanent dysregulation of the part [?] of the neuroendocrine system controlling energy balance"?
[...]
As a clinician who had known him for years and struggled with obesity throughout my own life, surely I had fared better in conveying empathy for his struggle and had added some nuance to the discussion?
"the part" of "activity-sparing technology"
Cohen and Spiegelman, "Cell biology of fat storage" (2016)
GLP-1 agonists: Diabetes drugs and weight loss
Diabetes drugs in the GLP-1 [receptor] agonists class include:

  • Dulaglutide (Trulicity), taken by injection weekly
  • Exenatide extended release (Bydureon), taken by injection weekly
  • Exenatide (Byetta), taken by injection twice daily
  • Semaglutide (Ozempic), taken by injection weekly
  • Semaglutide (Rybelsus), taken by mouth once daily
  • Liraglutide (Victoza), taken by injection daily
  • Lixisenatide (Adlyxin), taken by injection daily
by Cat on Sun Dec 12th, 2021 at 02:06:14 AM EST
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