Morbid Obesity C031
Current RMA Instruments
| Reasonable Hypothesis | 43 of 2022 |
| Balance of Probabilities | 44 of 2022 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 278.0
- ICD-10-AM Codes: E66.8
Brief description
This is a condition where excessive accumulation of fat in the body results in a body mass index (BMI) of 40 kg/m2 or higher, in adults. Note that there is a different criterion for persons aged 18 years or younger (see SOP definition).
Confirming the diagnosis
The diagnosis is made by calculating the person's BMI from their height and weight. Note that the SOP definition previously specified a current BMI, but that requirement has been removed. If a person's BMI has been at or over the threshold in the past, but the current BMI is below the threshold, then the SOP may still be applicable. Examples may include: where a person has undergone bariatric surgery for morbid obesity; and, where a person's BMI has fluctuated above and below the threshold and is currently slightly below. In cases where the BMI is not currently at or above the threshold at the time a claim is made the individual circumstances should be considered and medical advice sought as to whether a morbid obesity diagnosis is warranted.
Body mass index = [Mass in kg] divided by [height in metres, squared] = (kg/m2).
The World Health Organisation Body Mass Index charts referred to in the SOP definition, for persons aged 18 years or younger, are linked below.
Additional diagnoses covered by SOP
- Nil
Conditions excluded from SOP
- Obesity – not a disease or injury - see the RMA declaration
- Overweight – not a disease or injury.
Clinical onset
Clinical onset of morbid obesity is when the person first reached the BMI threshold. If a person's weight subsequently fluctuated below and then back above the threshold, that will not represent a new clinical onset in most circumstances (unless there has been a substantial decrease in BMI and that decrease was maintained for a significant period of time).
Clinical worsening
Clinical worsening may be evidenced by a significant increase in weight, beyond the normal weight trajectory or pattern for that person.
Source URL: https://clik.dva.gov.au/ccps-medical-research-library/statements-principles/m/morbid-obesity-c031-e668
Rulebase for morbid obesity
<h5><strong>Current RMA Instruments</strong></h5><table border="1" cellpadding="1" cellspacing="1"><tbody><tr><td><address><a href="http://www.rma.gov.au/assets/SOP/2022/8e87e59341/043.pdf" target="_blank">Reasonable Hypothesis</a></address></td><td>43 of 2022</td></tr><tr><td><address><a href="http://www.rma.gov.au/assets/SOP/2022/d3a364d4c7/044.pdf" target="_blank">Balance of Probabilities</a></address></td><td><p>44 of 2022</p></td></tr></tbody></table><h5>Changes from previous Instruments</h5><p><drupal-media data-entity-type="media" data-entity-uuid="7aeedf0d-9441-4644-909c-2d2c73814582" data-view-mode="wysiwyg"></drupal-media></p><h5>ICD Coding</h5><ul><li>ICD-9-CM Codes: 278.0</li><li>ICD-10-AM Codes: E66.8</li></ul><h5>Brief description</h5><p>This is a condition where excessive accumulation of fat in the body results in a body mass index (BMI) of 40 kg/m<sup>2</sup> or higher, in adults. Note that there is a different criterion for persons aged 18 years or younger (see SOP definition).</p><h5>Confirming the diagnosis</h5><p>The diagnosis is made by calculating the person's BMI from their height and weight. Note that the SOP definition previously specified a current BMI, but that requirement has been removed. If a person's BMI has been at or over the threshold in the past, but the current BMI is below the threshold, then the SOP may still be applicable. Examples may include: where a person has undergone bariatric surgery for morbid obesity; and, where a person's BMI has fluctuated above and below the threshold and is currently slightly below. In cases where the BMI is not currently at or above the threshold at the time a claim is made the individual circumstances should be considered and medical advice sought as to whether a morbid obesity diagnosis is warranted.</p><p>Body mass index = [Mass in kg] divided by [height in metres, squared] = (kg/m<sup><font size="2">2</font></sup>).</p><p>The World Health Organisation Body Mass Index charts referred to in the SOP definition, for persons aged 18 years or younger, are linked below.</p><p><drupal-media data-entity-type="media" data-entity-uuid="677b4f98-da9e-4bd1-8e5a-1e73593e77fe" data-view-mode="wysiwyg"></drupal-media></p><p><drupal-media data-entity-type="media" data-entity-uuid="5b9e6b74-0540-4735-8cb2-fadf4eb6134b" data-view-mode="wysiwyg"></drupal-media></p><h5><strong>Additional diagnoses covered by SOP</strong></h5><ul><li>Nil</li></ul><h5><strong>Conditions excluded from SOP </strong></h5><ul><li>Obesity – not a disease or injury - see the <a href="http://www.rma.gov.au/sops/condition/obesity" target="_blank">RMA declaration </a></li><li>Overweight – not a disease or injury.</li></ul><h5><strong>Clinical onset</strong></h5><p>Clinical onset of morbid obesity is when the person first reached the BMI threshold. If a person's weight subsequently fluctuated below and then back above the threshold, that will not represent a new clinical onset in most circumstances (unless there has been a substantial decrease in BMI and that decrease was maintained for a significant period of time).</p><h5>Clinical worsening</h5><p>Clinical worsening may be evidenced by a significant increase in weight, beyond the normal weight trajectory or pattern for that person.</p><p> </p>
Source URL: https://clik.dva.gov.au/ccps-medical-research-library/statements-principles/m/rulebase-morbid-obesity
Binge-eating disorder
Current RMA Instruments
| Reasonable Hypothesis | 43 of 2022 |
| Balance of Probabilities | 44 of 2022 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 278.0
- ICD-10-AM Codes: E66.8
Brief description
This is a condition where excessive accumulation of fat in the body results in a body mass index (BMI) of 40 kg/m2 or higher, in adults. Note that there is a different criterion for persons aged 18 years or younger (see SOP definition).
Confirming the diagnosis
The diagnosis is made by calculating the person's BMI from their height and weight. Note that the SOP definition previously specified a current BMI, but that requirement has been removed. If a person's BMI has been at or over the threshold in the past, but the current BMI is below the threshold, then the SOP may still be applicable. Examples may include: where a person has undergone bariatric surgery for morbid obesity; and, where a person's BMI has fluctuated above and below the threshold and is currently slightly below. In cases where the BMI is not currently at or above the threshold at the time a claim is made the individual circumstances should be considered and medical advice sought as to whether a morbid obesity diagnosis is warranted.
Body mass index = [Mass in kg] divided by [height in metres, squared] = (kg/m2).
The World Health Organisation Body Mass Index charts referred to in the SOP definition, for persons aged 18 years or younger, are linked below.
Additional diagnoses covered by SOP
- Nil
Conditions excluded from SOP
- Obesity – not a disease or injury - see the RMA declaration
- Overweight – not a disease or injury.
Clinical onset
Clinical onset of morbid obesity is when the person first reached the BMI threshold. If a person's weight subsequently fluctuated below and then back above the threshold, that will not represent a new clinical onset in most circumstances (unless there has been a substantial decrease in BMI and that decrease was maintained for a significant period of time).
Clinical worsening
Clinical worsening may be evidenced by a significant increase in weight, beyond the normal weight trajectory or pattern for that person.
Source URL: https://clik.dva.gov.au/ccps-medical-research-library/statements-principles/m/morbid-obesity-c031-e668/rulebase-morbid-obesity/binge-eating-disorder
Excessive caloric intake
Current RMA Instruments
| Reasonable Hypothesis | 43 of 2022 |
| Balance of Probabilities | 44 of 2022 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 278.0
- ICD-10-AM Codes: E66.8
Brief description
This is a condition where excessive accumulation of fat in the body results in a body mass index (BMI) of 40 kg/m2 or higher, in adults. Note that there is a different criterion for persons aged 18 years or younger (see SOP definition).
Confirming the diagnosis
The diagnosis is made by calculating the person's BMI from their height and weight. Note that the SOP definition previously specified a current BMI, but that requirement has been removed. If a person's BMI has been at or over the threshold in the past, but the current BMI is below the threshold, then the SOP may still be applicable. Examples may include: where a person has undergone bariatric surgery for morbid obesity; and, where a person's BMI has fluctuated above and below the threshold and is currently slightly below. In cases where the BMI is not currently at or above the threshold at the time a claim is made the individual circumstances should be considered and medical advice sought as to whether a morbid obesity diagnosis is warranted.
Body mass index = [Mass in kg] divided by [height in metres, squared] = (kg/m2).
The World Health Organisation Body Mass Index charts referred to in the SOP definition, for persons aged 18 years or younger, are linked below.
Additional diagnoses covered by SOP
- Nil
Conditions excluded from SOP
- Obesity – not a disease or injury - see the RMA declaration
- Overweight – not a disease or injury.
Clinical onset
Clinical onset of morbid obesity is when the person first reached the BMI threshold. If a person's weight subsequently fluctuated below and then back above the threshold, that will not represent a new clinical onset in most circumstances (unless there has been a substantial decrease in BMI and that decrease was maintained for a significant period of time).
Clinical worsening
Clinical worsening may be evidenced by a significant increase in weight, beyond the normal weight trajectory or pattern for that person.
Source URL: https://clik.dva.gov.au/ccps-medical-research-library/statements-principles/m/morbid-obesity-c031-e668/rulebase-morbid-obesity/excessive-caloric-intake
Hypercortisolism
Current RMA Instruments
| Reasonable Hypothesis | 43 of 2022 |
| Balance of Probabilities | 44 of 2022 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 278.0
- ICD-10-AM Codes: E66.8
Brief description
This is a condition where excessive accumulation of fat in the body results in a body mass index (BMI) of 40 kg/m2 or higher, in adults. Note that there is a different criterion for persons aged 18 years or younger (see SOP definition).
Confirming the diagnosis
The diagnosis is made by calculating the person's BMI from their height and weight. Note that the SOP definition previously specified a current BMI, but that requirement has been removed. If a person's BMI has been at or over the threshold in the past, but the current BMI is below the threshold, then the SOP may still be applicable. Examples may include: where a person has undergone bariatric surgery for morbid obesity; and, where a person's BMI has fluctuated above and below the threshold and is currently slightly below. In cases where the BMI is not currently at or above the threshold at the time a claim is made the individual circumstances should be considered and medical advice sought as to whether a morbid obesity diagnosis is warranted.
Body mass index = [Mass in kg] divided by [height in metres, squared] = (kg/m2).
The World Health Organisation Body Mass Index charts referred to in the SOP definition, for persons aged 18 years or younger, are linked below.
Additional diagnoses covered by SOP
- Nil
Conditions excluded from SOP
- Obesity – not a disease or injury - see the RMA declaration
- Overweight – not a disease or injury.
Clinical onset
Clinical onset of morbid obesity is when the person first reached the BMI threshold. If a person's weight subsequently fluctuated below and then back above the threshold, that will not represent a new clinical onset in most circumstances (unless there has been a substantial decrease in BMI and that decrease was maintained for a significant period of time).
Clinical worsening
Clinical worsening may be evidenced by a significant increase in weight, beyond the normal weight trajectory or pattern for that person.
Source URL: https://clik.dva.gov.au/ccps-medical-research-library/statements-principles/m/morbid-obesity-c031-e668/rulebase-morbid-obesity/hypercortisolism
Hypothalamic disorder causing hyperphagia
Current RMA Instruments
| Reasonable Hypothesis | 43 of 2022 |
| Balance of Probabilities | 44 of 2022 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 278.0
- ICD-10-AM Codes: E66.8
Brief description
This is a condition where excessive accumulation of fat in the body results in a body mass index (BMI) of 40 kg/m2 or higher, in adults. Note that there is a different criterion for persons aged 18 years or younger (see SOP definition).
Confirming the diagnosis
The diagnosis is made by calculating the person's BMI from their height and weight. Note that the SOP definition previously specified a current BMI, but that requirement has been removed. If a person's BMI has been at or over the threshold in the past, but the current BMI is below the threshold, then the SOP may still be applicable. Examples may include: where a person has undergone bariatric surgery for morbid obesity; and, where a person's BMI has fluctuated above and below the threshold and is currently slightly below. In cases where the BMI is not currently at or above the threshold at the time a claim is made the individual circumstances should be considered and medical advice sought as to whether a morbid obesity diagnosis is warranted.
Body mass index = [Mass in kg] divided by [height in metres, squared] = (kg/m2).
The World Health Organisation Body Mass Index charts referred to in the SOP definition, for persons aged 18 years or younger, are linked below.
Additional diagnoses covered by SOP
- Nil
Conditions excluded from SOP
- Obesity – not a disease or injury - see the RMA declaration
- Overweight – not a disease or injury.
Clinical onset
Clinical onset of morbid obesity is when the person first reached the BMI threshold. If a person's weight subsequently fluctuated below and then back above the threshold, that will not represent a new clinical onset in most circumstances (unless there has been a substantial decrease in BMI and that decrease was maintained for a significant period of time).
Clinical worsening
Clinical worsening may be evidenced by a significant increase in weight, beyond the normal weight trajectory or pattern for that person.
Source URL: https://clik.dva.gov.au/ccps-medical-research-library/statements-principles/m/morbid-obesity-c031-e668/rulebase-morbid-obesity/hypothalamic-disorder-causing-hyperphagia
Hypothyroidism
Current RMA Instruments
| Reasonable Hypothesis | 43 of 2022 |
| Balance of Probabilities | 44 of 2022 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 278.0
- ICD-10-AM Codes: E66.8
Brief description
This is a condition where excessive accumulation of fat in the body results in a body mass index (BMI) of 40 kg/m2 or higher, in adults. Note that there is a different criterion for persons aged 18 years or younger (see SOP definition).
Confirming the diagnosis
The diagnosis is made by calculating the person's BMI from their height and weight. Note that the SOP definition previously specified a current BMI, but that requirement has been removed. If a person's BMI has been at or over the threshold in the past, but the current BMI is below the threshold, then the SOP may still be applicable. Examples may include: where a person has undergone bariatric surgery for morbid obesity; and, where a person's BMI has fluctuated above and below the threshold and is currently slightly below. In cases where the BMI is not currently at or above the threshold at the time a claim is made the individual circumstances should be considered and medical advice sought as to whether a morbid obesity diagnosis is warranted.
Body mass index = [Mass in kg] divided by [height in metres, squared] = (kg/m2).
The World Health Organisation Body Mass Index charts referred to in the SOP definition, for persons aged 18 years or younger, are linked below.
Additional diagnoses covered by SOP
- Nil
Conditions excluded from SOP
- Obesity – not a disease or injury - see the RMA declaration
- Overweight – not a disease or injury.
Clinical onset
Clinical onset of morbid obesity is when the person first reached the BMI threshold. If a person's weight subsequently fluctuated below and then back above the threshold, that will not represent a new clinical onset in most circumstances (unless there has been a substantial decrease in BMI and that decrease was maintained for a significant period of time).
Clinical worsening
Clinical worsening may be evidenced by a significant increase in weight, beyond the normal weight trajectory or pattern for that person.
Source URL: https://clik.dva.gov.au/ccps-medical-research-library/statements-principles/m/morbid-obesity-c031-e668/rulebase-morbid-obesity/hypothyroidism
Inability to obtain appropriate clinical management for morbid obesity
Current RMA Instruments
| Reasonable Hypothesis | 43 of 2022 |
| Balance of Probabilities | 44 of 2022 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 278.0
- ICD-10-AM Codes: E66.8
Brief description
This is a condition where excessive accumulation of fat in the body results in a body mass index (BMI) of 40 kg/m2 or higher, in adults. Note that there is a different criterion for persons aged 18 years or younger (see SOP definition).
Confirming the diagnosis
The diagnosis is made by calculating the person's BMI from their height and weight. Note that the SOP definition previously specified a current BMI, but that requirement has been removed. If a person's BMI has been at or over the threshold in the past, but the current BMI is below the threshold, then the SOP may still be applicable. Examples may include: where a person has undergone bariatric surgery for morbid obesity; and, where a person's BMI has fluctuated above and below the threshold and is currently slightly below. In cases where the BMI is not currently at or above the threshold at the time a claim is made the individual circumstances should be considered and medical advice sought as to whether a morbid obesity diagnosis is warranted.
Body mass index = [Mass in kg] divided by [height in metres, squared] = (kg/m2).
The World Health Organisation Body Mass Index charts referred to in the SOP definition, for persons aged 18 years or younger, are linked below.
Additional diagnoses covered by SOP
- Nil
Conditions excluded from SOP
- Obesity – not a disease or injury - see the RMA declaration
- Overweight – not a disease or injury.
Clinical onset
Clinical onset of morbid obesity is when the person first reached the BMI threshold. If a person's weight subsequently fluctuated below and then back above the threshold, that will not represent a new clinical onset in most circumstances (unless there has been a substantial decrease in BMI and that decrease was maintained for a significant period of time).
Clinical worsening
Clinical worsening may be evidenced by a significant increase in weight, beyond the normal weight trajectory or pattern for that person.
Source URL: https://clik.dva.gov.au/ccps-medical-research-library/statements-principles/m/morbid-obesity-c031-e668/rulebase-morbid-obesity/inability-obtain-appropriate-clinical-management-morbid-obesity
Treatment with a drug as specified for morbid obesity
Current RMA Instruments
| Reasonable Hypothesis | 43 of 2022 |
| Balance of Probabilities | 44 of 2022 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 278.0
- ICD-10-AM Codes: E66.8
Brief description
This is a condition where excessive accumulation of fat in the body results in a body mass index (BMI) of 40 kg/m2 or higher, in adults. Note that there is a different criterion for persons aged 18 years or younger (see SOP definition).
Confirming the diagnosis
The diagnosis is made by calculating the person's BMI from their height and weight. Note that the SOP definition previously specified a current BMI, but that requirement has been removed. If a person's BMI has been at or over the threshold in the past, but the current BMI is below the threshold, then the SOP may still be applicable. Examples may include: where a person has undergone bariatric surgery for morbid obesity; and, where a person's BMI has fluctuated above and below the threshold and is currently slightly below. In cases where the BMI is not currently at or above the threshold at the time a claim is made the individual circumstances should be considered and medical advice sought as to whether a morbid obesity diagnosis is warranted.
Body mass index = [Mass in kg] divided by [height in metres, squared] = (kg/m2).
The World Health Organisation Body Mass Index charts referred to in the SOP definition, for persons aged 18 years or younger, are linked below.
Additional diagnoses covered by SOP
- Nil
Conditions excluded from SOP
- Obesity – not a disease or injury - see the RMA declaration
- Overweight – not a disease or injury.
Clinical onset
Clinical onset of morbid obesity is when the person first reached the BMI threshold. If a person's weight subsequently fluctuated below and then back above the threshold, that will not represent a new clinical onset in most circumstances (unless there has been a substantial decrease in BMI and that decrease was maintained for a significant period of time).
Clinical worsening
Clinical worsening may be evidenced by a significant increase in weight, beyond the normal weight trajectory or pattern for that person.
Source URL: https://clik.dva.gov.au/ccps-medical-research-library/statements-principles/m/morbid-obesity-c031-e668/rulebase-morbid-obesity/treatment-drug-specified-morbid-obesity