Available online 15 October 2025

Obesity is a well-known asthma risk factor, and weight loss benefits asthma outcomes. Asthma guidelines recommend weight reduction as part of care; however, provider practices are not known.

To evaluate if weight management is integrated into routine asthma care for patients with comorbid obesity.

We analyzed outpatient encounter notes from patients with both asthma and obesity seen by primary care, allergy/immunology, or pulmonary providers at a large health system between January 01, 2020, and September 30, 2023. Notes were extracted from electronic health records for visits with a primary asthma diagnosis. Using GPT-4o, a large language model (LLM), we assessed documentation of: (1) asthma management; (2) obesity management; (3) integration of obesity management into asthma care; (4) specific weight management strategies. Inclusion rates were compared across specialties, and encounter-level predictors were identified. Chart review evaluated GPT-4o’s performance.

Of 17,658 encounters (N=8992 patients), only 12.6% included obesity management as part of asthma care, more frequently in subspecialty (11.0%) than in primary care (1.6%) settings. In adjusted models, male sex, middle age, higher body mass index, higher education, and pulmonology care increased odds of an encounter with obesity management linked to asthma care; oral steroid use decreased the odds. Obesity management strategies differed by specialty, though exercise and general weight counseling was common. GPT-4o demonstrated robust performance.

LLM evaluation of >17,000 encounters demonstrate that, in contrast to guidelines, weight management is infrequently addressed in asthma care. These results highlight actionable opportunities to improve asthma outcomes.

Artificial intelligence

Clinical documentation

Natural language processing

Obesity management

Severe asthma

Weight loss

Artificial intelligence

The Global Initiative for Asthma

Generative pre-trained transformer

International classification of diseases

Inhaled corticosteroids

Long-acting beta agonist

Long-acting muscarinic antagonist

Leukotriene receptor antagonist

Natural language processing

Short-acting beta agonist

Short-acting muscarinic antagonist

© 2025 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology