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Assessment of an Obese Patient
Essentials
- The overall assessment of an obese patient includes
- measurement of weight and height and calculation of body mass index (BMI)
- measurement of waist circumference (indicated if BMI is 25-35)
- assessment of associated diseases
- mapping of living habits and life situation.
- Determine the degree of obesity.
- In adults the body mass index (BMI) is a suitable measure (see table T1).
- Treatment is usually indicated if the BMI exceeds 30. The more overweight the person is, the more active measures are necessary.
- Assess the degree of abdominal obesity.
- The assessment is based on measuring waist circumference.
- Waist circumference measurement has the greatest impact on treatment in patients with BMI in the range 25-35. Weight reduction should be considered if the patient has abdominal obesity.
- Assess disorders associated with obesity.
- Treatment should be particularly active if the patient has a disease that is related to obesity and that can be alleviated by weight reduction.
- It is worthwhile to treat overweight (mild obesity, BMI 25-30) if the patient has an increased waist circumference (> 90 cm in women and > 100 cm in men) or if he/she has associated diseases or is at a great risk of such a disease.
- Consider the patient's age when planning the treatment.
- The younger the patient the more active the treatment should be.
- The importance of maintaining exercise and preserving muscle mass is emphasized by age, particularly after retirement.
- Intense weight reduction should be avoided in patients above the age of 65-70.
- Weight (kg) divided by square of height (m2 )
- For example, 78 kg/(1.70 m × 1.70 m) = 27.0 kg/m2
- See table T1. For calculation see program Bmi.
- Waist circumference is measured with the patient standing. The correct place of measurement is the area between the iliac crest and the lowest rib, which is easily identified also in fairly obese patients (picture ). The measurement becomes more accurate if the right level is marked on both sides by a pen and the measure passes over these marks. In women waist circumference > 90 cm and in men > 100 cm increases considerably the risk of cardiovascular disease. Even if the waist circumference is somewhat less (> 90 cm in men, > 80 cm in women), the risk is already slightly increased.
- When BMI is > 30 the waist circumference is increased in most cases, and when BMI is > 35, the circumference is always increased.
Classification of weight based on the body mass index
Index | Class | 160 cm | 170 cm | 180 cm |
---|
<18.5 | underweight | <47 | <53 | <60 kg |
18.5-25 | normal range | 47-64 | 53-72 | 60-81 kg |
25-30 | overweight | 64-77 | 72-87 | 81-97 kg |
30-35 | obesity | 77-90 | 87-101 | 97-113 kg |
35-40 | severe obesity | 90-102 | 101-116 | 113-130 kg |
>40 | morbid obesity | >102 | >116 | >130 kg |
Evidence Summaries ⬆