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Editors

KirsiPietiläinen

Raising the Subject of Obesity, and Assessment of Obesity

Essentials

  • Obesity is a chronic disease presenting in many forms and with a complex aetiology - it is not the person's fault or choice.
  • The subject of obesity should be brought up respectfully, if it is associated with the reason for seeing the doctor or if the patient expresses an interest in discussing it.
  • Overall assessment of obesity includes determining its degree, any associated disorders and underlying factors (aetiology).
  • Habits can be reviewed using the idea of four foundation pillars, for example: food, physical activity, sleep, mental skills.
  • Solutions and possible courses of action should be sought in an encouraging and positive spirit together with the patient.

Raising the subject of obesity

  • The subject of obesity should be brought up at the right time, respecting the patient; see Motivational interviewing The Role of Motivational Interviewing in Changing Lifestyles and in Treatment. It is essential to avoid making the patient feel guilty.
  • Obesity involves a lot of stigma or shaming (prejudice associated with weight) that the patient may have experienced in society and/or health care. Reduce the stigma by your actions. Speak and act responsibly and respectfully. Improve the patient's self-esteem.
  • Bring up the subject of weight in a natural situation if you feel that the atmosphere is one of trust and you have the chance to offer support for the treatment of obesity or if you can agree with the patient how they can proceed by themselves.
  • The subject of weight can be brought up most naturally if the patient suggests this.
  • If the patient does not bring up their weight but you feel this is necessary, you can ask the patient whether it is OK to speak about their weight.
  • It is often best to discuss not the patient's weight but their health, wellbeing and resources, and to offer support for these. The subject of weight can be brought up naturally in such situations.
  • As obesity causes or aggravates numerous diseases, it is appropriate and necessary to bring it up in such situations and to offer support for its treatment.
  • However, you should not hesitate too much to bring up obesity. Most patients appreciate bringing it up directly but kindly.
  • Show that you understand that weight management may be challenging. Show that you are willing to support the patient.
  • Ask about the development/history of their weight. Pay attention not only to any times or situations that were challenging for weight management but also to any successes.
  • Consider a change of habits; success is not only represented by weight loss.
  • Obesity should be discussed following the “people first” principle, using expressions such as “people with overweight or obesity” or “people with a body mass index exceeding the limit of overweight or obesity”. The aim should thus be to avoid the adjective “obese”, just as we avoid the term “diabetic” when talking about a person.
  • A respectful manner should also be observed when making entries in patient records.

Patient history

  • Life situation, psychosocial factors
  • Diseases
  • Medication
  • Weight development/history
  • History of weight reduction
  • Body image
  • Food
    • Experience/regulation of satiety and hunger
    • Meal rhythm
    • Vegetables
    • Proteins
    • Drinks
    • Savoury and sweet treats
    • Cravings
    • Emotional eating
    • Binge eating (binge eating scale, BES, as necessary; check local sources for a version in local language)
    • Other symptoms of eating disorders
    • Relationship with food and body
  • Exercise
    • Sedentary lifestyle
    • Daily physical activity
    • Aerobic exercise
    • Strength training exercise
  • Sleep
    • Sleep duration
    • Sleep quality
    • Sleep apnoea
  • Mental skills
    • Time management
    • Stress management
    • Sources of pleasure/displeasure
    • Improvement of self-esteem
    • Self-compassion
  • Alcohol consumption (AUDIT Audit, as necessary)
  • Smoking, nicotine products
  • Other intoxicants

Overall assessment of obesity

  • Defining the degree of obesity: height, weight, body mass index; see BMI calculator Bmi and table T1)
    • Observe any negativity associated with weighing. You can offer the chance of weighing the patient without them seeing their weight, as necessary. It is not always necessary to weigh the patient.
    • Note that weight or BMI are no measures of health, body composition or fat distribution. Nevertheless, they are often used as the grounds for choosing and following up on the efficacy of treatment.
    • Assessment of abdominal obesity, as necessary (waist circumference > 90 cm in women or > 100 cm in men)
    • Exclusion of secondary causes of obesity (such as hypothyroidism, Cushing's disease, medication causing weight gain such as antipsychotic drugs)

Associated diseases

Investigations

  • Laboratory tests: basic blood count with platelet count, creatinine, potassium, sodium, fasting plasma glucose, HbA1c, cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, ALT, TSH
  • Blood pressure measurement
  • Status: auscultation of the heart and lungs, skin, palpation of the thyroid gland, abdominal status, lymph nodes as appropriate, periphery (oedema, pulses, feet)

Classification of weight based on body mass index

IndexClassification160 cm170 cm180 cm
<18.5Underweight<47<53<60 kg
18.5-25Normal range47-6453-7260-81 kg
25-30Overweight (excess weight)64-7772-8781-97 kg
30-35Obesity77-9087-10197-113 kg
35-40Severe obesity90-102101-116113-130 kg
>40Morbid obesity
N.B. The word "morbid" will probably not be used in future		>102>116>130 kg