![](https://webarchive.library.unt.edu/web/20090113185021im_/http://win.niddk.nih.gov/images/clear.gif)
|
![Publications](pubsbut.gif)
![Return to the NIDDK Home Page.](homebut2.gif)
![Download this document in PDF Format](DownloadPDF.gif)
(229KB)
![Return to the NIDDK HomePage.](getacro.gif)
|
Approximately 32 percent of adults in the United States are obese, up from 23 percent a decade ago. The U.S. Government considers obesity to be one of the most serious health concerns facing the nation. As prevalence rates continue to rise, almost all health care providers can expect to encounter obese patients in their practices. This fact sheet offers practical tips for overcoming the challenges unique to providing optimal care to patients who are obese, independent of weight-loss treatment.
Top
|
Obesity and Body Mass
Index |
Body mass index (BMI) closely correlates with body fat in most people and can help predict the development of health problems related to excess weight. BMI is calculated by dividing a person's weight in kilograms by height in meters squared. The mathematical formula is "weight (kg) / height (m²)."
The National Institutes of Health identify obesity as a BMI greater than or equal to 30. Obesity is further broken down to Class I (BMI of 30 to 34.9), Class II (BMI of 35 to 39.9), and Class III (BMI = 40) or "extreme obesity." For more information about calculating BMI, a patient can visit http://nhlbisupport.com/bmi/bminojs.htm.
Top
|
Challenges in Treating Obese
Patients |
Patients who are obese may delay seeking medical care. They may also be less likely to receive certain preventive care services, such as Pap smears, breast examinations, and pelvic examinations. Insufficient medical care is probably the result of both patient and physician factors.
Top
|
Providing Optimal Medical Care to
Obese Patients
|
Health care providers can take steps to overcome barriers to ensure optimal medical care for patients who are obese. Optimal care begins with educating staff about treating patients with respect. Having appropriate equipment and supplies on hand further increases patient access to care. Weighing patients privately and only when necessary may help them overcome their reluctance to seek medical services. Offering preventive services in addition to monitoring and treating ongoing medical conditions helps ensure that obese patients receive the same level of care as nonobese patients. Finally, providers should encourage healthy behaviors and self acceptance even in the absence of weight loss.
Using the following checklist may improve patient care in your office. To create a positive office environment, review the checklist with your medical and administrative staff.
Create an accessible and
comfortable office environment.
- Provide sturdy, armless chairs
and high, firm sofas in waiting rooms.
- Provide sturdy, wide examination tables that are bolted to the floor to prevent tipping.
- Provide a sturdy stool or step with handles to help patients get on the examination table.
- Provide extra large examination gowns.
- Install a split lavatory seat and provide a specimen collector with a handle.
Use medical
equipment that can accurately assess patients who are
obese.
- Use large adult blood pressure cuffs or thigh cuffs on patients with an upper-arm circumference greater than 34 cm.
- Have extra long phlebotomy needles, tourniquets, and large
vaginal speculae on hand.
- Have a weight scale with adequate capacity (greater than 350 pounds) for obese patients.
Reduce
patient fears about weight.
- Weigh patients only when
medically appropriate.
- Weigh patients in a private
area.
- Record weight without
comments.
- Ask patients if they wish to
discuss their weight or health.
- Avoid using the term obesity.
Your patients may be more comfortable with terms
such as "difficulties with weight" or "being
overweight." You may wish to ask your patients what terms they prefer when discussing their weight.
|
Body Mass Index
Table
|
To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight. The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.
|
|
BMI
|
19 |
20 |
21 |
22 |
23 |
24 |
25 |
26 |
27 |
28 |
29 |
30 |
31 |
32 |
33 |
34 |
35 |
36 |
37 |
38 |
39 |
40 |
Weight
(Pounds) |
Height (Inches) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
58 |
91 |
96 |
100 |
105 |
110 |
115 |
119 |
124 |
129 |
134 |
138 |
143 |
148 |
153 |
158 |
162 |
167 |
172 |
177 |
181 |
186 |
191 |
59 |
94 |
99 |
104 |
109 |
114 |
119 |
124 |
128 |
133 |
138 |
143 |
148 |
153 |
158 |
163 |
168 |
173 |
178 |
183 |
188 |
193 |
198 |
60 |
97 |
102 |
107 |
112 |
118 |
123 |
128 |
133 |
138 |
143 |
148 |
153 |
158 |
163 |
168 |
174 |
179 |
184 |
189 |
194 |
199 |
204 |
61 |
100 |
106 |
111 |
116 |
122 |
127 |
132 |
137 |
143 |
148 |
153 |
158 |
164 |
169 |
174 |
180 |
185 |
190 |
195 |
201 |
206 |
211 |
62 |
104 |
109 |
115 |
120 |
126 |
131 |
136 |
142 |
147 |
153 |
158 |
164 |
169 |
175 |
180 |
186 |
191 |
196 |
202 |
207 |
213 |
218 |
63 |
107 |
113 |
118 |
124 |
130 |
135 |
141 |
146 |
152 |
158 |
163 |
169 |
175 |
180 |
186 |
191 |
197 |
203 |
208 |
214 |
220 |
225 |
64 |
110 |
116 |
122 |
128 |
134 |
140 |
145 |
151 |
157 |
163 |
169 |
174 |
180 |
186 |
192 |
197 |
204 |
209 |
215 |
221 |
227 |
232 |
65 |
114 |
120 |
126 |
132 |
138 |
144 |
150 |
156 |
162 |
168 |
174 |
180 |
186 |
192 |
198 |
204 |
210 |
216 |
222 |
228 |
234 |
240 |
66 |
118 |
124 |
130 |
136 |
142 |
148 |
155 |
161 |
167 |
173 |
179 |
186 |
192 |
198 |
204 |
210 |
216 |
223 |
229 |
235 |
241 |
247 |
67 |
121 |
127 |
134 |
140 |
146 |
153 |
159 |
166 |
172 |
178 |
185 |
191 |
198 |
204 |
211 |
217 |
223 |
230 |
236 |
242 |
249 |
255 |
68 |
125 |
131 |
138 |
144 |
151 |
158 |
164 |
171 |
177 |
184 |
190 |
197 |
204 |
210 |
216 |
223 |
230 |
236 |
243 |
249 |
256 |
262 |
69 |
128 |
135 |
142 |
149 |
155 |
162 |
169 |
176 |
182 |
189 |
196 |
203 |
210 |
216 |
223 |
230 |
236 |
243 |
250 |
257 |
263 |
270 |
70 |
132 |
139 |
146 |
153 |
160 |
167 |
174 |
181 |
188 |
195 |
202 |
209 |
216 |
222 |
229 |
236 |
243 |
250 |
257 |
264 |
271 |
278 |
71 |
136 |
143 |
150 |
157 |
165 |
172 |
179 |
186 |
193 |
200 |
208 |
215 |
222 |
229 |
236 |
243 |
250 |
257 |
265 |
272 |
279 |
286 |
72 |
140 |
147 |
154 |
162 |
169 |
177 |
184 |
191 |
199 |
206 |
213 |
221 |
228 |
235 |
242 |
250 |
258 |
265 |
272 |
279 |
287 |
294 |
73 |
144 |
151 |
159 |
166 |
174 |
182 |
189 |
197 |
204 |
212 |
219 |
227 |
235 |
242 |
250 |
257 |
265 |
272 |
280 |
288 |
295 |
302 |
74 |
148 |
155 |
163 |
171 |
179 |
186 |
194 |
202 |
210 |
218 |
225 |
233 |
241 |
249 |
256 |
264 |
272 |
280 |
287 |
295 |
303 |
311 |
75 |
152 |
160 |
168 |
176 |
184 |
192 |
200 |
208 |
216 |
224 |
232 |
240 |
248 |
256 |
264 |
272 |
279 |
287 |
295 |
303 |
311 |
319 |
76 |
156 |
164 |
172 |
180 |
189 |
197 |
205 |
213 |
221 |
230 |
238 |
246 |
254 |
263 |
271 |
279 |
287 |
295 |
304 |
312 |
320 |
328 |
Source: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, National Institutes of Health, National Heart, Lung, and Blood Institute, September 1998.
Top
|
|
Monitor
obesity-related medical conditions and risk
factors.
- Conduct tests to assess type 2 diabetes, dyslipidemia, hypertension,
sleep apnea, ischemic heart disease, thyroid disease, and nonalcoholic steatohepatitis as medically indicated.
- Consider concerns of the extremely obese patient that may be overlooked such as lower extremity edema, thromboembolic disease, respiratory insufficiency (Pickwickian syndrome), skin compression (ulcers), and fungal infections.
Offer
preventive care services.
- Allow adequate time during office visits for preventive care
services.
- Recommend or provide preventive care services such as Pap smears, breast examinations, mammography, prostate examinations,
and stool testing.
Encourage
healthy behaviors.
- Discuss weight loss—as little as 5 to 10 percent of body weight—as a treatment for weight-related medical conditions. Work with your patient to establish realistic treatment goals.
- Emphasize healthy behaviors to prevent further weight gain, whether or not the patient is able or willing to lose weight.
- Encourage physical activity to
improve cardiovascular health.
- Seek professional
resources to assist your patients and provide
referrals to registered dietitians, certified
diabetes educators, exercise physiologists, weight
management programs, and support groups, as
appropriate.
- Provide printed educational materials and lists of resources to patients. Offering this information may be especially helpful if your time with the patient is limited. Be sure that reading materials appropriately emphasize health rather than thinness.
- Promote self-acceptance and
encourage patients to lead a full and active
life.
Providing optimal medical care to patients who are obese may be challenging. Changes that foster a supportive and accessible environment for the patient, however, are within reach of most health care providers and can go far to overcome both patient and provider barriers to care.
Top
|
Additional Reading From the Weight-control Information Network
|
Active at Any Size. National Institutes of Health (NIH) Publication No. 04-4352.
Healthy Eating and Physical
Activity Across Your Lifespan: Better Health and
You. NIH Publication No. 04-4992.
Just Enough for You: About Food Portions. NIH Publication No.
03-5287.
Walking...A Step in the Right Direction. NIH Publication No. 04-4155.
Prescription Medications for the Treatment of Obesity. NIH Publication No. 04-4191.
Top
|
Additional Reading |
American Medical Association. Assessment and Management of Adult Obesity: A Primer for Physicians. Available at: www.ama-assn.org/ama/pub/category/10931.html. Updated April 6, 2006. Accessed January 2007.
National Heart, Lung, and Blood Institute, NIH. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Available at: www.nhlbi.nih.gov.guidelines/obesity/ob_gdlns.pdf. September 1998. Accessed January 2007.
National Task Force on the Prevention and Treatment of Obesity. Medical Care for Obese Patients: Advice for Health Care Professionals. American Family Physician. 2002;65(1):81–88.
Top
|
Additional Patient
Information
|
American
Association of Diabetes Educators
100 West Monroe Street
Suite 400
Chicago, IL 60603
Phone: 1–800–338–3633
Email: aade@aadenet.org
Internet: www.aadenet.org
Locate a certified diabetes educator
(C.D.E).
American Dietetic
Association
120 South Riverside Plaza
Suite 2000
Chicago, IL 60606–6995
Phone: 1–800–877–1600
Email: findnrd@eatright.org
Internet: www.eatright.org
Locate a registered dietitian (R.D.).
National Diabetes
Information Clearinghouse
1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov
Find health information and publications on diabetes.
Top
|
Medical Supplies and
Equipment |
Amplestuff: Make Your World
Fit You (Catalog)
Department WS
P.O. Box 116
Bearsville, NY 12409
Phone: (845) 679–3316
Toll-free number: 1–866–486–1655
Email: amplestuff2@aol.com
Internet: www.amplestuff.com
Top
|
Advocacy
and Policy Organizations |
NAASO, The Obesity Society
8630 Fenton Street
Suite 918
Silver Spring, MD 20910
Phone: (301) 563–6526
Internet: www.naaso.org
Council on Size
and Weight Discrimination
P.O. Box 305
Mount Marion, NY 12456
Phone: (845) 679–1209
Email: info@cswd.org
Internet: www.cswd.org
National
Association to Advance Fat Acceptance
P.O. Box 22501
Oakland, CA 94609
Phone: (916) 558–6880
Internet: www.naafa.org
Rudd
Center for Food Policy and Obesity
Yale University
309 Edwards Street
New Haven, CT 06520–8369
Phone: (203) 432–6700
Internet: www.YaleRuddcenter.org
Top
|
|
Weight-control
Information Network
1 WIN Way
Bethesda, MD 20892–3665
Phone: (202) 828–1025
FAX: (202) 828–1028 Toll-free number: 1–877–946–4627
Internet: http://www.win.niddk.nih.gov
Email: win@info.niddk.nih.gov
The Weight-control Information Network (WIN) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health, which is the Federal Government's lead agency responsible for biomedical research on nutrition and obesity. Authorized by Congress (Public Law 103–43), WIN provides the general public, health professionals, the media, and Congress with up-to-date, science-based health information on weight control, obesity, physical activity,
and related nutritional issues.
Publications produced by WIN are reviewed by both NIDDK scientists and outside experts. This fact sheet was also reviewed by Kelly D. Brownell, Ph.D., Rudd Center for Food Policy and Obesity, Yale University, and Rebecca Puhl, Ph.D., Rudd Center for Food Policy and Obesity, Yale University.
Special thanks to Lynn McAfee of the Council on Size and Weight Discrimination for providing the patient quotes for this fact sheet.
This e-text is not
copyrighted. WIN encourages users of this e-pub to
duplicate and distribute as many copies as
desired.
Top
|
![Publications](medical/pubsbut.gif)
![Return to the NIDDK Home Page.](medical/homebut2.gif)
|
U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No.
03–4150
February 2003
Updated January 2007
e-text posted: April
2007
|
|
|