Definitions

1
Definitions

• Body Mass Index (BMI) describes relative
• weight for height weight (kg)/height (m2)
• Overweight 2529.9 BMI
• Obesity gt30 BMI

2
Age-Adjusted Prevalence of Overweight BMI
(2529.9) and Obesity (BMI gt30)
Percent
BMI gt30
BMI 2529.9
CDC/NCHS, United States, 1960-94, ages 20-74 years
3
NHANES III Prevalence of Hypertension According
to BMI
Percent
Defined as mean systolic blood pressure ?140 mm
Hg, mean diastolic ?90 mm Hg, or currently taking
antihypertensive medication.
Brown C et al. Body Mass Index and the
Prevalence of Hypertension and Dyslipidemia. Obes
Res. 2000 8605-619.
4
NHANES III Prevalence of High Blood Cholesterol
According to BMI
Percent
Defined as gt240 mg/dL.
Brown C et al. Body Mass Index and the
Prevalence of Hypertension and Dyslipidemia. Obes
Res. 2000 8605-619.
5
NHANES III Prevalence of Low HDL-Cholesterol
According to BMI
Percent
Defined as lt35 mg/dL in men and lt45 mg/dL in
women.
Brown C et al. Body Mass Index and the
Prevalence of Hypertension and Dyslipidemia. Obes
Res. 20008605-619.
6
Health Benefits of Weight Loss

• Decreased cardiovascular risk
• Decreased glucose and insulin levels
• Decreased blood pressure
• Decreased LDL and triglycerides, increased HDL
• Decreased severity of sleep apnea
• Reduced symptoms of degenerative joint disease
• Improved gynecological conditions

7
Care of Overweight/Obese Patients

• Requires two steps
• Assessment
• Management

8
Assessment of Overweight and Obesity

• Body Mass Index
• Weight (kg)/height (m2)
• Weight (lb)/height (in2) x 703
• Table
• Waist Circumference
• High risk
• Men gt102 cm (40 in.)
• Women gt88 cm (35 in.)

9
Classification of Overweight and Obesity by BMI
10
Determine Absolute Risk Status

• Evaluate
• Disease conditions (e.g., CHD, type 2 diabetes,
  sleep apnea)( very high risk)
• Other obesity-associated diseases (e.g.,
  gynecological abnormalities, osteoarthritis)
• Cardiovascular risk factors smoking,
  hypertension, high LDL, low HDL, IGT, family hx
  (gt3 high risk)
• Other risk factors
• Physical inactivity
• High serum triglycerides (gt200 mg/dL)

11
Treatment Algorithm
1
Patient Encounter
2
Hx of 25 BMI?
³
No
Yes
BMI measured in past 2 years?
3
4
6
BMI
³

30 OR

5
Measure weight,
³
7
BMI 25 OR

BMI 25 to 29.9
height, and waist

Assess risk factors
Yes
Yes
waist circumference
OR waist circumference
circumference
8
gt 88 cm (F)
gt88 cm (F) gt102 cm (M)

Calculate BMI
³
AND 2 risk

gt 102 cm (M)
Clinician and patient
factors
devise goals and
treatment strategy
No
for weight loss and
No
risk factor control
Does
14
12
Yes
Yes
patient want to
³
Hx BMI 25?

lose weight?
9
Progress
Yes
being made/goal
No
No
15
13
achieved?
Brief reinforcement/
Advise to maintain
No
educate on weight
weight/address
management
other risk factors
Examination
11
10
16
Treatment
Maintenance counseling Dietary therapy
Behavior therapy Physical activity
Assess reasons for
Periodic weight
failure to lose weight
check




12
Treatment Algorithm (Part 1 of 3)
1
Patient Encounter
Examination
2
Hx of ³25 BMI?
Treatment
No
Yes

3
BMI measured in past 2 years?
4
BMI ³30 OR BMI 25 to 29.9 OR waist gt88 cm
(F) gt102 cm (M) AND ³2 risk factors
7
6


Measure weight, height, and waist circumference
Calculate BMI
5

BMI ³25 OR waist gt88 cm (F) gt102 cm (M)
Yes
Yes
Assess risk factors


No
No

13
Treatment Algorithm (Part 2 of 3)
BMI ³30 OR BMI 25 to 29.9 OR waist gt88 cm
(F) gt102 cm (M) AND ³2 risk factors
7
Yes


8


Devise goals and treatment strategy for weight
loss and risk factor control
Examination
Treatment
No
12

Desire to lose weight?
No
Yes
9
Yes
Progress made?
13
Advise to maintain weight Address other risk
factors
No
11
10
16
Maintenance counseling
Assess reasons for failure to lose weight
Periodic weight check

14
Treatment Algorithm (Part 3 of 3)
5

BMI ³25 OR waist gt88 cm (F) gt102 cm (M)
Yes
Examination
Treatment
No
14
Yes
Hx BMI ³25?


No
15
13
Brief reinforcement Educate on
weightmanagement
Advise to maintain weight Address other risk
factors
This algorithm applies only to the assessment
for overweight and obesity and subsequent
decisions based on that assessment. It does not
include any initial overall assessment for
cardiovascular risk factors or diseases that are
indicated.
16
Periodic weight check