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Definitions

Definitions. Body Mass Index (BMI) describes relative weight for height: weight (kg)/height (m 2 ) Overweight = 25–29.9 BMI Obesity = > 30 BMI. Age-Adjusted Prevalence of Overweight BMI (25–29.9) and Obesity (BMI >30). Percent. BMI 25–29.9. BMI > 30.

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Definitions

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  1. Definitions • Body Mass Index (BMI) describes relative • weight for height: weight (kg)/height (m2) • Overweight = 25–29.9 BMI • Obesity = >30 BMI

  2. Age-Adjusted Prevalence of Overweight BMI (25–29.9) and Obesity (BMI >30) Percent BMI 25–29.9 BMI >30 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; 8:605-619.

  4. NHANES III Prevalence of High Blood Cholesterol* According to BMI Percent *Defined as >240 mg/dL. Brown C et al. Body Mass Index and the Prevalence of Hypertension and Dyslipidemia. Obes Res. 2000; 8:605-619.

  5. NHANES III Prevalence of Low HDL-Cholesterol* According to BMI Percent *Defined as <35 mg/dL in men and <45 mg/dL in women. Brown C et al. Body Mass Index and the Prevalence of Hypertension and Dyslipidemia. Obes Res. 2000;8:605-619.

  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. Body Mass Index Weight (kg)/height (m2) Weight (lb)/height (in2) x 703 Table Waist Circumference High risk: Men >102 cm (40 in.) Women >88 cm (35 in.) Assessment of Overweight and Obesity

  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 (>3 = high risk) • Other risk factors: • Physical inactivity • High serum triglycerides (>200 mg/dL)

  11. Treatment Algorithm 1 Patient Encounter 2 ³ Hx of 25 BMI? No Yes BMI measured in past 2 years? 3 4 6 BMI ³ 30 OR • 5 ³ Measure weight, BMI 25 OR 7 {[BMI 25 to 29.9 Yes Yes height, and waist Assess risk factors waist circumference OR waist circumference circumference 8 > 88 cm (F) >88 cm (F) >102 cm (M)] • Calculate BMI ³ AND 2 risk > 102 cm (M) Clinician and patient factors} devise goals and treatment strategy No No for weight loss and 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 >88 cm (F) >102 cm (M)] AND ³2 risk factors} 7 6 •Measure weight, height, and waist circumference • Calculate BMI 5 BMI ³25 OR waist >88 cm (F) >102 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 >88 cm (F) >102 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 >88 cm (F) >102 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

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