Obesity
How is the condition diagnosed?
Diagnosis of obesity begins with a medical history and physical exam. The National Institute of Health, or NIH, recommends that healthcare providers follow these steps:
measure height and weight
determine the person's body mass index
measure waist circumference
assess comorbidities, or additional risk factors
use the treatment algorithm to see if the person should be treated for obesity
determine whether the person is ready and motivated to lose weight
Waist circumference
The amount of fat around the abdomen is very important in assessing disease risk. An individual's risk for certain disorders increases when waist circumference is larger than normal. These disorders include the following:
coronary heart disease
high blood pressure
type 2 diabetes
A waist measurement of more than 40 inches, or 102 cm, in men and more than 35 inches, or 88 cm, in women is above normal. Combined with overweight or obesity, a high waist circumference can raise the person's disease risks from high to extremely high.
Comorbidities
Some disorders place a person at high absolute risk for death if they are combined with obesity. An obese person with one or more of these factors should be treated aggressively. These factors include:
atherosclerotic diseases, such as peripheral arterial disease and carotid artery disease that causes symptoms
coronary artery disease, including a history of heart attack or heart bypass surgery
sleep apnea
type 2 diabetes
Other comorbidities increase an obese person's risk of death but are not life-threatening. These factors, which should be treated, include:
gallstones
gynecological problems, such as amenorrhea
osteoarthritis
stress incontinence
A third set of comorbidities also increases an obese person's risk of death if they are combined. Three or more of these factors increase a person's high absolute risk:
an age of 45 or older in men
an age of 55 or older in women
cigarette smoking
family history of early heart disease
high blood pressure, or current treatment with medicines to lower blood pressure
high LDL cholesterol, which is the bad carrier for cholesterol
impaired fasting blood glucose levels
low HDL cholesterol, which is the good carrier for cholesterol
Treatment algorithm
The treatment algorithm developed by NIH helps the provider decide if treatment for obesity is appropriate. It takes into account the person's BMI, waist circumference, and comorbidities.
Readiness and motivation
The healthcare provider will also ask questions to see if the person is ready and motivated to lose weight. These questions deal with the following issues:
attitudes toward physical activity
potential barriers to the person's adoption of change
previous attempts at weight loss
reasons and motivation for weight loss
support expected from family and friends
time availability
understanding of risk and benefits
|
Previous section
