Diagnosis
History
- Elicit the following in the history: Weight history, eating habits, physical activity, alcohol consumption, smoking, underlying diseases or conditions that hinder physical activities or weight loss
- Exclude secondary causes of obesity, such as medications (eg Insulin, Nateglinide, Repaglinide, Risperidone, Sertindole, Olanzapine,
- Clozapine, Mirtazapine, Valproate, Gabapentin), or history of genetic or endocrine disorders (eg hypothyroidism)
- Detect potential comorbidities (eg diabetes mellitus (DM), hypertension, dyslipidemia, sleep apnea, hyperinsulinemia)
- Its presence may affect the treatment decisions and outcomes
- Assess psychologic mental status (eg patient’s self image, general mental health, stress factors, eating disorder, presence of depression and other mood disorders, substance abuse)
- Detect pregnancy/lactation in women
- Not usually recommended for weight loss program
- Family history (eg obesity, presence of cardiovascular (CV) disease, hypertension, DM, dyslipidemia, obesity-related cancer, thyroid disease)
Physical Examination
- BP measurements
- Physical exam for evidence of goiter, Cushing’s syndrome, hypogonadism and dysmorphism
Anthropometry
- BMI
- Measures relative weight for height
- Indicates total body fat content
- An accurate predictor of future health status, as raised BMI increases CV events or deaths, total mortality, DM, sleep disorder, OA and certain cancers (eg endometrial, breast, colon)
- Done annually for screening and as needed for management
- Calculated by the formula: BMI = weight (kg)/[height (m)]2
- Calculation is for all age group, BMI percentile for age is used in children <18 years old to determine the healthy weight status
- Waist Circumference
- Useful measurement of intra-abdominal fat content before and during weight loss treatment
- Technique of choice for classifying central obesity and clinical risk
- A large waist circumference is associated with an increased risk for DM, dyslipidemia, hypertension and CV disease in patients who may not be considered obese by conventional BMI criteria
Laboratory Tests
- To assess comorbidities associated with obesity
- Lipid profile [eg low-density lipoprotein cholesterol (LDL-C), HDL-C and triglyceride (TG)]
- Fasting glucose level, A1C, thyroid function tests
- Uric acid, liver function (hepatic enzymes), renal function
- Urine free cortisol levels (perform in patients with signs of Cushing’s syndrome)
- Lab tests to rule out polycystic ovarian syndrome
- Electrocardiogram (ECG)
- Chest X-ray
Assessment
Risk Factor Assessment
Identify absolute risk status based on the presence of the following:
- Disease Conditions
- Coronary heart disease (CHD)
- Atherosclerosis
- Hypertension
- DM
- Sleep apnea
- Dyslipidemia
- Other Obesity-Associated Diseases
- Gynecological disorders (eg menorrhagia, amenorrhea)
- Osteoarthritis (OA)
- Asthma
- Gallstones
- Stress incontinence
- Nonalcoholic fatty liver disease
- Gastroesophageal reflux disease
- CV Risk Factors
- Cigarette smoking
- Hypertension
- Hyperlipidemia
- Impaired fasting glucose and impaired glucose tolerance
- Family history of premature CHD [eg myocardial infarction (MI) or sudden death in father/male 1st-degree relative at ≤55 years or mother/female 1st-degree relative at ≤65 years]
- Age ≥45 years for men or age ≥55 years for women or postmenopausal
- Others
- Physical inactivity
- Elevated serum TG (>2.3 mmol/L) and decreased HDL-C
Classification
ADULT CLASSIFICATION OF WEIGHT BY BODY MASS INDEX | ||||||||||||||
WHO Classification | WHO BMI Cut-off Points (kg/m2) | Risk of Comorbidities | Asian BMI Cut-off Points (kg/m2) | |||||||||||
Underweight | <18.5 | Low but increased risk of other clinical problems | <18.5 | |||||||||||
Normal | 18.5-24.9 | Average | 18.5-22.9 | |||||||||||
Overweight | ≥25.0 | ≥23.0 | ||||||||||||
Pre-obese | 25.0-29.9 | Increased | 23.0-27.4 | |||||||||||
Obese Class I | 30.0-34.9 | Moderate | 27.5-34.9 | |||||||||||
Obese Class II | 35.0-39.9 | Severe | 35.0-39.9 | |||||||||||
Obese Class III | ≥40.0 | Very severe | ≥40.0 | |||||||||||
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