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Medical Care of Obesity

“Getting patients to overcome their sense of shame when it comes to discussing food and diet progress is difficult—the most helpful action is to listen and establish a sense of trust.”

—A health care provider

Approximately 30 percent of adults in the United States are obese, up from 15 percent 2 decades ago. As prevalence rates continue to rise, most 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.

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Obesity and Body Mass Index

Body mass index (BMI) closely correlates with body fat and can help predict the development of health problems related to excess weight. BMI is calculated by dividing weight in kilograms by height in meters squared (or weight in pounds by height in inches squared and multiplied by 703), or by using the chart below.

The National Institutes of Health (NIH) identifies obesity as a BMI of 30 kg/m2 or greater. Obesity is further broken down to Class I (BMI of 30-34.9 kg/m2), Class II (BMI of 35-39.9 kg/m2), and Class III (BMI of 40 kg/m2 or greater), also called extreme obesity.

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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.

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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.

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BMI

Height
(Inches)

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

19

91

94

97

100

104

107

110

114

118

121

125

128

132

136

140

144

148

152

156

20

96

99

102

106

109

113

116

120

124

127

131

135

139

143

147

151

155

160

164

21

100

104

107

111

115

118

122

126

130

134

138

142

146

150

154

159

163

168

172

22

105

109

112

116

120

124

128

132

136

140

144

149

153

157

162

166

171

176

180

23

110

114

118

122

126

130

134

138

142

146

151

155

160

165

169

174

179

184

189

24

115

119

123

127

131

135

140

144

148

153

158

162

167

172

177

182

186

192

197

25

119

124

128

132

136

141

145

150

155

159

164

169

174

179

184

189

194

200

205

26

124

128

133

137

142

146

151

156

161

166

171

176

181

186

191

197

202

208

213

27

129

133

138

143

147

152

157

162

167

172

177

182

188

193

199

204

210

216

221

28

134

138

143

148

153

158

163

168

173

178

184

189

195

200

206

212

218

224

230

29

138

143

148

153

158

163

169

174

179

185

190

196

202

208

213

219

225

232

238

30

143

148

153

158

164

169

174

180

186

191

197

203

209

215

221

227

233

240

246

31

148

153

158

164

169

175

180

186

192

198

204

210

216

222

228

235

241

248

254

32

153

158

163

169

175

180

186

192

198

204

210

216

222

229

235

242

249

256

263

33

158

163

168

174

180

186

192

198

204

211

216

223

229

236

242

250

256

264

271

34

162

168

174

180

186

191

197

204

210

217

223

230

236

243

250

257

264

272

279

35

167

173

179

185

191

197

204

210

216

223

230

236

243

250

258

265

272

279

287

36

172

178

184

190

196

203

209

216

223

230

236

243

250

257

265

272

280

287

295

37

177

183

189

195

202

208

215

222

229

236

243

250

257

265

272

280

287

295

304

38

181

188

194

201

207

214

221

228

235

242

249

257

264

272

279

288

295

303

312

39

186

193

199

206

213

220

227

234

241

249

256

263

271

279

287

295

303

311

320

40

191

198

204

211

218

225

232

240

247

255

262

270

278

286

294

302

311

319

328

 

 

 

 Weight (Pounds)

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Providing Optimal Medical Care to Obese Patients 

“My doctor talks about nutrition and what to eat for my type, but not about dieting. She encourages exercise, but doesn't push. I have been able to make beneficial changes in my diet under her non-judgmental guidance. She is very respectful... my comfort seems to be a goal for her.”—A patient 

“My doctor never judges me on my weight, and never talks down to me about it.”—A patient

Health care providers can take steps to overcome barriers to ensure optimal medical care of 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 overcome their reluctance to seek out 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 non-obese patients. Finally, providers should encourage healthy behaviors and self-acceptance even in the absence of weight loss.

Using the following checklist can 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.

bullet Provide sturdy, armless chairs and high, firm sofas in waiting rooms.
bullet Provide sturdy, wide examination tables that are bolted to the floor to prevent tipping.
bullet Provide extra-large examination gowns.
bullet Install a split lavatory seat and provide a specimen collector with a handle.

Use medical equipment that can accurately assess patients who are obese.

bullet Use large adult blood pressure cuffs or thigh cuffs on patients with an upper-arm circumference greater than 34 cm.
bullet Have extra-long phlebotomy needles, tourniquets, and large vaginal speculae on hand.
bullet Have a weight scale with adequate capacity (greater than 350 pounds) for obese patients.

Reduce patient fears about weight.

bullet Weigh patients only when medically appropriate.
bullet Weigh patients in a private area.
bullet Record weight without comments.
bullet Ask patients if they wish to discuss their weight or health.
bullet Avoid using the term obesity. Your patients may be more comfortable with terms such as “difficulties with weight” or “being overweight.”

Monitor obesity-related medical conditions and risk factors.

bullet Conduct tests to assess type 2 diabetes, dyslipidemia, hypertension, sleep apnea, ischemic heart disease, and nonalcoholic steatohepatitis.
bullet 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.

bullet Allow adequate time during office visits for preventive care services.
bullet Recommend or provide preventive care services that are not impeded by the size of the patient, such as Pap smears, breast examinations, mammography, prostate examinations, and stool testing.

Encourage healthy behaviors.

bullet Discuss weight loss—as little as 5 to 10 percent of body weight—as a treatment for weight-related medical conditions.
bullet Emphasize healthy behaviors to prevent further weight gain, whether or not the patient is able or willing to lose weight.
bullet Encourage physical activity to improve cardiovascular health.
bullet Seek out 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.
bullet 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.

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Patient Barriers to Adequate Medical Care and Preventive Services
bullet Self-consciousness about weight
bullet
Fears of disparaging, negative, or inappropriate comments from physicians and medical staff
bullet
Weight gain or failure to lose weight since last medical appointment
bullet
Past negative experiences with or disrespectful treatment from physicians and medical staff

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Health Care Provider Barriers to Adequate Medical Care and Preventive Services

bullet

Lack of appropriate medical equipment to accurately assess and treat patients who are obese

bullet

Lack of training in accommodating the physical and emotional needs of persons who are obese

bullet

Perception that patients’ obesity is mainly due to lack of willpower

bullet

Difficulty performing examinations, such as pelvic exams, due to the patient’s size

bullet

Focus on treating ongoing medical conditions, to the exclusion of preventive care services

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Additional Reading

Active at Any Size. NIH Publication No. 00-4352. Published by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and available through the Weight-control Information Network (WIN).

Healthy Eating and Physical Activity Across Your Lifespan: Better Health and You. NIH Publication No. 02-4992. Published by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and available through the Weight-control Information Network (WIN).

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Patient Referrals and Information

National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Tel: (301) 654-3327
Toll-free: 1-800-860-8747
Email: ndic@info.niddk.nih.gov
Web: www.niddk.nih.gov/health/diabetes/ndic
Provides health information and publications on diabetes.

American Dietetic Association
216 West Jackson Boulevard
Chicago, IL 60606-6995
Toll-free: 1-800-366-1655
Email: findnrd@eatright.org
Web: www.eatright.org
Locate a registered dietitian (RD).

American Association of Diabetes Educators
100 West Monroe Street
Suite 400
Chicago, IL 60603
Toll-free: 1-800-338-3633
Email: aade@aadenet.org
Web: http://aade@aadenet.org
Locate a certified diabetes educator (CDE).

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Medical Supplies and Equipment

Amplestuff: Make your world fit you (catalog)
PO Box 116
Bearsville, NY 12409
Tel: (845) 679-3316
Toll-free: 1-866-486-1655
Email: amplestuff@aol.com
Web: www.amplestuff.com

ConvaQuip Bariatric Equipment
Toll-free: 1-800-637-8436
Web: