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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.

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.

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.

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.
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)

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.

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

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

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

Reduce patient fears about weight.

	Weigh patients only when medically appropriate.
	Weigh patients in a private area.
	Record weight without comments.
	Ask patients if they wish to discuss their weight or health.
	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.

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

	Allow adequate time during office visits for preventive care services.
	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.

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

Patient Barriers to Adequate Medical Care and Preventive Services

Self-consciousness about weight

	Fears of disparaging, negative, or inappropriate comments from physicians and medical staff
	Weight gain or failure to lose weight since last medical appointment
	Past negative experiences with or disrespectful treatment from physicians and medical staff

Health Care Provider Barriers to Adequate Medical Care and Preventive Services

	Lack of appropriate medical equipment to accurately assess and treat patients who are obese
	Lack of training in accommodating the physical and emotional needs of persons who are obese
	Perception that patients’ obesity is mainly due to lack of willpower
	Difficulty performing examinations, such as pelvic exams, due to the patient’s size
	Focus on treating ongoing medical conditions, to the exclusion of preventive care services

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).

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).

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: