Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults

Definitions 

Body Mass Index (BMI) describes relative

weight for height:  weight (kg)/height (m²) 

•    Overweight = 25–29.9 BMI 
  
•    Obesity = >30 BMI

Age-Adjusted Prevalence of  
Overweight BMI (25–29.9) and Obesity (BMI >30) 

BMI >30 

BMI 25–29.9 

CDC/NCHS, United States, 1960-94, ages 20-74 years 

Percent

NHANES III Prevalence of Hypertension*  
According to BMI 

*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. 

Percent

NHANES III Prevalence of  
High Blood Cholesterol* According to BMI 

*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. 

Percent

NHANES III Prevalence of  
Low HDL-Cholesterol* According to BMI 

*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. 

Percent

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

Care of Overweight/Obese Patients 

Requires two steps:

• Assessment
• Management

Assessment of Overweight and Obesity 

• 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.)

Classification of Overweight and Obesity by BMI

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)

Treatment Algorithm 

Patient Encounter 

Hx of    25 BMI? 

³  

• 

Measure weight,  

height, and waist 

  

circumference  

• 

Calculate BMI 

Examination 

Brief reinforcement/  

educate on weight  

management 

Periodic weight  

check 

Advise to maintain  

weight/address  

other risk factors 

Clinician and patient  

devise goals and   

treatment strategy 

for weight loss and 

risk factor control 

Assess reasons for   

failure to lose

weight 

Maintenance counseling:

  Dietary therapy

  Behavior therapy

  Physical activity 

:  

  

  

  

Treatment 

Assess risk  
factors 

No 

Yes 

1 

2 

14 

15 

13 

12 

11 

10 

16 

3 

4 

6 

5 

7 

8 

9 

Yes 

No 

Yes 

No 

Hx BMI   25? 

  

³  

No 

Yes 

Yes 

No 

Does  

patient want to  

lose weight? 

Yes 

No 

Progress  

being made/goal  

achieved? 

BMI    25 OR  

  

³  

waist circumference  

> 88 cm (F)  

> 102 cm (M) 

BMI   

  

³  

30 OR  

{[BMI 25 to 29.9   

OR waist circumference   

>88 cm (F) >102 cm (M)]   

AND    2 risk   

  

³  

factors}  

BMI

measured in past

2 years?

 

No 

BMI

³30 OR

{[BMI 25 to 29.9

OR waist >88 cm (F)

>102 cm (M)]  
AND ³2 risk

factors}  

Treatment Algorithm

(Part 1 of 3) 

Patient Encounter 

Hx of ³25  BMI? 

• Measure weight, height, and waist circumference

• Calculate BMI 
 

  

  

Assess risk  
factors 

No 

Yes 

1 

2 

3 

4 

6 

5 

7 

Yes 

No 

  

BMI  
measured in past  
2 years?

  

  

BMI ³25 OR

waist >88 cm (F)

>102 cm (M)

 

 

  

  

   

Yes 

  

  

Examination 

Treatment

Devise goals and

treatment strategy for

weight loss and risk

factor control 

Assess reasons for

failure to lose weight  

Maintenance

counseling 

  

12 

11 

10 

8 

9 

No 

Yes 

Yes 

No 

  

Desire to

lose weight?

  

Yes 

No 

Progress

made?

  

BMI

³30 OR

{[BMI 25 to 29.9

OR waist >88 cm (F)

>102 cm (M)]

AND ³2 risk

factors} 

  

  

  

  

Examination 

Treatment 

7 

Periodic weight

check  

• Advise to maintain weight

• Address other risk factors

  

13 

16 

Treatment Algorithm

(Part 2 of 3)

• Brief reinforcement

• Educate on weight 
management

  

Periodic weight

check 

• Advise to maintain weight

• Address other risk factors

  

14 

15 

13 

16 

5 

Yes 

No 

Yes 

No 

Hx BMI ³25? 

  

  

  

BMI ³25 OR

waist >88 cm (F)

>102 cm (M)

 

  

Examination 

Treatment 

Treatment Algorithm

(Part 3 of 3) 

* 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.