Home > 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)
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
Care of
Overweight/Obese Patients
Requires two steps:
Assessment
of Overweight and Obesity
Classification of Overweight and Obesity by BMI
Determine
Absolute Risk Status
Evaluate:
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.
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