1. Definitions Body Mass Index (BMI) describes relative weight for height: weight (kg)/height (m 2 ) Overweight = 25–29.9 BMI Obesity = >30 BMI

2. Age-Adjusted Prevalence of Overweight BMI (25–29.9) and Obesity (BMI >30) BMI >30BMI 25–29.9 CDC/NCHS, United States, 1960-94, ages 20-74 years Percent

3. 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

4. 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

5. 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

6. 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

7. Care of Overweight/Obese Patients Requires two steps: Assessment Management

8. Assessment of Overweight and Obesity Body Mass Index –Weight (kg)/height (m 2 ) –Weight (lb)/height (in 2 ) x 703 – Table Waist Circumference –High risk: Men >102 cm (40 in.) Women >88 cm (35 in.)

9. Classification of Overweight and Obesity by BMI

10. 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)

11. Treatment Algorithm Patient Encounter Hx of 25 BMI?  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 1513 12 1110 16 3 46 5 7 8 9 Yes No Yes No Hx BMI 25?  No Yes No Does patient want to lose weight? Yes No Progress being made/goal achieved? BMI 25 OR  waist circumference > 88 cm (F) > 102 cm (M) BMI  30 OR {[BMI 25 to 29.9 OR waist circumference >88 cm (F) >102 cm (M)] AND 2 risk  factors} BMI measured in past 2 years?

12. No BMI  30 OR {[BMI 25 to 29.9 OR waist >88 cm (F) >102 cm (M)] AND  2 risk factors} Treatment Algorithm (Part 1 of 3) Patient Encounter Hx of  25 BMI? Measure weight, height, and waist circumference Calculate BMI Assess risk factors No Yes 1 2 3 4 6 5 7 No BMI measured in past 2 years? BMI  25 OR waist >88 cm (F) >102 cm (M)  Yes  Examination Treatment

13. 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 No Desire to lose weight? Yes No Progress made? BMI  30 OR {[BMI 25 to 29.9 OR waist >88 cm (F) >102 cm (M)] AND  2 risk factors}   Examination Treatment 7 Periodic weight check Advise to maintain weight Address other risk factors 13 16 Treatment Algorithm (Part 2 of 3)

14. 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  25?  BMI  25 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.