Medical Care for Patients with Obesity
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More than one-third of adults in the United States are obese. The U.S. Government views obesity as one of the most severe health concerns facing the nation. With so many people struggling with obesity, almost all health care providers can expect to care for patients who are obese. This fact sheet offers helpful tips for health care providers to overcome the challenges unique to providing optimal care to these patients, no matter what weight-loss treatment is used.
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What Is Obesity? |
“Obesity” refers to an excess amount of body fat. It develops when the number of calories (energy) consumed in food and beverages exceeds the number of calories that the body burns to function. There are few studies in humans that link direct amounts of total body fat to sickness and death. There are also no formal standards issued by the National Institutes of Health (NIH) that define obesity based on the amount or percentage of a person's total body fat. A common way to screen for obesity is the body mass index.
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What Is the Body Mass Index?
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The Body Mass Index (BMI) is a tool used to measure weight as it relates to height. BMI has its limits. It does not assess body fat or muscle directly. BMI is measured by dividing a person's weight in pounds by height in inches squared and multiplying by 703.
Men and women can have the same BMI but different body fat percentages. As a rule, women usually have more body fat than men. A bodybuilder with large muscle mass and low body fat may have the same BMI as a person who has more body fat. However, a BMI of 30 or higher usually suggests excess body fat.
The NIH currently defines overweight as a BMI of 25 to 29.9 and obesity as a BMI greater than or equal to (>) 30. Obesity is further broken down into Class I (BMI of 30 to 34.9), Class II (BMI of 35 to 39.9), and Class III (BMI > 40) or “extreme obesity.” (See BMI table.) An online tool for measuring BMI is available at http://www.nhlbisupport.com/bmi/bminojs.htm  .
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What Are Some of the Challenges to Treating Patients with Obesity?
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Patients with obesity may delay seeing a health care provider for routine medical care. They may also be less likely to receive certain health tests, such as Pap smears, breast exams, and pelvic exams. Lack of routine medical care is most likely the result of both patient and provider factors. Both the patient and the health care provider play a role in the health of the patient.
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How Can Health Care Providers Offer Optimal Medical Care to Patients with Obesity?
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Health care providers can take steps to make sure that their patients receive quality care. Health care providers should do the following:
- Treat patients with respect.
- Have suitable equipment and supplies on hand to improve patient access to care.
- Support healthy behaviors and self-acceptance even if the patient does not wish to lose weight or cannot successfully lose weight.
To create a positive office climate‚ medical and other staff should review this fact sheet.
Create a positive, open, and comfortable office space
- Provide sturdy‚ armless chairs and high‚ firm sofas in
waiting rooms.
- Provide sturdy‚ wide exam tables bolted to the floor to
prevent tipping.
- Provide a sturdy stool or step with handles to help patients
climb onto the exam table.
- Provide extra-large patient gowns.
- Install a split toilet seat. Provide a specimen collector with
a handle.
- Provide reading materials in the waiting room that focus on healthy habits‚ rather than physical looks or being “thin.”
Use medical devices that can correctly assess patients with obesity
- Use large adult blood pressure cuffs or thigh cuffs on patients
with an upper-arm circumference greater than 34 cm.
- Use extra long needles to draw blood and have large vaginal
specula on hand.
- Have a weight scale with the capacity to measure patients who
weigh more than 400 pounds.
Be respectful when talking about the patient’s weight
- Weigh patients in a private area and only when
medically needed.
- Record weight without
comments.
- Ask patients if they wish to
discuss their weight or health.
- Avoid using the term “obesity.” Your patients may prefer such terms as “BMI” or “weight.” Ask your patients what terms they would like you to use when discussing their weight.
Track and test for the following health problems linked to obesity:
- type 2 diabetes
- hypertension (high blood pressure)
- sleep apnea (when breathing pauses while sleeping)
- nonalcoholic steatohepatitis (fatty liver disease)
- lower extremity edema (swelling of the legs and feet)
- skin compression (ulcers)
Offer well-care services
- Allow enough time during office visits to provide well-care services.
- Suggest or provide such services as Pap smears‚ breast exams‚ mammography‚ prostate exams‚ and stool testing.
Promote healthy behaviors
- Ask your patients if they would like to talk about weight loss. If they want to talk about losing weight‚ let them know that a weight loss of 5 to 7 percent of body weight may lower their chance of developing diabetes. Work with your patients to establish realistic goals.
- Start small. Encourage patients to start with simple goals such as walking for 10 minutes‚ three times a day. Once they achieve this goal‚ they can build on it.
- Offer patients information and referrals to registered dietitians‚ other health providers‚ and support groups‚ as needed.
- Promote self-acceptance and encourage patients to lead full and active lives.
Health care providers have the power to help improve the lives of patients with obesity. Changes that foster respect for the patient and a supportive and well-designed space for receiving services are within reach of most health care providers. The suggestions outlined in this fact sheet offer a solid starting place. Additional resources to help achieve these changes are listed at the end of this fact sheet.
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Additional Information for Health Care Providers |
Davis NJ, Shishodia H, Taqui B, Dumfeh C, Wylie-Rosett J. Resident physician attitudes and competence about obesity treatment: need for improved education. Medical Education Online. 2008;13:5. Available at http://www.med-ed-online.net/index.php/meo/article/download/4475/4655 . Accessed March 2011.
Huizinga MM, Cooper LA, Bleich SN, Clark JM, Beach MC. Physician respect for patients with obesity. Journal of General Internal Medicine. Nov 2009;24(11):1236–1239. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771236/?tool=pubme. Accessed March 2011.
National Heart, Lung, and Blood Institute, NIH. Body Mass Index Tables. http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm. Accessed June 2011.
National Task Force on the Prevention and Treatment of Obesity. Medical care for obese patients: advice for health care professionals. American Family Physician. 2002;65(1):81–88. Available at http://www.aafp.org/afp/2002/0101/p81.html . Accessed March 2011.
Shay LE, Shobert JL, Seibert D, Thomas LE. Adult weight management: translating research and guidelines into practice. Journal of the American Academy of Nurse Practitioners. Apr 2009;21(4):197–206. Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1745-7599.2008.00383.x/full . Accessed March 2011.
Medical Supplies and Equipment
Amplestuff: Make Your World Fit You (Catalog)
Department WS
P.O. Box 116
Bearsville, NY 12409
Phone: 845–679–3316
Toll-free number: 1–866–486–1655
Email: amplestuff2@aol.com
Internet: http://www.amplestuff.com
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Additional Reading from the Weight-control Information Network |
The following publications are available online at the addresses listed in each description and also by calling WIN toll-free at 1–877–946–4627.
Active at Any Size is a brochure that provides ideas and tips on how people who are overweight or obese can be physically active. It focuses on handling common barriers and setting goals. Available at http://www.win.niddk.nih.gov/publications/active.htm.
Bariatric Surgery for Severe Obesity is a fact sheet that discusses bariatric surgery as an option for people who are severely obese and who cannot lose weight by standard means or who suffer from serious health problems linked to obesity. Available at http://www.win.niddk.nih.gov/publications/gastric.htm.
Just Enough for You: About Food Portions is a brochure defining the difference between a portion—the amount of food a person chooses to eat—and a measured serving. It offers tips for judging portion sizes and for controlling portions at home and when eating out. Available in English and Spanish at http://www.win.niddk.nih.gov/publications.
Talking With Patients About Weight Loss: Tips for Primary Care Professionals is a fact sheet discussing how primary care providers are in an ideal position to offer weight-loss guidance to patients who are overweight or obese. This fact sheet offers tips that can help professionals talk with patients about this subject. Available at http://www.win.niddk.nih.gov/publications/talking.htm.
Walking … A Step in the Right Direction is a brochure explaining how to start a walking program, presenting a sample program, and showing stretches for warming up and cooling down. Available in English and Spanish at http://www.win.niddk.nih.gov/publications.
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Additional Information for Patients
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American
Association of Diabetes Educators
100 West Monroe Street,
Suite 400
Chicago, IL 60603
Phone: 1–800–338–3633
Email: aade@aadenet.org
Internet:http://www.diabeteseducator.org
Locate a certified diabetes educator
(C.D.E).
American Dietetic
Association
120 South Riverside Plaza,
Suite 2000
Chicago, IL 60606–6995
Phone: 1–800–877–1600
Email: findnrd@eatright.org
Internet: http://www.eatright.org
Locate a registered dietitian (R.D.).
National Diabetes
Information Clearinghouse
1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
Email: ndic@info.niddk.nih.gov
Internet: http://www.diabetes.niddk.nih.gov
Find health information and publications on diabetes.
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To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight (in pounds). The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off. (Click on the image of the BMI Table below to open a larger and accessible version.)
Source: Adapted from Clinical Guidelines on the Identification‚ Evaluation‚ and Treatment of Overweight and Obesity in Adults. The Evidence Report. NIH Publication No. 98–4083: National Heart‚ Lung‚ and Blood Institute; 1998.
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Advocacy
and Policy Organizations |
Council on Size and Weight Discrimination
P.O. Box 305
Mount Marion, NY 12456
Phone: 845–679–1209
Email: info@cswd.org
Internet: http://www.cswd.org
National
Association to Advance Fat Acceptance
P.O. Box 4662
Foster City, CA 94404–0662
Phone: 916–558–6880
Internet: http://www.naafa.org
Obesity Action Coalition
4511 North Himes Avenue, Suite 250
Tampa, FL 33614
Phone: 800–717–3117
Internet: http://www.obesityaction.org
Rudd
Center for Food Policy and Obesity
Yale University
309 Edwards Street
New Haven, CT 06520–8369
Phone: 203–432–6700
Internet: http://www.yaleruddcenter.org
The Obesity Society
8630 Fenton Street,
Suite 918
Silver Spring, MD 20910
Phone: 301–563–6526
Internet: http://www.obesity.org/
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Weight-control
Information Network
1 WIN Way
Bethesda, MD 20892–3665
Phone: 202–828–1025
Toll-free number: 1–877–946–4627
Fax: 202–828–1028
Email: win@info.niddk.nih.gov
Internet: http://www.win.niddk.nih.gov
The Weight-control Information Network (WIN) is a national information service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH). WIN provides the general public, health professionals, and the media with science-based, up-to-date, culturally relevant materials and tips. Topics include healthy eating, barriers to physical activity, portion control, and nutrition myths.
Publications produced by WIN are reviewed by both NIDDK scientists and outside experts. This fact sheet was also reviewed by Rebecca Puhl, Ph.D., Rudd Center for Food Policy and Obesity, Yale University.
Special thanks to Lynn McAfee of the Council on Size and Weight Discrimination for providing the patient quotes for this fact sheet.
This publication is not
copyrighted. WIN encourages users of this fact sheet to duplicate and distribute as many copies as desired. This fact sheet is also available at http://www.win.niddk.nih.gov.
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U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No.
03–5335
February 2003
Updated July 2011
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