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Assessment

Assessment of
of Overweight
Overweight
and
and Obesity
Obesity and
and the
the Need
Need
for
for Weight
Weight Loss
Loss
Dr. David L. Gee
FCSN/PE 446
Nutrition, Weight Control & Exercise

Assessment
Assessment for
for Overweight
Overweight
and
and Obesity
Obesity
1998 NIH Clinical Guidelines for the Identification,
Evaluation and Treatment of Overweight and Obesity in
Adults.

Determine BMI
Determine fat distribution
Assess risk factors and presence of obesity
related diseases

Body
Body Mass
Mass Index
Index
better

correlation with mortality and


health risks than weight for height
BMI = BW(kg) / HT2 (m2)
BW = 154 lbs / 2.2 lbs/kg = 70 kg
HT = 70 in x 0.0254 m/in = 1.78 m
BMI = 70 / 1.782 = 22.1

Classification
Classification of
of Overweight
Overweight and
and
Obesity
Obesity by
by BMI
BMI
Obesity Class

BMI kg/m2

Underweight

<18.5

Normal

18.524.9

Overweight

2529.9

Obesity

Extreme Obesity

30.034.9

II

35.039.9

III

40.0

Cautions
Cautions
High

BMI may be due to excessive


lean body mass
use clinical judgement

Elevated

BMI without other risk


factors may indicate a healthy weight
Assess other risk factors

Distribution
Distribution of
of Excessive
Excessive Body
Body Fat
Fat
isis an
an Important
Important Determinant
Determinant of
of Risk
Risk
Excessive

visceral fat tissue

associated with increased health risk


Excessive

subcutaneous fat tissue

less associated with increased health risk

Elevated
Elevated Visceral
Visceral Fat
Fat
Metabolically more active
Greater effect on visceral organs

Greater Insulin Resistance


hyperinsulinemia
impaired glucose tolerance
Type 2 diabetes

Hyperlipidemia
Hypertriglyceridemia
Hypercholesterolemia

Hypertension

Photographs and Abdominal Magnetic Resonance Images Obtained


before and after Action and Risk Factors for Coronary Heart
Disease

Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease
Klein, S. et al. N Engl J Med 2004;Volume 350:2549-2557

Effects of Liposuction on Body Composition in Obese Women


with Normal Glucose Tolerance or Type 2 Diabetes

Klein, S. et al. N Engl J Med 2004;350:2549-2557

Effects of Liposuction on Risk Factors for Coronary Heart


Disease in Obese Women with Normal Glucose Tolerance or
Type 2 Diabetes

Klein, S. et al. N Engl J Med 2004;350:2549-2557

Body
Body Fat
Fat Distribution:
Distribution:
other
other names
names
Android

Obesity

abdominal obesity
central obesity
upper body fat
apple shape obesity

Gynoid

Obesity

lower body obesity


pear shaped obesity

Assessment
Assessment of
of Body
Body Fat
Fat Distribution
Distribution
Old
Old Method
Method
Waist

to Hip Ratio

W/H ratio
Upper

Body Obesity
when W/H is:
> 0.8 females
> 0.9 males

Assessment
Assessment of
of Body
Body Fat
Fat Distribution
Distribution
1998

NIH Guidelines
Waist Circumference
for BMI: 25 - 35
> 40 inches in males
> 35 inches in females
Waist circumference is measured just
above the iliac crest.

Additional
Additional Risk
Risk Factors
Factors
Each

additional risk factor increases


chronic disease risk
hypertension (>140/90)
impaired glucose tolerance (110 125
mg/dl)

hypertriglyceridemia (>150mg/dl)

Additional
Additional Risk
Risk Factors
Factors
hypercholesterolemia (>240mg/dl,
>160mg/dl LDL)
low HDL-C (<35mg/dl)
family history (parent/sibling) of early
CHD, hpt, DM

M>55, F>65

Age M>45 or F>55

Presence
Presence of
of Obesity
Obesity Related
Related
Diseases
Diseases

Obesity Related Diseases


Symptomatic coronary heart disease
Diabetes
Stroke or other indicators of high stroke risk

In combination (>2) with BMI > 25


establishes client at a unhealthy weight
and weight loss is recommended

Summary
Summary of
of Assessment
Assessment

BMI < 25
Relative risk is low
Unless high waist circumference (see following)

Subject is at a healthy weight


Weight loss is unnecessary

BMI > 30
Relative risk is high to extremely high
RR dependent on presence of other risk factors

Weight loss is recommended

Summary
Summary of
of Assessment
Assessment
BMI

= 25-29.9 (overweight)
Or waist circumference > 35F,
40M
AND 2 or more risk factors
Relative risk: high to extremely high
Weight loss is recommended

Initial
Initial Weight
Weight Loss
Loss Goals
Goals
Client should attempt to lose 10% of body
weight over 6 months
Example:

45 yo male, Ht=70, BW=200lbs, mild


hypertension, glucose intolerance, waist
circumference = 38
BMI = 29
client at unhealthy weight
initial weight loss goal 20 pounds

Initial
Initial Weight
Weight Loss
Loss Goals
Goals

Reassess at 6 months
If 10% weight loss not achieved:
New strategies for weight loss
Prevent further weight gain

If 10% weight loss achieved:


risk factors normalized or no obesity related disease
focus on weight maintenance

risk factors not normalized, presence of obesity related


disease with weight loss, inadequate weight loss
strategies for further weight loss
prevention of further weight gain

Treatment
Treatment of
of Overweight
Overweight
Based

on overall disease risk

assessment of BMI
assessment of other risk factors (>2)
presence of obesity related disease

The
The realities
realities of
of weight
weight change:
change:

Weight gain occurs when:


Positive energy balance
Energy in > energy out

Stable weight occurs when:


Energy equilibrium
Energy in = energy out

Weight loss occurs when:


Negative energy balance
Energy in < energy out

Weight loss is simple but not easy!

Treatment
Treatment Affecting
Affecting Energy
Energy
Intake
Intake
listed

from low to high risk


Healthy diet (+Behavior Modification)
Balanced hypocaloric diet (+BM)
Drugs
Very Low Calorie Diets
Gastric & Intestinal Surgery

Treatment
Treatment Affecting
Affecting Energy
Energy
Expenditure
Expenditure &
& Losses
Losses
listed

Increase

from low to high risk

lifestyle activity
Aerobic exercise (BM)
Strength training (BM)
Drugs