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Medical Care for Patients with Obesity PDF cover

Medical Care for Patients with Obesity

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.

“Helping patients to overcome their sense of shame when it comes to discussing food and healthy eating may be hard—the most helpful action is to listen and establish a sense of trust.”

—A health care provider

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?

 

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?

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.

Here are some issues that may prevent patients with obesity from seeking help:

  • Being ashamed or embarrassed about their weight
  • Hearing hurtful comments that the health care provider or staff may say about their weight
  • Being disrespected by staff or health care providers in the past

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How Can Health Care Providers Offer Optimal Medical Care to Patients with Obesity?

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.

Here are some issues that may prevent a health care provider from providing the best care to patients who are obese:

  • Lack of suitable medical tools to correctly assess and treat patients
  • Lack of training in providing the physical and emotional support that patients may need
  • Belief that a patient’s weight is mainly due to lack of willpower
  • Challenges performing exams‚ such as pelvic exams‚ due to a patient’s size

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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 Exit Disclaimer. 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 Exit Disclaimer. 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 Exit Disclaimer. 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 Exit Disclaimer
Internet: http://www.amplestuff.com Exit Disclaimer

“My doctor talks about nutrition and what to eat for my type‚ but not about dieting. She encourages exercise‚ but doesn’t push. I have been able to make beneficial changes in my diet under her nonjudgmental guidance. She is very respectful. . . . My comfort seems to be a goal for her.”

—A patient

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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.

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.

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Additional Information for Patients

 

American Association of Diabetes Educators
100 West Monroe Street, Suite 400
Chicago, IL 60603
Phone: 1–800–338–3633
Email: aade@aadenet.org Exit Disclaimer
Internet:http://www.diabeteseducator.org Exit Disclaimer
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 Exit Disclaimer
Internet: http://www.eatright.org Exit Disclaimer
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.

"My doctor never judges me on my weight, and never talks down to me about it."

—A patient

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Body Mass Index Table

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.)

Body Mass Index Table

To use the table, find the appropriate height in the left-hand column labled 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.

  Normal Overweight Obese Extreme Obesity
         
BMI 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Height
(inches)		     Body Weight
(pounds)		  
58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 172 177 181 186 191 196 201 205 210 215 220 224 229 234 239 244 248 253 258
59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 198 203 208 212 217 222 227 232 237 242 247 252 257 262 267
60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 184 189 194 199 204 209 215 220 225 230 235 240 245 250 255 261 266 271 276
61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211 217 222 227 232 238 243 248 254 259 264 269 275 280 285
62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 196 202 207 213 218 224 229 235 240 246 251 256 262 267 273 278 284 289 295
63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 203 208 214 220 225 231 237 242 248 254 259 265 270 278 282 287 293 299 304
64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232 238 244 250 256 262 267 273 279 285 291 296 302 308 314
65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240 246 252 258 264 270 276 282 288 294 300 306 312 318 324
66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 223 229 235 241 247 253 260 266 272 278 284 291 297 303 309 315 322 328 334
67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 230 236 242 249 255 261 268 274 280 287 293 299 306 312 319 325 331 338 344
68 125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230 236 243 249 256 262 269 276 282 289 295 302 308 315 322 328 335 341 348 354
69 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236 243 250 257 263 270 277 284 291 297 304 311 318 324 331 338 345 351 358 365
70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278 285 292 299 306 313 320 327 334 341 348 355 362 369 376
71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 257 265 272 279 286 293 301 308 315 322 329 338 343 351 358 365 372 379 386
72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 265 272 279 287 294 302 309 316 324 331 338 346 353 361 368 375 383 390 397
73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302 310 318 325 333 340 348 355 363 371 378 386 393 401 408
74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 280 287 295 303 311 319 326 334 342 350 358 365 373 381 389 396 404 412 420
75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 287 295 303 311 319 327 335 343 351 359 367 375 383 391 399 407 415 423 431
76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328 336 344 353 361 369 377 385 394 402 410 418 426 435 443

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 Exit Disclaimer
Internet: http://www.cswd.org Exit Disclaimer

National Association to Advance Fat Acceptance
P.O. Box 4662
Foster City, CA 94404–0662
Phone: 916–558–6880
Internet: http://www.naafa.org Exit Disclaimer

Obesity Action Coalition
4511 North Himes Avenue, Suite 250
Tampa, FL 33614
Phone: 800–717–3117
Internet: http://www.obesityaction.org Exit Disclaimer

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 Exit Disclaimer

The Obesity Society
8630 Fenton Street, Suite 918
Silver Spring, MD 20910
Phone: 301–563–6526
Internet: http://www.obesity.org/ Exit Disclaimer

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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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To contact WIN, call toll free 1–877–946–4627; fax: 202–828–1028; email: win@info.niddk.nih.gov;
or write Weight-control Information Network, 1 WIN Way, Bethesda, MD 20892–3665.

Last Modified: August 4, 2011
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