7. Assessment of people living with obesity Flashcards
what is the objective of an obesity assessment?
-confirm diagnose
-determine the severity
-identify triggers and drivers
-guide appropriate management discussions
what do you initiate a discussion with the patient?
about their values and goals for treatment
what is the definition of obesity?
a complex chronic disease in which abnormal or excess
body fat (adiposity) impairs health, increases the risk of long-term
medical complications and reduces lifespan
An adaptation
of the 5As’ template has been developed by Obesity Canada for
use in clinical practice. The main components of this framework
include:
- ASKING for permission to discuss weight and explore readiness;
- ASSESSING obesity-related risks and root causes of obesity;
- ADVISING on health risks and treatment options;
- AGREEING on health outcomes and behavioural goals; and
- ASSISTING in accessing appropriate resources and providers.
Finally, when conducting an obesity assessment and in order to
achieve long-term success, it is important to assess what?
readiness to change, intrinsic motivation and value and goals
the BMI can be misleading and needs to
be interpreted with caution in what populations?
the elderly, very muscular patients and those with
extreme tall or short stature
what is BMI for overweight (increased risk and requires further evaluation)?
25 and over;
23 and over for S, SE, E Asians
WC has been
independently associated to increase what risk?
cardiovascular risk
WC is not a good predictor of what?
visceral adipose tissue
how to measure height and weight?
barefoot, in light clothing;
nearest 0.1kg and 1cm;
standardized tech and equipment by trained professionals
how to calculate BMI?
weight divided by the square of the body height in meters (kg/m2)
what is underweight BMI?
<18.5
what is the limitation of BMI?
- BMI is not a direct measure of body fat, cardiovascular risk or
health. - BMI does not indicate body fat distribution.
- BMI does not account for muscle mass (it overestimates body
fat in muscular individuals). - BMI can underestimate body fat in people who have lost muscle
mass (sarcopenic obesity). - BMI does not distinguish between men, women or ethnicity.
- BMI is less accurate in certain populations (e.g., the elderly, people
with physical disability, people <18 years of age, people with
severe obesity, during pregnancy and in patients with ascites or
severe edema). - BMI over- or underestimates body fat in certain ethnic groups,
such as Indigenous Peoples, South Asians, Chinese and other
populations.
the use of WC has been recommended as a surrogate measure of …
abdominal or visceral fat
how to measure WC?
- Remove clothing from the waistline.
- Stand with feet shoulder width apart (25 to 30 cm or 10 to 12 inches) and a straight back.
- Palpate the abdomen to locate inferior margin of the
last rib at the level of the mid-axillary line. - Palpate and identify the crest of the ileum in both sides.
Use the area between the thumb and index finger to
feel for the hip bone at the level of the mid-axillary line.
This is the part of the hip bone at the side of the waist,
not at the front of the body. - WC should be measured at the end of a normal expiration, midway between the inferior margin of the last rib and the crest of the ileum in a horizontal plane using a stretch-resistant tape that provides a constant 100 g
tension and should be recorded to the nearest 1 cm. - Have the patient take two normal breaths, and on the
exhale of the second breath tighten the tape measure so
it is snug but not digging into the skin.
what is the indication of increased risk of visceral adiposity and of developing cardiometabolic comorbidities in terms of WC?
WC equal or over 102 cm (men);
88 cm (in women)
Asian - 85 in men, 75 in women
what is the limitation of WC?
- WC is not a direct measure of visceral fat.
- Considerable training and standardization are required to ensure
inter- and intra-reader reproducibility. - WC is sensitive to abdominal distention due to food or fluid
intake, bloating, ascites, pregnancy, etc - Varying cut-offs for ethnic populations.
- Less sensitive measure of visceral fat with increasing BMI.
- WC requires further body exposure and can be perceived as an
intrusive measurement by some patients.
who is at increased risk of developing cardiometabolic risk factors, such as diabetes mellitus type 2 and hypertension?
6 Patients
with an increased BMI (< 35 kg/m2) and an elevated WC
Those with a BMI > 35 kg/m2 are likely to be at an increased risk
of ?
cardiometabolic risk factors irrespective of their WC.
why is it good to measure WC in patients with BMI >35 kg/m2?
valuable information regarding
the efficacy of their treatment during their long-term follow-up.
Some patients can see changes in adipose distribution before a
significant change in body weight or BMI.
what are some non-metabolic conditions associated with obesity?
sleep apnea, depression and joint/back pain
EOSS is a measure of the 3 different impact that obesity has had on the patient’s health. what are they?
mental, metabolic, physical impact
what stages do EOSS have?
0-4 stages
what is structured interview formats, 5As?
- Ask for permission to discuss
- Assess risks and root causes
- Advise health risks and treatment options
- Agree on health outcomes and goals
- Assist in accessing appropriate resources and providers
what is stage 0 of EOSS?
No apparent obesity-related risk factors (e.g.,
blood pressure, serum lipids, fasting glucose, etc.
within normal range), no physical symptoms, no
psychopathology, no functional limitations and/
or impairment of wellbeing
what is stage 1?
Presence of obesity-related subclinical risk factors
(e.g., borderline hypertension, impaired fasting
glucose, elevated liver enzymes, etc.), mild physical
symptoms (e.g., dyspnea on moderate exertion,
occasional aches and pains, fatigue, etc.), mild
psychopathology, mild functional limitations
and/or mild impairment of wellbeing
what is stage 2?
Presence of established obesity-related chronic
disease (e.g., hypertension, type 2 diabetes,
sleep apnea, osteoarthritis, reflux disease, polycystic ovary syndrome, anxiety disorder, etc.),
moderate limitations in activities of daily living
and/or wellbeing
what is stage 3?
Established end-organ damage such as myocardial
infarction, heart failure, diabetic complications,
incapacitating osteoarthritis, significant psychopathology, significant functional limitations and/
or impairment of wellbeing
what is stage 4?
Severe (potentially end-stage) disabilities from
obesity-related chronic diseases, severe disabling
psychopathology, severe functional limitations
and/or severe impairment of wellbeing
if patient is obese and has hypertension and diabetes, what stage is this person in, and what is the management?
stage 2;
initiation of obesity treatment, including all psycho interventions, pharmacological and surgical treatment options;
close monitor and manage comorbidities as indicated
if the person with obesity has diabetes complications, what stage is the person in, and what is the management?
stage 3;
more intensive obesity treatment including all psycho interventions, pharmacological and surgical treatment options;
aggressive management of comorbidities as indicated
the patient with obesity has impaired fasting glucose, and mild physical symptoms, what stage is this person in, and what is the management?
stage 1;
investigate for other (non-weight-related) risk factors, more intense behavioural interventions, including nutrition therapy, exercise and psychological treatments to prevent further weight gain;
monitor risk factors and health status
