Obesity Management Flashcards
What are the 3 main tools for diagnosing overweight/obesity
- BMI
- Waist circumference
- Edmonton Obesity Stages System
BMI
- calculate
- levels and classes
- As a measurement: is it preferred? what populations do we use it/not use it on?
weight (kg) / height (m^2)
or
weight (Ibs) x 703 / height (inches^2)
<18.5 underweight; class 0 18.5-24.9 normal; class 0 25-29.9 overweight; class 0 30-34.9 obese; class I 35-39.9 obese; class II >40 obese; class III
- BMI is the preferred measure of adiposity
- still need other health measures
- used for most adults 18-65, excluding: those with high muscle mass (body builders, long distance athletes); those with lower muscle mass (children) or those losing muscle mass (elderly); and pregnant/lactating people
BMI clinical applications (5)
BMI limitations (1) and misinterpretations (3)
- screens for overweight/obesity (and health risks)
- predicts future morbidity and death
- track changes in weight
- refer patients who may benefit from obesity management specialists
- categorize cardio-metabolic risk of patients
- measures weight only, not body composition (fat vs muscle vs bone)
Misinterpretations:
- older adults have more fat with same BMI as younger ppl
- women have more fat with same BMI as men
- muscular people have higher BMI because of high muscle mass
Pediatric obesity classification
- what age can BMI be used?
- how do we track pediatric BMI?
- classification of obesity in children?
- children over 2 years (to see if they are at risk for obesity and overweight)
- use BMI-for-age growth chart
- overweight: 85th percentile =< BMI-for-age <97th percentile
- obese: 97th percentile =< BMI-for-age <99.9th percentile
- severe obesity: BMI-for-age >= 99.9th percentile
prevalence of obesity in Canada
increasing every year
** obese classes II and III are increasing at disproportionate levels
Adult waist circumference
- what should it be (in 3 categories?)
- how to measure?
Canada, USA
Women: >=88cm
Men: >=104cm
caucasian/europoid, middle eastern, mediterranean, sub-saharan African:
Women: >=80cm
Men: >=94cm
Asian, central and south american
Women: >=80cm
Men: >=90cm
–> measuring tape just above ASIS; tighten around waist without depressing skin; recommended to use calibrator
Adult waist circumference clinical implications
- distribution of body fat is an indicator of health risk
- abdominal fat is most biologically active (releasing cytokines, inflammation, and insulin resistance)
- high waist circumference is associated with a high risk for CVD and T2D
- measuring waist circumference can screen for people who have normal BMI, but more abdominal fat (different fat distribution, normal BMI - high risk for obesity related illness and death)
Edmonton Obesity Staging System (EOSS)
- what is it for?
- staging system designed to complement BMI, to describe severity of obesity
- independent of BMI; for those who are already obese
- to describe morbidity and functional limitations associated with excess weight (5 graded categories, 0-4)
- independently predicts mortality associated with obesity, independent of BMI
Edmonton Obesity Staging System
- describe each stage
Stage 0
- No: physical, psychological, functional, or obesity related risk-factors
Stage 1
- patient has subclinical obesity related risk-factors (borderline hypertension, elevated liver enzymes, impaired fasting glucose)
OR
- mild physical symptoms (joint pain, dyspnea on moderate exertion, fatigue) - not requiring medical treatment
OR
- mild obesity related psychological symptoms or impairment of well-being (QoL not affected)
**stages 0 and 1, no admission, refer to primary care for prevention methods
Stage 2
- patient has established obesity related co-morbidities requiring medical intervention (hypertension, diabetes, sleep apnea, PCOS, osteoarthritis, reflux disease)
OR
- moderate obesity related psychological symptoms (depression, eating disorders, anxiety disorders)
OR
- moderate functional limitations in everyday life (quality of life beginning to be impacted)
Stage 3
- patient has significant obesity related end-organ damage (MI, diabetic complications, heart failure, debilitating osteoarthritis)
OR
- Significant obesity related psychological symptoms (major depression, suicidal)
OR
- Significant functional limitations in everyday life (unable to work or complete routine activities, reduced mobility)
OR
- Significant impairment of well-being (quality of life severely impacted)
Stage 4
- Severe obesity-related comorbidities (possibly end-stage)
OR
- Severely disabling psychological symptoms
OR
- Severe functional limitations
What stage and class is this? - physically active female, BMI 32 kg/m2, no risk factors, no physical symptoms, no self-esteem issues, and no functional limitations
Class I; Stage 0
What stage and class is this? - 49 year old female with a BMI of 67kg/m2, diagnosed with sleep apnea, CV disease, GERD, and suffered from stroke, Patient's mobility is significantly limited due to osteoarthritis and gout
Class III; Stage 3
What stage and class is this? - 32 year old male with BMI of 36kg/m2, with primary hypertension and obstructive sleep apnea
Class II; Stage 2
What stage and class is this? - 38 yo female with BMI of 59.2kg/m2, borderline hypertension, mild lower back pain, and knee pain. Patient does not require any medical intervention
Class III; Stage 1
What stage and class is this? - 45 yo female with BMI of 54 kg/m2, who is in a wheelchair, because of disabling arthritis, severe hyperpnea, and anxiety disorder
Class III; Stage 4
EOSS clinical limitations
- clinicians may disagree whether it’s obesity that caused the medical conditions
- uses definitions of risk/comorbidities that may change with new research
- subjective parameters to stage psychological factors
- doesn’t capture weight related issues that occur at lower BMIs
- doesn’t contain a measure for readiness to change
- EOSS-P (pediatrics), is currently undergoing validation
