Getting patients to overcome their sense of shame when it comes to discussing food and diet progress is difficultthe most helpful action is to listen and establish a sense of trust.

A health care provider

• Obesity and Body Mass Index

• Challenges in Treating Obese Patients

• Body Mass Index Table

• Providing Optimal Medical Care to Obese Patients

• Patient Barriers to Adequate Medical Care

• Health Care Provider Barriers to Adequate Medical Care

• Additional Reading

• Patient Referrals and Information

• Medical Supplies and Equipment

• Advocacy Organizations

Approximately 30 percent of adults in the United States are obese, up from 15 percent 2 decades ago. As prevalence rates continue to rise, most health care providers can expect to encounter obese patients in their practices. This fact sheet offers practical tips for overcoming the challenges unique to providing optimal care to patients who are obese, independent of weight loss treatment.

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Obesity and Body Mass Index

Body mass index (BMI) closely correlates with body fat and can help predict the development of health problems related to excess weight. BMI is calculated by dividing weight in kilograms by height in meters squared (or weight in pounds by height in inches squared and multiplied by 703), or by using the chart below.

The National Institutes of Health (NIH) identifies obesity as a BMI of 30 kg/m2 or greater. Obesity is further broken down to Class I (BMI of 30-34.9 kg/m2), Class II (BMI of 35-39.9 kg/m2), and Class III (BMI of 40 kg/m2 or greater), also called extreme obesity.

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Challenges in Treating Obese Patients

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Health care providers can take steps to overcome barriers to ensure optimal medical care of patients who are obese. Optimal care begins with educating staff about treating patients with respect. Having appropriate equipment and supplies on hand further increases patient access to care. Weighing patients privately and only when necessary may help overcome their reluctance to seek out medical services. Offering preventive services in addition to monitoring and treating ongoing medical conditions helps ensure that obese patients receive the same level of care as non-obese patients. Finally, providers should encourage healthy behaviors and self-acceptance even in the absence of weight loss.

Using the following checklist can improve patient care in your office. To create a positive office environment, review the checklist with your medical and administrative staff.

Create an accessible and comfortable office environment.

• Provide sturdy, armless chairs and high, firm sofas in waiting rooms.
• Provide sturdy, wide examination tables that are bolted to the floor to prevent tipping.
• Provide extra-large examination gowns.
• Install a split lavatory seat and provide a specimen collector with a handle.

Use medical equipment that can accurately assess patients who are obese.

• Use large adult blood pressure cuffs or thigh cuffs on patients with an upper-arm circumference greater than 34 cm.
• Have extra-long phlebotomy needles, tourniquets, and large vaginal speculae on hand.
• Have a weight scale with adequate capacity (greater than 350 pounds) for obese patients.

Reduce patient fears about weight.

• Weigh patients only when medically appropriate.
• Weigh patients in a private area.
• Record weight without comments.
• Ask patients if they wish to discuss their weight or health.
• Avoid using the term obesity. Your patients may be more comfortable with terms such as difficulties with weight or being overweight.

Monitor obesity-related medical conditions and risk factors.

• Conduct tests to assess type 2 diabetes, dyslipidemia, hypertension, sleep apnea, ischemic heart disease, and nonalcoholic steatohepatitis.
• Consider concerns of the extremely obese patient that may be overlooked such as lower extremity edema, thromboembolic disease, respiratory insufficiency (Pickwickian syndrome), skin compression (ulcers), and fungal infections.

Offer preventive care services.

• Allow adequate time during office visits for preventive care services.
• Recommend or provide preventive care services that are not impeded by the size of the patient, such as Pap smears, breast examinations, mammography, prostate examinations, and stool testing.

Encourage healthy behaviors.

• Discuss weight lossas little as 5 to 10 percent of body weightas a treatment for weight-related medical conditions.
• Emphasize healthy behaviors to prevent further weight gain, whether or not the patient is able or willing to lose weight.
• Encourage physical activity to improve cardiovascular health.
• Seek out professional resources to assist your patients and provide referrals to registered dietitians, certified diabetes educators, exercise physiologists, weight management programs, and support groups, as appropriate.
• Promote self-acceptance and encourage patients to lead a full and active life.

Providing optimal medical care to patients who are obese may be challenging. Changes that foster a supportive and accessible environment for the patient, however, are within reach of most health care providers and can go far to overcome both patient and provider barriers to care.

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Patient Barriers to Adequate Medical Care and Preventive Services

• Self-consciousness about weight

• Fears of disparaging, negative, or inappropriate comments from physicians and medical staff

• Weight gain or failure to lose weight since last medical appointment

• Past negative experiences with or disrespectful treatment from physicians and medical staff

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Health Care Provider Barriers to Adequate Medical Care and Preventive Services

• Lack of appropriate medical equipment to accurately assess and treat patients who are obese

• Lack of training in accommodating the physical and emotional needs of persons who are obese

• Perception that patients’ obesity is mainly due to lack of willpower

• Difficulty performing examinations, such as pelvic exams, due to the patient’s size

• Focus on treating ongoing medical conditions, to the exclusion of preventive care services

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Additional Reading

National Task Force on the Prevention and Treatment of Obesity. Medical Care for Obese Patients: Advice for Health Care Professionals. American Family Physician. Volume 65, Number 1. January 1, 2002.

Active at Any Size. NIH Publication No. 00-4352. Published by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and available through the Weight-control Information Network (WIN).

Healthy Eating and Physical Activity Across Your Lifespan: Better Health and You. NIH Publication No. 02-4992. Published by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and available through the Weight-control Information Network (WIN).

To request a free brochure, call WIN at 1-877-946-4627 or log on to www.niddk.nih.gov/health/nutrit/nutrit.htm.

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Patient Referrals and Information

National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Tel: (301) 654-3327
Toll-free: 1-800-860-8747
Email: ndic@info.niddk.nih.gov
Web: http://diabetes.niddk.nih.gov/index.htm
Provides health information and publications on diabetes.

American Dietetic Association
216 West Jackson Boulevard
Chicago, IL 60606-6995
Toll-free: 1-800-366-1655
Email: findnrd@eatright.org
Web: http://www.eatright.org/
Locate a registered dietitian (RD).

American Association of Diabetes Educators
100 West Monroe Street
Suite 400
Chicago, IL 60603
Toll-free: 1-800-338-3633
Email: aade@aadenet.org
Web: http://aade@aadenet.org/
Locate a certified diabetes educator (CDE).

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Medical Supplies and Equipment

Amplestuff: Make your world fit you (catalog)
PO Box 116
Bearsville, NY 12409
Tel: (845) 679-3316
Toll-free: 1-866-486-1655
Email: amplestuff@aol.com
Web: http://www.amplestuff.com/

ConvaQuip Bariatric Equipment
Toll-free: 1-800-637-8436
Web: http://www.convaquip.com/

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Advocacy Organizations

American Obesity Association
1250 24th Street, NW
Suite 300
Washington, DC 20037
Tel: (202) 776-7711
Web: http://www.obesity.org/

Council on Size and Weight Discrimination
PO Box 305
Mount Marion, NY 12456
Tel: (845) 679-1209
Web: http://www.cswd.org/

National Association to Advance Fat Acceptance
PO Box 188620
Sacramento, CA 95818
Tel: (916) 558-6880
Web: http://www.naafa.org/

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Weight-control Information Network

1 WIN WAY
BETHESDA, MD 20892-3665
Phone: (202) 828-1025
FAX: (202) 828-1028
Toll-free number: 1-877-946-4627

Internet: www.niddk.nih.gov/health/nutrit/nutrit.htm
E-mail: win@info.niddk.nih.gov

The Weight-control Information Network (WIN) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, which is the Department of Health and Human Services' lead agency responsible for biomedical research on nutrition and obesity. Authorized by Congress (Public Law 103-43), WIN provides the general public, health professionals, the media, and Congress with up-to-date, science-based health information on weight control, obesity, physical activity, and related nutritional issues.

WIN answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about weight control and related issues.

Publications produced by WIN are reviewed by both NIDDK scientists and outside experts. This fact sheet was also reviewed by Domenica Rubino, M.D., George Washington University Weight Management Program.

Special thanks to Lynn McAfee of the Council on Size and Weight Discrimination for providing the patient quotes for this fact sheet.

This e-text is not copyrighted. WIN encourages users of this e-pub to duplicate and distribute as many copies as desired.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health

NIH Publication No. 03-5335
February 2003

e-text posted: March 2003