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.
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.
Patients who are obese may delay seeking medical care. They may
also be less likely to receive certain preventive care services, such as
Pap smears, breast examinations, and pelvic examinations. Insufficient
medical care is probably the result of both patient and physician
To use the table, find the appropriate height
in the left-hand column labeled Height. Move across to a given
weight. The number at the top of the column is the BMI at that
height and weight. Pounds have been rounded off.
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 non-judgmental
guidance. She is very respectful... my comfort seems to be a goal for
My doctor never judges me on my weight, and never talks down to me
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.
an accessible and comfortable office environment.
Provide sturdy, armless chairs and high, firm sofas in waiting
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
large adult blood pressure cuffs or thigh cuffs on patients with an
upper-arm circumference greater than 34 cm.
extra-long phlebotomy needles, tourniquets, and large vaginal speculae
a weight scale with adequate capacity (greater than 350 pounds) for
Reduce patient fears about weight.
Weigh patients only when medically appropriate.
Weigh patients in a private area.
Record weight without comments.
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
Monitor obesity-related medical conditions and risk
Conduct tests to assess type 2 diabetes, dyslipidemia,
hypertension, sleep apnea, ischemic heart disease, and nonalcoholic
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
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
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
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
Promote self-acceptance and encourage patients to lead a full and
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
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
National Diabetes Information Clearinghouse 1 Information
Way Bethesda, MD 20892-3560 Tel: (301) 654-3327 Toll-free:
1-800-860-8747 Email: email@example.com 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:
firstname.lastname@example.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: email@example.com Web: http://firstname.lastname@example.org/ Locate
a certified diabetes educator (CDE).
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.
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
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
Special thanks to Lynn McAfee of the Council on Size and
Weight Discrimination for providing the patient quotes for this fact
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