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Medical Care for Obese Patients

 

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Return to the NIDDK Home Page.

 

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


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

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 factors.

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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. The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.

BMI

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

Weight
(Pounds)

Height
(Inches)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

58

91

96

100

105

110

115

119

124

129

134

138

143

148

153

158

162

167

172

177

181

186

191

59

94

99

104

109

114

119

124

128

133

138

143

148

153

158

163

168

173

178

183

188

193

198

60

97

102

107

112

118

123

128

133

138

143

148

153

158

163

168

174

179

184

189

194

199

204

61

100

106

111

116

122

127

132

137

143

148

153

158

164

169

174

180

185

190

195

201

206

211

62

104

109

115

120

126

131

136

142

147

153

158

164

169

175

180

186

191

196

202

207

213

218

63

107

113

118

124

130

135

141

146

152

158

163

169

175

180

186

191

197

203

208

214

220

225

64

110

116

122

128

134

140

145

151

157

163

169

174

180

186

192

197

204

209

215

221

227

232

65

114

120

126

132

138

144

150

156

162

168

174

180

186

192

198

204

210

216

222

228

234

240

66

118

124

130

136

142

148

155

161

167

173

179

186

192

198

204

210

216

223

229

235

241

247

67

121

127

134

140

146

153

159

166

172

178

185

191

198

204

211

217

223

230

236

242

249

255

68

125

131

138

144

151

158

164

171

177

184

190

197

204

210

216

223

230

236

243

249

256

262

69

128

135

142

149

155

162

169

176

182

189

196

203

210

216

223

230

236

243

250

257

263

270

70

132

139

146

153

160

167

174

181

188

195

202

209

216

222

229

236

243

250

257

264

271

278

71

136

143

150

157

165

172

179

186

193

200

208

215

222

229

236

243

250

257

265

272

279

286

72

140

147

154

162

169

177

184

191

199

206

213

221

228

235

242

250

258

265

272

279

287

294

73

144

151

159

166

174

182

189

197

204

212

219

227

235

242

250

257

265

272

280

288

295

302

74

148

155

163

171

179

186

194

202

210

218

225

233

241

249

256

264

272

280

287

295

303

311

75

152

160

168

176

184

192

200

208

216

224

232

240

248

256

264

272

279

287

295

303

311

319

76

156

164

172

180

189

197

205

213

221

230

238

246

254

263

271

279

287

295

304

312

320

328

 

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Providing Optimal Medical Care to Obese Patients

 

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 her.

A patient

 

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

A patient

 

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 patientsí obesity is mainly due to lack of willpower

  • Difficulty performing examinations, such as pelvic exams, due to the patientís 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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Publications
Return to the NIDDK Home Page.

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

NIH Publication No. 03-5335
February 2003

e-text posted: March 2003