Assessment
Assessment of
of Overweight
Overweight
and
and Obesity
Obesity and
and the
the Need
Need
for
for Weight
Weight Loss
Loss
Dr. David L. Gee
FCSN/PE 446
Nutrition, Weight Control & Exercise
Assessment
Assessment for
for Overweight
Overweight
and
and Obesity
Obesity
1998 NIH Clinical Guidelines for the Identification,
Evaluation and Treatment of Overweight and Obesity in
Adults.
Determine BMI
Determine fat distribution
Assess risk factors and presence of obesity
related diseases
Body
Body Mass
Mass Index
Index
better
correlation with mortality and
health risks than weight for height
BMI = BW(kg) / HT2 (m2)
BW = 154 lbs / 2.2 lbs/kg = 70 kg
HT = 70 in x 0.0254 m/in = 1.78 m
BMI = 70 / 1.782 = 22.1
Classification
Classification of
of Overweight
Overweight and
and
Obesity
Obesity by
by BMI
BMI
Obesity Class
BMI kg/m2
Underweight
<18.5
Normal
18.524.9
Overweight
2529.9
Obesity
Extreme Obesity
30.034.9
II
35.039.9
III
40.0
Cautions
Cautions
High
BMI may be due to excessive
lean body mass
use clinical judgement
Elevated
BMI without other risk
factors may indicate a healthy weight
Assess other risk factors
Distribution
Distribution of
of Excessive
Excessive Body
Body Fat
Fat
isis an
an Important
Important Determinant
Determinant of
of Risk
Risk
Excessive
visceral fat tissue
associated with increased health risk
Excessive
subcutaneous fat tissue
less associated with increased health risk
Elevated
Elevated Visceral
Visceral Fat
Fat
Metabolically more active
Greater effect on visceral organs
Greater Insulin Resistance
hyperinsulinemia
impaired glucose tolerance
Type 2 diabetes
Hyperlipidemia
Hypertriglyceridemia
Hypercholesterolemia
Hypertension
Photographs and Abdominal Magnetic Resonance Images Obtained
before and after Action and Risk Factors for Coronary Heart
Disease
Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease
Klein, S. et al. N Engl J Med 2004;Volume 350:2549-2557
Effects of Liposuction on Body Composition in Obese Women
with Normal Glucose Tolerance or Type 2 Diabetes
Klein, S. et al. N Engl J Med 2004;350:2549-2557
Effects of Liposuction on Risk Factors for Coronary Heart
Disease in Obese Women with Normal Glucose Tolerance or
Type 2 Diabetes
Klein, S. et al. N Engl J Med 2004;350:2549-2557
Body
Body Fat
Fat Distribution:
Distribution:
other
other names
names
Android
Obesity
abdominal obesity
central obesity
upper body fat
apple shape obesity
Gynoid
Obesity
lower body obesity
pear shaped obesity
Assessment
Assessment of
of Body
Body Fat
Fat Distribution
Distribution
Old
Old Method
Method
Waist
to Hip Ratio
W/H ratio
Upper
Body Obesity
when W/H is:
> 0.8 females
> 0.9 males
Assessment
Assessment of
of Body
Body Fat
Fat Distribution
Distribution
1998
NIH Guidelines
Waist Circumference
for BMI: 25 - 35
> 40 inches in males
> 35 inches in females
Waist circumference is measured just
above the iliac crest.
Additional
Additional Risk
Risk Factors
Factors
Each
additional risk factor increases
chronic disease risk
hypertension (>140/90)
impaired glucose tolerance (110 125
mg/dl)
hypertriglyceridemia (>150mg/dl)
Additional
Additional Risk
Risk Factors
Factors
hypercholesterolemia (>240mg/dl,
>160mg/dl LDL)
low HDL-C (<35mg/dl)
family history (parent/sibling) of early
CHD, hpt, DM
M>55, F>65
Age M>45 or F>55
Presence
Presence of
of Obesity
Obesity Related
Related
Diseases
Diseases
Obesity Related Diseases
Symptomatic coronary heart disease
Diabetes
Stroke or other indicators of high stroke risk
In combination (>2) with BMI > 25
establishes client at a unhealthy weight
and weight loss is recommended
Summary
Summary of
of Assessment
Assessment
BMI < 25
Relative risk is low
Unless high waist circumference (see following)
Subject is at a healthy weight
Weight loss is unnecessary
BMI > 30
Relative risk is high to extremely high
RR dependent on presence of other risk factors
Weight loss is recommended
Summary
Summary of
of Assessment
Assessment
BMI
= 25-29.9 (overweight)
Or waist circumference > 35F,
40M
AND 2 or more risk factors
Relative risk: high to extremely high
Weight loss is recommended
Initial
Initial Weight
Weight Loss
Loss Goals
Goals
Client should attempt to lose 10% of body
weight over 6 months
Example:
45 yo male, Ht=70, BW=200lbs, mild
hypertension, glucose intolerance, waist
circumference = 38
BMI = 29
client at unhealthy weight
initial weight loss goal 20 pounds
Initial
Initial Weight
Weight Loss
Loss Goals
Goals
Reassess at 6 months
If 10% weight loss not achieved:
New strategies for weight loss
Prevent further weight gain
If 10% weight loss achieved:
risk factors normalized or no obesity related disease
focus on weight maintenance
risk factors not normalized, presence of obesity related
disease with weight loss, inadequate weight loss
strategies for further weight loss
prevention of further weight gain
Treatment
Treatment of
of Overweight
Overweight
Based
on overall disease risk
assessment of BMI
assessment of other risk factors (>2)
presence of obesity related disease
The
The realities
realities of
of weight
weight change:
change:
Weight gain occurs when:
Positive energy balance
Energy in > energy out
Stable weight occurs when:
Energy equilibrium
Energy in = energy out
Weight loss occurs when:
Negative energy balance
Energy in < energy out
Weight loss is simple but not easy!
Treatment
Treatment Affecting
Affecting Energy
Energy
Intake
Intake
listed
from low to high risk
Healthy diet (+Behavior Modification)
Balanced hypocaloric diet (+BM)
Drugs
Very Low Calorie Diets
Gastric & Intestinal Surgery
Treatment
Treatment Affecting
Affecting Energy
Energy
Expenditure
Expenditure &
& Losses
Losses
listed
Increase
from low to high risk
lifestyle activity
Aerobic exercise (BM)
Strength training (BM)
Drugs
