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Obesity in Adults
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BMI and waist circumference should be measured every 2 years for obese patients (A)
For obese adults with obesity related disease-increased risk (DM, CVD, stroke, gout, liver or gallbladder disease), BMI and waist circumference should be measured every 12 months (A)
Weight reduction therapy (dietary, pharmacologic, surgical or behavioral) in those with and without obesity related disease weight reduction should be considered if BMI is more than 27-overweight and obesity (B)
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Clinical Considerations
Increased consumption of more energy-dense, nutrient poor foods with high levels of sugar and saturated fats, combined with reduced physical activity, have led to obesity rates that have risen three-fold or more since 1980 in some areas of Middle East and certain other countries worldwide.
Who is at higher risk of obesity related complications?
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Who is at higher risk?
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What should be done?
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How often?
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Average risk
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All population
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• Assess BMI and waist circumference in all adults over 18 years of age. In children and adolescents use age specific BMI charts.
• Offer general education on nutrition and physical activity
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Every 2 years
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Increased risk
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• Clients with existing diabetes or cardiovascular disease, stroke, gout, liver or gallbladder disease
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Assess BMI and waist circumference in all clients over 18 years of age. Offer individual education on nutrition and physical activity
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Every 12 months
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Identified risk of obesity
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Clients who are overweight or obese
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Assess weight and waist circumference. Develop weight management plan
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Every 6 months
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Body Mass Index (BMI)
BMI is calculated the same way for both adults and children (Ref. CDC, BMI- Body Mass Index). The formula for BMI is weight in kilograms divided by height in meters squared; i.e., ((weight (kg) / [height (m)]2)).
Example: Weight = 68 kg, Height = 165 cm (1.65 m) – Calculation: 68 ÷ (1.65)2 = 24.98
Interpretation of BMI for adults
For adults 20 years and older, BMI is interpreted using standard weight status categories that are the same for all ages and for both men and women.
Waist circumference
An adult’s waist circumference is measured half way between the inferior margin of the last rib and the crest of the ilium in the mid-axillary plane. The measurement is taken at the end of normal expiration
- >94 cm in males and >80 cm in females conveys increased risk
- >102 cm in males and >88 cm in females conveys high risk
Combining measures to assess obesity and disease risk
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Classification
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BMI (kg/m2)
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Disease risk (relative to normal measures)
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Waist circumference
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Waist circumference
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Men 94–102 cm
Women 80–88 cm
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Men >102 cm
Women >88 cm
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Underweight
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<18.5
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-
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-
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Healthy weight
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18.5–24.9
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-
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Increased
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Overweight
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25.0–29.9
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Increased
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High
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Obesity
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30.0–39.9
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High to very high
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Very high
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Severe obesity
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>40.0
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Extremely high
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Extremely high
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Interpretation of BMI for Children and Adolescents
For children aged 2 years and teens, the interpretation of BMI is both age- and sex-specific. After BMI is calculated for children and teens, the BMI number is plotted on the CDC BMI-for-age growth charts (see Appendix I) (for either girls or boys) to obtain a percentile ranking. The percentile indicates the relative position of the child’s BMI number among children of the same sex and age. The growth charts show the weight status categories used with children and teens (underweight, healthy weight, at risk of overweight, and overweight).
For children and adolescents, BMI age- and sex-specific percentiles are used for two reasons
- The amount of body fat changes with age.
- The amount of body fat differs between girls and boys.
- BMI-for-age weight status categories and the corresponding percentiles are shown in the following table.
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Weight Status Category
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Percentile Range
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Underweight
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Less than the 5th percentile
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Healthy weight
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5th percentile to less than the 85th percentile
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At risk of overweight
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85th to less than the 95th percentile
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Overweight
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Equal to or greater than the 95th percentile
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