Obesity Author: George A. Bray, MD
Editorial changes - 2009-11-06
Author information and module status
Prevention
Screening
Diagnosis
Consultation for Diagnosis
Hospitalization
Non-drug Therapy
Drug Therapy
Patient Education
Consultation for Management
Follow-up
Tables
Figures
References
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Quality Measures Quality Measures
Prevention
  • Provide counseling for pregnant women concerning gestational factors that can increase the risk of pregnancy and of unhealthy weight and outcomes in their offspring.
  • Provide counseling and preventive strategies for children who are at risk for weight gain.
  • Provide counseling and preventive strategies for adults who are at risk for weight gain.
  • Advise patients to reduce BMI and central adiposity to decrease health risks and improve quality of life, especially in patients with BMI 30 kg/m2.

Provide counseling for pregnant women concerning gestational factors that can increase the risk of pregnancy and of unhealthy weight and outcomes in their offspring. B

  • Advise patients to stop smoking during pregnancy.
  • If diabetes is present or occurs during pregnancy, control glucose appropriately.
  • Counsel patients to maintain good nutrition and monitor for weight changes.
  • Advise overweight mothers of the increased risk of maternal and fetal complications and anomalies and of the risk for overweight children, particularly for nulliparous women.
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Provide counseling and preventive strategies for children who are at risk for weight gain. A

  • Determine if the child is overweight or obese by noting:
    • Body weight in relation to height on the CDC charts
    • If the parents are overweight
  • If a child's weight is above the 99th percentile for height and rising further above this upper bound, genotyping for genetic disorders associated with obesity may be considered.
  • Counsel at-risk children and their parents about:
    • The appropriate weight for the child
    • The loss of self-esteem associated with obesity
    • The value of breast feeding for more than 3 months in preventing weight gain
    • Regular physical activity
    • Getting adequate sleep
    • Controlling caloric intake by using small portion sizes
    • Eating a lower fat diet
    • Eating lower glycemic load foods
    • Avoiding excessive protein intake
    • Influence of medications on weight gain
    • The potential value of higher calcium intake
    • The value of eating breakfast
    • Watching less television
    • Eating family meals together
    • Drinking fewer carbonated, sugar-sweetened beverages
    • See the CDC body mass index-for-age charts
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Provide counseling and preventive strategies for adults who are at risk for weight gain. A

  • Identify individuals who are at risk for obesity and its associated comorbidities by noting:
    • Body weight increasing at a rate above 1 to 2 pounds per year
    • Strong family history of being overweight
    • Abnormal waist circumference: >102 cm (40 in) for males or >88 cm (35 in) for females (for Asians, >90 cm for males or >80 cm for females)
    • Increased WHR: >0.95 for males or >0.85 for females
    • Low level of physical activity
    • Presence of the metabolic syndrome
  • Counsel at-risk individuals about the importance of:
    • Exercising for 30 minutes or more, five times per week
    • Getting adequate sleep
    • Controlling calorie intake
    • Lowering fat intake for weight loss or weight maintenance
    • Increasing dietary fiber
    • Eating breakfast
    • Controlling blood pressure
    • Treating components of the metabolic syndrome if weight loss does not accomplish this
    • Controlling stress
  • Explain the importance of understanding the increased risk for:
    • Weight gain in smokers who stop smoking
    • Increasing weight with age
    • Diabetes
    • Heart disease
    • Sleep apnea
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Advise patients to reduce BMI and central adiposity to decrease health risks and improve quality of life, especially in patients with BMI >=30 kg/m2. A

  • Identify patients at risk by determining BMI and family history of obesity.
  • Identify patients at risk due to increasing body weight or low levels of activity.
  • Acquaint at-risk patients with potential danger of obesity, including increased mortality and higher risks of:
    • Diabetes
    • Heart disease
    • Hypertension
    • Stroke
    • Gall bladder disease
    • Osteoarthritis
    • Sleep apnea
    • Some forms of cancer
    • Erectile dysfunction
  • Develop a plan to reduce body weight.
  • Develop a plan to treat comorbidities if weight loss does not ameliorate them.
  • See figure Body Mass Index.
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FAQs
George A. Bray, MD, is a speaker for Eli Lilly, Amylin Corp., and Merck & Co., received grants from Merck & Co., and Takeda Pharmaceuticals; and has consulted for Sanofi-Aventis, Merck, and Amylin.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.

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