By John D Charbonneau, MD, MPH, FACOEM

First Published: July 11, 2014

The Centers for Disease Control and Prevention facts regarding the obesity epidemic are alarming:

1. An estimated 97 million adults in the United States are overweight or obese.
2. Obesity is a risk factor for hypertension, abnormal blood lipids, type 2 diabetes, coronary artery disease, stroke, gall bladder disease, osteoarthritis, sleep apnea (please see the companion CDME Article regarding this topic) and certain respiratory conditions.
3. Obesity is linked to the occurrence of cancers of the endometrium, breast, prostate and colon.
4. Obesity is associated with an increase in mortality from all causes.
5. Societal stigmatization and isolation.

The costs associated with the obesity epidemic are similarly staggering:

1. In 2008, medical costs associated with obesity were estimated at $147 billion.
2. Annual medical costs for obese people are $1,429 higher than those of normal weight.
3. Annual costs associated with obesity are greater than those associated with smoking.

Obesity is both a major public health problem and an opportunity for workplace intervention and prevention.
The publication Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity has been prepared by a working group convened by the North American Association for the Study of Obesity and the National Heart, Lung and Blood Institute. The disease is both misunderstood and under-treated.

Obesity and overweight are usually assessed and tracked by means of two simple measurements:

1. Body Mass index. This is an estimate of total body fat content rather than simply body weight. It is a simple calculation based upon a person’s height and weight.
   • BMI = weight in kg divided by height in meters squared
   • BMI = weight in pounds x 703 divided by height in inches squared
   • Underweight is a BMI < 18.5
   • Normal is a BMI of 18.5 – 24.9
   • Overweight is a BMI of 25 – 29.9
   • Obesity is a BMI of 30.0 – 39.9
   • Extreme Obesity is a BMI of > or equal to 40.
2. Waist circumference in inches.
   • Men – High risk if greater than 40 inches
   • Women – High Risk if greater than 35 inches

Clinical judgment must be used to assess any individual patient but the measures above can be used as simple “rules of thumb.”

The approach to the treatment of any patient is an individualized assessment of:

1. BMI and waist circumference measurements.
2. Identification of high risk status by determining the presence of coronary heart disease or other atherosclerotic diseases (peripheral vascular disease, aortic aneurysm or carotid artery disease), all often referred to as “hardening of the arteries,” Type 2 Diabetes and Sleep Apnea.
3. Identification of other obesity-associated diseases.
4. Assess cardiovascular risk factors such as smoking, hypertension, abnormal blood lipids, impaired fasting glucose family history of premature coronary heart disease, and age and gender (Men over 45 years of age and women over 55 years of age).
5. Other risk factors such as physical inactivity.
6. All of these individual health variables are important to the overall diagnostic assessment of the patient and the individualized treatment prescription. Remember that “Diagnosis always precedes treatment.” It is tempting to skip the diagnostic evaluation, as it requires time and some expense but the appropriate assessment leads to the optimization of treatment and the best outcomes. It is also the best way to ensure safe exercise and weight loss.

There is certainly no shortage of weight reduction programs but this publication summarizes the 10 steps to treating overweight and obesity in the primary care setting:

1. Measure height and weight.
2. Measure waist circumference.
3. Assess co-morbidities.
4. Determine if the patient needs treatment.
5. Assess the patient’s readiness and motivation to lose weight. This is critical in ensuring success.
6. Determine an appropriate diet plan.
7. Agree to an appropriate, safe physical activity goal. Cardiovascular screening may be required.
8. Review weekly progress.
9. Dietary education.
10. Track goals and progress towards them.

Medications and surgical treatments (bariatric surgery) are usually reserved for patients with severe and complicated obesity problems.

Finally, the publication provides a wealth of useful information regarding shopping for food, nutrition and dietary advice, making appropriate choices when eating out, exercise and tracking your progress with your doctor.

We highly encourage you to visit with your primary care provider to discuss weight management and all of your health care needs. Helpful resources include:

1. Bariatric Center of the Rockies
2. Community health programs in northern Colorado
3. Seven steps to begin a weight loss plan