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Diagnosing obesity in your patients
Despite its increasing prevalence, obesity is one of the most misunderstood conditions in medicine. In fact, the AMA didn’t recognize it as a disease until 2013! In the United States, there are an estimated 30 million adults with diabetes, and 100 million adults with obesity. Obesity increases health risks and is associated with more than 60 comorbidities.
Physicians are key to the diagnosis of obesity, nevertheless studies show that only 55% of patients with obesity who seek treatment are diagnosed with this condition. Two key criteria for diagnosis include BMI ≥ 30 and sex-specific waist circumference (>40 inches in men; >35 inches in women).
When assessing waist circumference, be sure to take the following steps:
- Place the tape measure horizontally around the patient’s waist (i.e., between the lowest rib and the top of the hip bone); the umbilicus (i.e., belly button); or at the narrowest point of the midsection.
- Maintain a snug fit around the patient’s waist without pressing the skin and have the patient take a deep breath and exhale.
- Measure the waist circumference on exhalation.
Which of your patients do you evaluate for obesity? What measures do you use to diagnose obesity, and who takes these measures?
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Daniel Katselnik2yrall of em -
Lynn Hartman, UP HEALTH SYSTEM - MARQUETTE (FKA MARQUETTE GENERAL HOSPITAL)2yrBMI is calculated by the EMR but hardly ever do I calculate waist circumference. I have done this a few times but usually only with corporate wellness programs. I rely more on bmi but probably should also do waist.
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Kristy Chappell, BAPTIST HEALTH MADISONVILLE (FKA REGIONAL MEDICAL CENTER OF HOPKINS COUNTY)2yrAll patients have height and weight taken by the MA at each visit, EPIC calculates BMI. I also include a "dot phrase" in my assessment for each patient who is overweight (BMI >25) documenting that we discussed it and what efforts are being made (diet, lifestyle changes, medications), and also what the sequelae of obesity are (hypertension, GERD, etc.). This statement in the assessment provides info that is used to help get a PA on the medication, if needed.
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Leon Ronen2yrEMR automatically calculates the BMI. Only do waist circumference measurements only if other parameters of Metabolic syndrome are present: Triglycerides > 150, BP >130/80, HDL < 40 for men and <50 for women, FBS > 100
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Michael Koteles2yrHeight, weight and BMI by MA. I look for condition brought on by obesity (OA of knees/ankles, HLP, diabetes, HTH etc),record highest non-pregnant weight. Have not been measuring waist but feel it would be helpful.
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Irina Robinson2yrAll pts with metabolic conditions, using calculated BMI based on pts weight and height, I try to discuss weight management w/every pt who has BMI over 27
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Daniel Katselnik2yrBMI is the measure we use
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Ronald Villanueva, COMMUNITY MEDICAL CENTER2yrMy MA will do the vitals and input it into the EMR - the EMR does the calculation for the BMI. We do this for all out patients -not just the diabetics or obese patients as part of the vital signs. I proactively discuss weight /BMI with my patients - specially if they are overweight / Obese. I screen for sleep apnea/ fatty liver, as well as address their DM/ prediabetes/ lipid/ BP issues. A few patients will want their waist circumference checked and recorded and we do those as well
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Michelle Jardine2yrAll of those over 27 on bmi
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Michelle Jardine2yrI always get bmi height and weight and assess for obesity tratemrnt
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Michelle Jardine2yrpatient is evaluated for obesity with a BMI is checked height weight as well as risk for type 2 diabetes mellitus and other comorbid illnesses that would require treatment
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Nancy Squires3yrBMI is calculated by emr . Diagnosis has to be entered manually. Have not found waist circumference documentation to be too helpful but would take into account those with more muscle mass.
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Muhammad Nawaz3yrEvery patient in my practice gets evaluated for Obesity as weight /BMI recored along with the other vital signs on every encounter so gives a good idea about the weight gain over course of time , do take in to account the Lean Muscle mass in athletes and the body buliders where BMI Can be misleading , having taken in to account the BMI I also pay attention to the Waist to Hip ratio which is a much more significant predictor for the CV disease and is more important in the individuals who are not obese and in the above discussion is the correct way of measuring the waist , Medical assitant in my office reocrd these measures and are well trained in doing so ! When looking in to the waist circumference truncal obesity( fat in the paracolic gutters ) needs to be differntialed from the "love handles Subcutaneous fat as the protruded round belly seen in truncal obesity is the one whcih corresponds to the Increased CV risk as compared to the Subcutaneous fat seen laterally as "love handles "
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AIDA ATIQ3yrMostly BMI calculated by EMR and waist circumference for diagnosis of Metabolic syndrome to help patient understand there CVD risk .
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Christopher Case3yrAll with BMI, weight, height by myself or MA. Our weight management clinic dieitician does waist circumference measurements and bioelectrical impedence.
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Peggy Cyr3yrThis is an extremely important topic. I believe every patient should be screened for overweight and obesity. I feel so strongly about it I wrote an article about it! %3A-Predictors-of-Family-Physicians-Cyr-Haskins/13cb0452500e6c55f4d6123b851f06c849e14f3b
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Jorge Osorio3yrAll patients are evaluated for obesity, the medical assistant takes the vitals, weight, height than the bmi is calculated.
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RAMZY R, Physician3yrOur EMR auto-calculated BMI. I use BMI as another marker to diagnose obesity using the height and weight captured in triage. Nearly all patients with an elevated BMI have obesity discussions.