activity. A personalized treatment plan must, therefore, take into account each patient’s capability for adherence to a lifestyle intervention based on personal and cultural preferences and psychological, social, and environmental factors. Interventions that do not take these factors into account are likely to lead to a poorer outcome. Accordingly, the diagnostic evaluation of obesity must provide clinical data that address psychosocial, behavioral, and environmental factors in addition to the presence of complications and their impact on quality of life. The diagnosis of overweight and obesity as well as risk stratification and determination of which treatment approaches are appropriate has historically been based on the American Heart Association (AHA) and World Health Organization (WHO) guidelines which exclusively use BMI and waist circumference. The use of new clinical staging systems that take into account other characteristics besides simply BMI provides the opportunity for healthcare providers (HCPs) to match and prioritize treatments to individuals with obesity depending upon the severity and complications of their disease.
factors such as personal and cultural preferences for food and physical activity, the built environment with access to unprocessed food or exercise facilities, support systems, and health literacy in developing effective lifestyle prescriptions.
FIGURE 3.2 The diagnostic evaluation of patients with obesity has both anthropometric and clinical components. BMI, body mass index.
of BMI to include a clinical component. The clinical component of the diagnosis involves a full medical history and examination that assess the risk, presence, and severity of complications and establishes the degree to which an increase in adipose mass affects the patient’s health. The development of weight-related complications varies markedly among patients at any given BMI level.1 While the likelihood of weight-related complications generally increases as a function of progressive obesity, there can be a poor correlation between BMI and the emergence of complications. Patients with obesity need not have weight-related complications and can be free of increased risk for certain disease-related morbidity and mortality. On the other hand, patients with comparable degrees of excess adipose tissue can develop multiple cardiometabolic and biomechanical complications in a manner that is independent of the increased BMI. Thus, the clinical evaluation can provide the basis for the identification of the high-risk patient and disease staging. Since weight loss will ameliorate or prevent many weight-related complications, the clinical component of the diagnosis also helps guide the intensity and modality of treatment and helps inform the end points of therapy.
FIGURE 3.3 Adiposity-based chronic disease (ABCD). ABCD as a diagnostic term for obesity signifies: (1) “what we are treating” which relates to abnormalities in the mass, distribution, or function of adipose tissue, and (2) “why we are treating it” as a chronic disease which is to prevent or ameliorate obesity complications that confer morbidity and mortality and impair the quality of life.
TABLE 3.1 Aggravating Factors and Social and Environmental Determinants
the empowerment of patients for self-care and the availability of evidence-based treatments. Lack of access to unprocessed and healthy foods or outlets for physical activity can reduce the effectiveness of prescriptions for lifestyle therapy. Behavioral attributes, cultural preferences, work patterns, and time management issues can also impede therapeutic success if not identified and addressed. Solutions to address these social and environmental determinants can involve culturally appropriate education and lifestyle modifications, individualized counseling, and referrals to social workers, registered dietitian nutritionist (RDN), and community resources.
instances, further testing beyond the intake evaluation may be necessary for the diagnosis and assessing the severity of individual complications.
TABLE 3.2 Underlying Causes of or Aggravating Factors Causing Obesity