Assessment of the Obese Adult
Article Outline
Obesity is a prevalent and growing problem in America that demands attention and intervention. Two thirds of all adults in the United States are overweight or obese.1 Obesity is a risk factor for many medical conditions such as type 2 diabetes, coronary heart disease, hypertension, dyslipidemia, infertility, various cancers, sleep apnea, and osteoarthritis. Merely 42% of all obese adults report being told to lose weight by their health care providers.2 Nurse practitioners (NPs) have the opportunity to confront this epidemic and educate their patients about weight loss. The National Institutes of Health (NIH) recommends using the 5 A's when discussing weight loss with obese patients: assess, ask, advise, assist, and arrange.2
First, assess the patient's risk of developing obesity-related comorbidities by classifying the degree of obesity. Different methods may be used to determine if a person is overweight or obese. Body fat calipers measure body fat through skin-fold thickness. This method is primarily utilized by fitness and weight loss centers and is not necessarily reflective of the patient's overall body size. Some health care workers will obtain waist circumference measurements to categorize patients. This is a useful tool to determine a patient's abdominal obesity and associated risk for cardiovascular disease. Men with a waist circumference greater than 40 inches and women with a waist circumference greater than 35 inches are considered abdominally obese.3 This measurement has some limitations because not all health care professionals will use the same body landmarks to obtain a consistent measurement, and the waist circumference does not take into account the entire physique.
The NIH recommends calculating the body mass index (BMI) to determine obesity in the health care setting.2 The BMI is a calculation of weight in kilograms, divided by meters squared. Persons age 18 years and older with a BMI of 25 to 29.9 are considered overweight and those with a BMI of 30.0 or greater are considered obese (Table 1). The BMI is not applicable to pregnant or lactating women.
Table 1. Weight Classification by BMI
| Classification | BMI Category (kg/m2) |
|---|---|
| Underweight | < 18.5 |
| Normal weight | 18.5–24.9 |
| Overweight | 25.0–29.9 |
| Obese class I | 30.0–34.9 |
| Obese class II | 35.0–39.9 |
| Obese class III | 40.0 and higher |
Ask about readiness to lose weight. How long has the patient been overweight or obese? Inquire about previous attempts to lose weight. What are the current motivating factors for weight loss? Is there an adequate social support system? Ask about specific behaviors that may interfere with a healthy lifestyle, such as time constraints, life stressors, and other factors that spur overeating.
In addition to diet, ask about the patient's exercise history. Follow the American Heart Association's FIT guidelines when inquiring about exercise. F is for frequency (number of days per week); I is for intensity (easy, moderate, or vigorous); and T is for time (amount per session). Are there any physical limitations that may prohibit or interfere with the patient's ability to perform certain exercises?
Advise patients who are ready to lose weight about an appropriate weight loss program curtailed to the individual's specific needs.2 Take a thorough diet history. If possible, have the patient keep a detailed food journal for 3 to 5 days and then review. Ask additional questions: Does the patient take lunch to work? How often do they eat fast food, fried foods, and red meat? How many servings of vegetables and fruits are incorporated into the daily diet? How many meals per week are eaten out at restaurants? Do they drink alcohol? If so, what type and how many ounces per day? Do they drink regular soda? How many ounces per day?
Assist patients in choosing appropriate interventions. A complete lifestyle change program, including a low-calorie, low-fat diet, regular exercise, behavioral therapy, and professional expertise provides the most successful regimen for weight loss.2 A decrease in caloric intake is the most important dietary change associated with weight loss.2 Instruct patients to reduce their number of daily calories by 500 to 1000 to produce a 0.5- to 1.0-pound weight loss per week.2 Patients should consume whole grains, high fiber, fish, vegetables, fruits, and low-fat dairy products. Minimize saturated fats, trans fats, cholesterol, sugars (including regular soda and alcohol), salt, and red meat. Encourage patients to slowly increase their physical activity to at least 30 minutes 5 days per week at a moderate pace.3 Teach patients to identify and correct those behaviors that lead to overeating. Involve other professionals such as dieticians, exercise physiologists, or psychologists to further target lifestyle problems and recommend appropriate changes.
Prescription medications for weight loss should be reserved for obese patients who have a BMI greater than 30 and no associated comorbidities or those with a BMI of 27 or greater with comorbidities.2 Patients with a BMI of 40 or more, or those who need to lose at least 100 pounds, may be considered for bariatric surgery.
Arrange for follow-up on a regular basis with patients during both the weight loss and weight maintenance phases. Close monitoring of patients, particularly after the first 6 months of weight loss, are crucial, as this is the time frame where weight loss stabilizes and weight gain begins.2
Obesity in the United States is a widespread problem encountered each day by the NP. NPs can help reduce the adult obesity rate one patient at a time. Remember to assess the patient's degree of obesity, ask about readiness to lose weight, advise those who are ready, assist with a proper weight loss strategy, and arrange for close follow-up.
References
- Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002 . JAMA . 2004;291:2847–2850
- . Weight loss counseling revisited . JAMA . 2003;289:1747–1750
- . Clinical management of metabolic syndrome: Report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association Conference on Scientific Issues Related to Management . Circulation . 2004;109:551–556
PII: S1555-4155(08)00413-3
doi:10.1016/j.nurpra.2008.07.021
© 2009 American College of Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
