Definitions

Body Mass Index (BMI) describes relative

weight for height: weight (kg)/height (m2)
Overweight = 2529.9 BMI
Obesity = > 30 BMI

Age-Adjusted Standardized Prevalence of Overweight

(BMI 2529.9) and Obesity (BMI >30)
NHES I

NHANES I

NHANES II

NHANES III

50

Percent

40
30
20
10
0
Men

Women

BMI 2529.9
CDC/NCHS, United States, 1960-94, ages 20-74 years

Men

BMI > 30

Women

NHANES III Age-Adjusted Prevalence of

Hypertension* According to BMI
BMI <25

BMI 25-26

BMI 27-29

BMI >30

50
38.4

Percent

40

32.2

30
20

18.2

22.5

25.2

21.9

24.0

16.5

10
0
Men
*Defined as mean systolic blood pressure 140 mm Hg, as mean diastolic 90 mm
Hg, or currently taking antihypertensive medication .
Brown C et al. Body Mass Index and the prevalence of
Risk Factors for Cardiovascular Disease (in preparation).

Women

NHANES III Age-Adjusted Prevalence of

High Blood Cholesterol* According to BMI
BMI <25

BMI 25-26

BMI 27-29

BMI >30

50

Percent

40

27.9

30
20

14.7

17.5

20.4

20.2

28.2

15.7

10
0
Men
*Defined as > 240 mg/dL.
Brown C et al. Body Mass Index and the Prevalence of
Risk Factors for Cardiovascular Disease (in preparation).

Women

24.7

NHANES III Age-Adjusted Prevalence of

Low HDL-Cholesterol* According to BMI
BMI <25

60

BMI 25-26

BMI 27-29

BMI >30

Percent

50

41.5

40

31.4

30

23.1
17.2

20
10

27.0

27.2

16.5

9.1

0
Men
*Defined as <35 mg/dL in men and <45 mg/dL in women.
Brown C et al. Body Mass Index and the Prevalence of
Risk Factors for Cardiovascular Disease (in preparation).

Women

Health Benefits of Weight Loss

Decreased cardiovascular risk

Decreased glucose and insulin levels
Decreased blood pressure
Decreased LDL and triglycerides, increased HDL
Decrease in severity of sleep apnea
Reduced symptoms of degenerative joint disease
Improved gynecological conditions

Care of Overweight/Obese Patients

Requires two steps:

Assessment
Management

Assessment of Overweight and Obesity

Body Mass Index
Weight (kg)/height (m2)
Weight (lb)/height (in2) x 703
Table
Waist Circumference
High risk:
Men >102 cm (40 in.)
Women >88 cm (35 in.)

Classification of Overweight and Obesity by BMI

Obesity Class

BMI kg/m

Underweight

<18.5

Normal

18.524.9

Overweight

2529.9

Obesity

Extreme Obesity

30.034.9

II

35.039.9

III

40.0

Determine Absolute Risk Status

Evaluate:
Disease conditions (e.g., CHD, type 2 diabetes, sleep apnea)
(+ = very high risk)
Other obesity-associated diseases (e.g., gynecological
abnormalities, osteoarthritis)
Cardiovascular risk factors: smoking, hypertension,
high LDL, low HDL, IGT, family hx (>3 = high risk)
Other risk factors:
Physical inactivity
High serum triglycerides (>200 mg/dL)

Patient Encounter

Treatment Algorithm

Hx of 25 BMI?
No

BMI
measured in past
2 years?

Yes

6
Measure weight,
height, and waist
circumference
Calculate BMI

BMI 25 OR
waist circumference
> 88 cm (F)
> 102 cm (M)

Yes

BMI

Assess risk
factors

30 OR

{[BMI 25 to 29.9
OR waist circumference Yes
>88 cm (F) >102 cm (M)]
AND 2 risk
factors}

No
14

Hx BMI 25?

15

Examination
Treatment

No

Brief reinforcement/
educate on weight
management

8
Clinician and patient
devise goals and
treatment strategy
for weight loss and
risk factor control

No
12

Yes

Does
patient want to
lose weight?
No

13

Yes
Yes

Advise to maintain
weight/address
other risk factors

Progress
being made/goal
achieved?
No

11

16
Periodic weight
check
:

10

Maintenance counseling: Assess reasons for

failure to lose
Dietary therapy
weight
Behavior therapy
Physical activity

Examination
Treatment

Hx of 25
BMI?
No

Treatment Algorithm
(Part 1 of 3)

Patient Encounter

BMI
measured in past
2 years?

Yes

4
Measure weight,
height, and waist
circumference
Calculate BMI

BMI 25 OR
Yes
Assess risk
waist > 88 cm (F)
factors
> 102 cm (M)
No

BMI
30 OR
{[BMI 25 to 29.9
OR waist >88 cm (F)
>102 cm (M)]
AND 2 risk
factors}
7

No

Yes

Examination

BMI
30 OR
7 {[BMI 25 to 29.9
>88 cm (F)
OR waist
>102 cm (M)]
AND 2 risk

factors}

Treatment

12
No

Treatment Algorithm
(Part 2 of 3)

Yes

8
Devise goals and
treatment strategy for
weight loss and risk
factor control

No

Desire to
lose weight?

Yes
Yes

13

Advise to maintain weight

No

Address other risk factors

16
Periodic weight
check

Progress
made?

11

10
Maintenance
counseling

Assess reasons for

failure to lose weight

BMI 25 OR
waist > 88 cm (F)
> 102 cm (M)

Treatment Algorithm
(Part 3 of 3)

Yes

Examination
Treatment

No
14

15

Yes

25?
Hx BMI
No

13

Brief reinforcement
Educate on weight
management

* This algorithm applies only to the

assessment for overweight and obesity

and subsequent decisions based on that
assessment. It does not include any
initial overall assessment for
cardiovascular risk factors or diseases
that are indicated.

Advise to maintain weight

Address other risk factors

16
Periodic weight
check