Long after New Year’s Day, you find yourself thinking about how you are managing your patients with obesity. In the United States, the majority of adults are either overweight or obese. As a primary care clinician, you frequently encounter health problems associated with obesity, including cardiovascular disease, diabetes, and joint and muscle aches and pains. At the same time, you can’t remember the last time you discussed a patient’s weight if he or she did not specifically mention it as a problem during the course of the visit. However, as a means of co-morbidity management and as a form of preventative care, it is critically important for you to have the conversation about weight loss and weight management with patients outside the normal weight range. How do you start?
As a first step, you should obtain the weight and height of every patient who comes into clinic. Next, calculate the body mass index (BMI) in one of three ways: you can use your clinic’s software to include a BMI calculation, plug the numbers into an online calculator, or solve the calculation by hand by converting the patient’s height to meters and weight to kilograms. The formula to calculate BMI is: BMI = weight(in kg)/(height (in m))2.
Using this equation, you will be able to determine if your patients are underweight (BMI less than 18.5), normal weight (BMI 18.5-24.9 in the United States, BMI 18-23 in India), overweight (BMI 25-29.9), or obese (BMI over 30).
The next step is the most difficult: taking the time out of a visit to talk about weight and weight management. It may make sense to create a template for how you want to have this conversation. Some clinicians discuss diet and exercise with every patient – regardless of weight. To do so, you need to have set aside time, suggestions for weight loss, weight maintenance, or weight gain management, and referrals. Management options can be categorized broadly as lifestyle modifications, medications, and bariatric surgery. Lifestyle modifications include behavioral changes, improved diet, and increased exercise. Some patients may request or require medications currently approved for weight loss in the United States. Other patients may even meet the BMI requirement (BMI > 40) for undergoing bariatric surgery. If they have a BMI between 35 and 40, they might be eligible for bariatric surgery if they have any weight-associated co-morbid conditions. Additionally, you should have a list of other professionals who may need to be involved in your patient’s care, including a vetted psychologist, nutritionist, physical trainer, and/or pharmacist for additional support.
Sturgiss EA, Elmitt N, Haesler E, Van weel C, Douglas KA. Role of the family doctor in the management of adults with obesity: a scoping review. BMJ Open. 2018;8(2):e019367.
Dr. V. Silverstein
Published on 5/6/19