II. Indications
- See Obesity for diagnostic criteria
III. Contraindications: Weight Reduction
- Temporary Exclusions
- Pregnancy
- Lactation (allowed if milk established)
- Unstable mental or medical illness
- Possible Exclusions
- Permanent Exclusions
- Anorexia Nervosa
- Terminal illness
IV. History
- History of lifetime weight changes
- Medical conditions and medications predisposing to weight gain
- Prior weight management strategies and their effectiveness?
- Prior Obesity Medication use
- Family History of Obesity and metabolic conditions
- Social history
- Substance use (Tobacco, Alcohol, Illicit Drug use)
- Behavioral health (e.g. Major Depression, Anxiety Disorder, emotional stress, Trauma, PTSD)
- Physical Activity (work, home, Exercise)
- Nutrition history
- Meals (timing, portions, content, preparation)
- Habits or disordered eating that may benefit from modification (e.g. Binge Eating)
V. Exam
- Vital Signs
- Oropharynx
- Mallampati Score (Grades 3-4 associated with Sleep Apnea)
-
General Exam
- Cardiopulmonary exam
- Skin exam
- Determine Obesity Measurements
- See Obesity Measurement
- Body Mass Index (BMI)
- Waist Circumference
- Neck circumference (best predictor of Sleep Apnea)
VI. Labs
- Fasting Lipid profile
- Chemistry panel (including Fasting Serum Glucose)
-
Thyroid Stimulating Hormone (TSH)
- Rarely the cause for weight gain
VII. Approach
- See Obesity Management
- Evaluate Comorbid Obesity Risk
- Is Patient Ready and Able to lose weight?
- Yes: Weight Reduction Protocol
- No: Prevention of Weight Gain Protocol
VIII. Resources
- Frank (1998) J Am Diet Assoc 98:S44-48 [PubMed]
- Keating (2024) Am Fam Physician 110(2): 145-56 [PubMed]
- Lyznicki (2001) Am Fam Physician 63(11):2185-96 [PubMed]
- Rippe (1998) J Am Diet Assoc 98:S9-15 [PubMed]
- Speer (1997) Phys Sportsmed 25:94-107 [PubMed]
- (1998) AOA Treatment Adult Obesity, 2nd edition
- (1998) Obesity Res 6(suppl 2):51S-209S