Obesity Risk

Aka: Obesity Risk, Obesity Comorbid Conditions

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II. Indications

  1. Obesity Evaluation for Management Strategy based on
    1. Comorbid conditions
    2. Body Mass Index (BMI)

III. Evaluation: Health Risk Stratification

  1. Minimal to Low Risk
    1. BMI <27 if no additional health risk factors
  2. Moderate Risk
    1. BMI >27 (or >25 if other risk factors present)
  3. High Risk (Class 1 Obesity)
    1. BMI >30 (Or >27 if other risk factors present)
  4. Very High Risk (Class 2 Obesity)
    1. BMI >35 (Or >30 if other risk factors present)
  5. Extremely High Risk (Class 3 Obesity)
    1. BMI >40 (Or >35 if other risk factors present)

IV. Evaluation: Comorbid Conditions

  1. Cardiovascular Disease: Nurses' Health Study
    1. Studied 115,818 nurses ages 30-55
    2. Over 14 years of study, 1292 nurses developed CAD
    3. Relative Risk (RR) of CAD increased with BMI
      1. Body Mass Index (BMI) < 21: RR = 1
      2. Body Mass Index (BMI) < 23: RR = 1.2
      3. Body Mass Index (BMI) < 25: RR = 1.48
      4. Body Mass Index (BMI) < 29: RR = 2.08
      5. Body Mass Index (BMI) > 29: RR = 3.53
    4. Reference
      1. Willett (1995) 273:461-5 [PubMed]
  2. Hypertension
    1. Systolic Blood Pressure increase 6.5mm per 10% weight
  3. Dyslipidemia
    1. Total Cholesterol increases 12 mg/dl per 10% weight
    2. Triglycerides increase with weight
    3. LDL Cholesterol increases with weight
    4. HDL Cholesterol falls with increasing weight
  4. Diabetes Mellitus (Type II Diabetes)
    1. Fasting Blood Sugar increases 2 mg/dl per 10% weight
    2. Obesity present in 80% of Type II Diabetes Mellitus
    3. BMI >35 confers 8-30x risk over normal weight
  5. Respiratory
    1. Sleep Apnea
    2. Pickwickian Hypoventilation
    3. Muscular work of breathing increased with weight
    4. Asthma worse at increased weight
    5. Pulmonary Hypertension
      1. Cardiomegaly
      2. Congestive Heart Failure
  6. Gastrointestinal Disease
    1. Gall Bladder Disease (Cholecystitis, Cholelithiasis)
    2. Nonalcoholic Steatohepatitis
  7. Joint Disease
    1. Osteoarthritis
    2. Degenerative Joint Disease
    3. Gouty Arthritis
  8. Miscellaneous Conditions
    1. Menstrual irregularities
  9. Malignancy
    1. Obese Women
      1. Endometrial CancerRelative Risk: 5
      2. Breast Cancer risk increased
      3. Cervical Cancer risk increased
      4. Ovarian Cancer risk increased
    2. Obese Men
      1. Colorectal Cancer risk increased
      2. Prostate Cancer risk increased

V. Evaluation: Risks for further weight gain

  1. Progressive weight gain since adolescence
  2. Family History of Obesity
  3. Bulimia or Binge Eating Disorder
  4. Depression, Anxiety or emotional Stress
  5. Medications Associated with Weight Gain
  6. Related Medical conditions
    1. Hyperinsulinemia (Type II Diabetes Mellitus)
    2. Breast Cancer
    3. Colon Cancer
    4. Endometrial Cancer
    5. Menopause
  7. Physical inactivity
  8. Smoking Cessation

VI. References

  1. Frank (1998) J Am Diet Assoc 98:S44-48 [PubMed]
  2. Hakala (2000) Chest 118:1315-21 [PubMed]
  3. Lyznicki (2001) Am Fam Physician 63(11):2185-96 [PubMed]
  4. Rippe (1998) J Am Diet Assoc 98:S9-15 [PubMed]
  5. Speer (1997) Phys Sportsmed 25:94-107 [PubMed]
  6. (1998) AOA Treatment Adult Obesity, 2nd edition
  7. (1998) Obesity Res 6(suppl 2):51S-209S

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