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

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Related Studies

Ontology: Obesity (C0028754)

Definition (MEDLINEPLUS)

Obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat, and/or body water. Both terms mean that a person's weight is greater than what's considered healthy for his or her height.

Obesity occurs over time when you eat more calories than you use. The balance between calories-in and calories-out differs for each person. Factors that might affect your weight include your genetic makeup, overeating, eating high-fat foods, and not being physically active.

Being obese increases your risk of diabetes, heart disease, stroke, arthritis, and some cancers. If you are obese, losing even 5 to 10 percent of your weight can delay or prevent some of these diseases. For example, that means losing 10 to 20 pounds if you weigh 200 pounds.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Definition (NCI_NCI-GLOSS) A condition marked by an abnormally high, unhealthy amount of body fat.
Definition (NCI_CTCAE) A disorder characterized by having a high amount of body fat.
Definition (NCI) Having a high amount of body fat (body mass index [BMI] of 30 or more).
Definition (CSP) excessively high accumulation of body fat or adipose tissue in relation to lean body mass; the amount of body fat (or adiposity) includes concern for both the distribution of fat throughout the body and the size of the adipose tissue deposits; individuals are usually at high clinical risk because of excess amount of body fat (BMI greater than 30).
Definition (MSH) A status with BODY WEIGHT that is grossly above the acceptable or desirable weight, usually due to accumulation of excess FATS in the body. The standards may vary with age, sex, genetic or cultural background. In the BODY MASS INDEX, a BMI greater than 30.0 kg/m2 is considered obese, and a BMI greater than 40.0 kg/m2 is considered morbidly obese (MORBID OBESITY).
Concepts Disease or Syndrome (T047)
MSH D009765
ICD9 278.00
ICD10 E66 , E66.9
SnomedCT 5476005, 154776002, 190963004, 414916001, 414915002
LNC LA6301-1
English Obesity, Obesity, unspecified, OBESITY, obesity (diagnosis), obesity, Obesity NOS, Obesity [Disease/Finding], obese, adiposity, Obesity, NOS, Obesity [Ambiguous], Obese, Obese (finding), Obesity (disorder)
French OBESITE, Obésité, non précisée, Obésité
Portuguese OBESIDADE, Obesidade NE, Obesidade
Spanish OBESIDAD, Obesidad no especificada, obesidad (trastorno), obesidad, obeso (hallazgo), obeso, Obesidad
Dutch obesitas niet-gespecificeerd, Vetzucht, niet gespecificeerd, zwaarlijvigheid, Adipositas, Vetzucht
German Fettleibigkeit, unspezifisch, ADIPOSITAS, Adipositas, nicht naeher bezeichnet, Adipositas, Fettsucht, Obesitas
Italian Obesità, non specificata, Obesità
Japanese 肥満, 肥満、詳細不明, ヒマン, ヒマンショウサイフメイ
Swedish Fetma
Czech obezita, Obezita, blíže neurčená, Obezita, otylost
Finnish Lihavuus
Korean 상세불명의 비만, 비만
Polish Otyłość
Hungarian Obesitas, nem meghatározott, Obesitas
Croatian Gojaznost, Pretilost
Norwegian Fedme

Ontology: Obesity Adverse Event (C1963185)

Concepts Finding (T033)
English Obesity Adverse Event, Obesity