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U.S. NIH’s Obesity Guidelines Part 32: Advice for weight loss treatments
Monday, December 20, 2004 10:12 pm Email this article
Weight loss surgery is an option for carefully selected patients with clinically severe obesity (BMI greater than 40 or BMI greater than 35 with comorbid conditions) when less invasive methods of weight loss have failed and the patient is at high risk for obesity-associated morbidity or mortality according to the U.S. NIH's Obesity Guidelines (p. xxiii).
Measure risk factors in addition to BMI. Health care professionals should evaluate a patient’s risk factors, such as elevations in blood pressure or blood cholesterol, or family history of obesity-related disease in addition to measuring BMI.
Waist should be less than 40 inches for men, 35 for women
A patient’s waist should be measured to approximate abdominal fat. Excess abdominal fat is an independent predictor of disease risk.
A waist circumference of over 40 inches in men and over 35 inches in women signifies increased risk in people with a BMI of 25 to 34.9.
Allow 6 months to lose 10%
Six months is a reasonable time to lose 10 percent of body weight. This allows for a weight loss of 1 to 2 pounds per week. (p. xi)
Weight maintenance should be a priority after 6 months
Weight maintenance should be a priority after the first 6 months of weight-loss therapy.
Avoid further weight gain
Overweight and obese patients who are not candidates for weight loss treatment or who do not want to lose weight should be counseled on strategies to avoid further weight gain.
Obesity-related diseases increase the risk of death
Overweight patients with any of the following conditions are at a very high risk for disease complications and death: established coronary heart disease (CHD), other atherosclerotic diseases, type 2 diabetes, and sleep apnea (p. xi).
Cardiovascular diseases risk factors
Patients with at least three of the following conditions are considered high risk (p. xi and 64):
- Cigarette smoking
- Hypertension (greater than 140/90)
- High-risk LDL-cholesterol (greater than 160 mg/dL)
- Low HDL-cholesterol (less than 35 mg/dL)
- Impaired fasting glucose (110 to 125 mg/dL)
- Family history of premature coronary heart disease (a heart attack or sudden death in father or first-degree male relative before age 55, or in mother or first-degree female relative before age 65)
- Age (men older than 45, and women older than 55 or postmenopausal)
- Physical inactivity
- High serum triglycerides (greater than 200 mg/dL)
Measuring obesity: BMI
Body Mass Index (BMI) provides an acceptable approximation of total body fat for the majority of people and should be used to determine overweight and obesity.
More accurate methods are available, but are expensive and not readily available. (p. xix and 55)
Classifications by BMI
Classifications of overweight and obesity using BMI is as follows: (p. 60)
- Underweight 18.4 or less
- Normal 18.5 to 24.9
- Overweight 25 to 29.9
- Obesity class I 30 to 34.9
- Obesity class II 35 to 39.9
- Obesity class III/Extreme obesity 40 or more
A BMI Table can be found here.
Waist measurement better predictor with age
A waist measurement also becomes more valuable at predicting the risk of disease as people age. (p. 61)
Waist increases risk of diabetes, hypertension and heart disease
A high waist circumference is associated with an increased risk for type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease. (p. xx and 61)
Waist measurement better for Asians
A waist measurement is a better than BMI at predicting the risk of disease in Asians or Asian-Americans. (p. 61)
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults : the evidence report / National Heart, Lung, and Blood Institute [Bethesda, Md.] : National Institutes of Health, National Heart, Lung, and Blood Institute, . NIH publication No. 98-4083.
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