WIN Weight-control Information Network

Medical Care

for Obese

Patients

U.S. DEPARTMENT

OF HEALTH AND

HUMAN SERVICES

“Getting patients

to overcome their

sense of shame

when it comes to

discussing food

and diet progress

is difficult—the

most helpful

action is to listen

and establish a

sense of trust.”

—A health care provider

Approximately 30 percent of adults in the United States are obese, up

from 15 percent 2 decades ago. As prevalence rates continue to rise, most

health care providers can expect to encounter obese patients in their

practices. This fact sheet offers practical tips for overcoming the

challenges unique to providing optimal care to patients who are obese,

independent of weight loss treatment.

Obesity and Body Mass Index

Body mass index (BMI) closely correlates with body fat and can help

predict the development of health problems related to excess weight. BMI

is calculated by dividing weight in kilograms by height in meters squared

(or weight in pounds by height in inches squared and multiplied by 703),

or by using the chart on page 3.

The National Institutes of Health (NIH) identifies obesity as a BMI of 30

kg/m2

 or greater. Obesity is further broken down to Class I (BMI of 30-

34.9 kg/m2

), Class II (BMI of 35-39.9 kg/m2), and Class III (BMI of 40

kg/m2

 or greater), also called extreme obesity.

Challenges in Treating Obese Patients

Patients who are obese may delay seeking medical care. They may also be

less likely to receive certain preventive care services, such as Pap smears,

breast examinations, and pelvic examinations. Insufficient medical care is

probably the result of both patient and physician factors.

Providing Optimal Medical Care to Obese Patients

Health care providers can take steps to overcome barriers to ensure

optimal medical care of patients who are obese. Optimal care begins with

educating staff about treating patients with respect. Having appropriate
2

equipment and supplies on hand further increases patient access to care.

Weighing patients privately and only when necessary may help overcome

their reluctance to seek out medical services. Offering preventive services

in addition to monitoring and treating ongoing medical conditions helps

ensure that obese patients receive the same level of care as non-obese

patients. Finally, providers should encourage healthy behaviors and selfacceptance even in the absence of weight loss.

Using the following checklist can improve patient care in your office. To

create a positive office environment, review the checklist with your

medical and administrative staff.

Create an accessible and comfortable office environment.

❏ Provide sturdy, armless chairs and high, firm sofas in waiting rooms.

❏ Provide sturdy, wide examination tables that are bolted to the floor to

prevent tipping.

❏ Provide extra-large examination gowns.

❏ Install a split lavatory seat and provide a specimen collector with a

handle.

Use medical equipment that can accurately assess patients who

are obese.

❏ Use large adult blood pressure cuffs or thigh cuffs on patients with an

upper-arm circumference greater than 34 cm.

❏ Have extra-long phlebotomy needles, tourniquets, and large vaginal

speculae on hand.

❏ Have a weight scale with adequate capacity (greater than 350 pounds)

for obese patients.

Reduce patient fears about weight.

❏ Weigh patients only when medically appropriate.

❏ Weigh patients in a private area.

❏ Record weight without comments.

❏ Ask patients if they wish to discuss their weight or health.

❏ Avoid using the term obesity. Your patients may be more comfortable

with terms such as “difficulties with weight” or “being overweight.”

Patient barriers to

adequate medical care

and preventive services

■ Self-consciousness about

weight

■ Fears of disparaging,

negative, or inappropriate

comments from

physicians and medical

staff

■ Weight gain or failure to

lose weight since last

medical appointment

■ Past negative experiences

with or disrespectful

treatment from physicians

and medical staff

Health care provider

barriers to adequate

medical care and

preventive services

■ Lack of appropriate

medical equipment to

accurately assess and

treat patients who are

obese

■ Lack of training in

accommodating the

physical and emotional

needs of persons who are

obese

■ Perception that patients’

obesity is mainly due to

lack of willpower

■ Difficulty performing

examinations, such as

pelvic exams, due to the

patient’s size

■ Focus on treating ongoing

medical conditions, to the

exclusion of preventive

care services
3

Monitor obesity-related medical conditions and risk factors.

❏ Conduct tests to assess type 2 diabetes, dyslipidemia, hypertension,

sleep apnea, ischemic heart disease, and nonalcoholic steatohepatitis.

❏ Consider concerns of the extremely obese patient that may be overlooked such as lower extremity edema, thromboembolic disease,

respiratory insufficiency (Pickwickian syndrome), skin compression

(ulcers), and fungal infections.

Offer preventive care services.

❏ Allow adequate time during office visits for preventive care services.

❏ Recommend or provide preventive care services that are not impeded

by the size of the patient, such as Pap smears, breast examinations,

mammography, prostate examinations, and stool testing.

To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight.

The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.

BMI 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

Height

(inches) Body Weight (pounds)

58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 172 177 181 186 191

59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 198

60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 184 189 194 199 204

61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211

62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 196 202 207 213 218

63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 203 208 214 220 225

64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232

65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240

66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 223 229 235 241 247

67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 230 236 242 249 255

68 125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230 236 243 249 256 262

69 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236 243 250 257 263 270

70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278

71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 257 265 272 279 286

72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 265 272 279 287 294

73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302

74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 280 287 295 303 311

75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 287 295 303 311 319

76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328

Body Mass Index Table

“My doctor never judges

me on my weight, and

never talks down to me

about it.”

—A patient
Encourage healthy behaviors.

❏ Discuss weight loss—as little as 5 to 10 percent of body weight—as a

treatment for weight-related medical conditions.

❏ Emphasize healthy behaviors to prevent further weight gain, whether

or not the patient is able or willing to lose weight.

❏ Encourage physical activity to improve cardiovascular health.

❏ Seek out professional resources to assist your patients and provide

referrals to registered dietitians, certified diabetes educators, exercise

physiologists, weight management programs, and support groups, as

appropriate.

❏ Promote self-acceptance and encourage patients to lead a full and

active life.

Providing optimal medical care to patients who are obese may be

challenging. Changes that foster a supportive and accessible environment

for the patient, however, are within reach of most health care providers

and can go far to overcome both patient and provider barriers to care.

4

“My doctor talks about

nutrition and what to eat

for my type, but not about

dieting. She encourages

exercise, but doesn’t push.

I have been able to make

beneficial changes in my

diet under her nonjudgemental guidance. She

is very respectful... my

comfort seems to be a

goal for her.”

—A patient
Additional Reading

National Task Force on the Prevention and Treatment of Obesity. Medical

Care for Obese Patients: Advice for Health Care Professionals. American

Family Physician. Volume 65, Number 1. January 1, 2002.

Active at Any Size. NIH Publication No. 00-4352. Published by the

National Institute of Diabetes and Digestive and Kidney Diseases

(NIDDK) and available through the Weight-control Information Network

(WIN).

Healthy Eating and Physical Activity Across Your Lifespan: Better Health

and You. NIH Publication No. 02-4992. Published by the National

Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and

available through the Weight-control Information Network (WIN).

Patient Referrals and Information

National Diabetes Information Clearinghouse

1 Information Way

Bethesda, MD 20892-3560

Tel: (301) 654-3327

Toll-free: 1-800-860-8747

Email: ndic@info.niddk.nih.gov

Web: www.niddk.nih.gov/health/diabetes/ndic

Provides health information and publications on diabetes.

American Dietetic Association

216 West Jackson Boulevard

Chicago, IL 60606-6995

Toll-free: 1-800-366-1655

Email: findnrd@eatright.org

Web: www.eatright.org

Locate a registered dietitian (RD).

American Association of Diabetes Educators

100 West Monroe Street

Suite 400

Chicago, IL 60603

Toll-free: 1-800-338-3633

Email: aade@aadenet.org

Web: http://aade@aadenet.org

Locate a certified diabetes educator (CDE).

5
Weight-control

Information

Network

1 WIN WAY

BETHESDA, MD 20892-3665

Phone: (202) 828-1025

Toll-free number:

1-877-946-4627

FAX: (202) 828-1028

Email:

WIN@info.niddk.nih.gov

Internet: www.niddk.nih.gov/

health/nutrit/nutrit.htm

The Weight-control Information

Network (WIN) is a national service

of the National Institute of Diabetes

and Digestive and Kidney Diseases

of the National Institutes of Health,

which is the Federal Government’s

lead agency responsible for

biomedical research on nutrition

and obesity. Authorized by Congress

(Public Law 103-43), WIN provides

the general public, health

professionals, the media, and

Congress with up-to-date, sciencebased health information on weight

control, obesity, physical activity,

and related nutritional issues.

WIN answers inquiries, develops and

distributes publications, and works

closely with professional and patient

organizations and Government

agencies to coordinate resources

about weight control and related

issues.

Publications produced by WIN are

reviewed by both NIDDK scientists

and outside experts. This fact sheet

was also reviewed by Domenica

Rubino, M.D., George Washington

University Weight Management

Program.

Special thanks to Lynn McAfee of

the Council on Size and Weight

Discrimination for providing the

patient quotes for this fact sheet.

This publication is not copyrighted. WIN

encourages users of this fact sheet to duplicate

and distribute as many copies as desired.

This fact sheet is also available at

www.niddk.nih.gov/health/nutrit/nutrit.htm.

Medical Supplies and Equipment

Amplestuff: Make your world fit you (catalog)

PO Box 116

Bearsville, NY 12409

Tel: (845) 679-3316

Toll-free: 1-866-486-1655

Email: amplestuff@aol.com

Web: www.amplestuff.com

ConvaQuip Bariatric Equipment

Toll-free: 1-800-637-8436

Web: www.convaquip.com

Advocacy Organizations

American Obesity Association

1250 24th Street, NW

Suite 300

Washington, DC 20037

Tel: (202) 776-7711

Web: www.obesity.org

Council on Size and Weight Discrimination

PO Box 305

Mount Marion, NY 12456

Tel: (845) 679-1209

Web: www.cswd.org

National Association to Advance Fat Acceptance

PO Box 188620

Sacramento, CA 95818

Tel: (916) 558-6880

Web: www.naafa.org

NIH Publication No. 03-5335

February 2003

National Institute of Diabetes and

Digestive and Kidney Diseases