Medical Care for

Patients with Obesity

WIN Weight-control Information Network

U.S. Department of Health 

and Human Services

NATIONAL INSTITUTES OF HEALTH

More than one-third of adults in the United States are obese. The U.S. 

Government views obesity as one of the most severe health concerns 

facing the nation. With so many people struggling with obesity, almost 

all health care providers can expect to care for patients who are obese. 

This fact sheet offers helpful tips for health care providers to overcome 

the challenges unique to providing optimal care to these patients, no 

matter what weight-loss treatment is used.

What Is Obesity?

“Obesity” refers to an excess amount of body fat. It develops when the 

number of calories (energy) consumed in food and beverages exceeds 

the number of calories that the body burns to function. There are few 

studies in humans that link direct amounts of total body fat to sickness 

and death. There are also no formal standards issued by the National 

Institutes of Health (NIH) that define obesity based on the amount 

or percentage of a person’s total body fat. A common way to screen for 

obesity is the body mass index. 

What Is the Body Mass Index?

The Body Mass Index (BMI) is a tool used to measure weight as it 

relates to height. BMI has its limits. It does not assess body fat or 

muscle directly. BMI is measured by dividing a person’s weight in 

pounds by height in inches squared and multiplying by 703.

Men and women can have the same BMI but different body fat 

percentages. As a rule, women usually have more body fat than men. 

A bodybuilder with large muscle mass and low body fat may have the 

same BMI as a person who has more body fat. However, a BMI of 30 

or higher usually suggests excess body fat. 

The NIH currently defines overweight as a BMI of 25 to 29.9 and 

obesity as a BMI greater than or equal to (≥) 30. Obesity is further 

broken down into Class I (BMI of 30 to 34.9), Class II (BMI of 35 to 

39.9), and Class III (BMI ≥ 40) or “extreme obesity.” (See BMI table 

on page 7.) An online tool for measuring BMI is available at 

http://www.nhlbisupport.com/bmi/bminojs.htm.

 “Helping patients 

to overcome 

their sense of 

shame when 

it comes to 

discussing 

food and healthy 

eating may 

be hard—the 

most helpful 

action is to listen 

and establish a 

sense of trust.”

—A health care 

 provider
What Are Some of the Challenges to Treating 

Patients with Obesity?

Patients with obesity may delay seeing a health care provider for 

routine medical care. They may also be less likely to receive certain 

health tests, such as Pap smears, breast exams, and pelvic exams. Lack 

of routine medical care is most likely the result of both patient and 

provider factors. Both the patient and the health care provider play a 

role in the health of the patient.

How Can Health Care Providers Offer Optimal 

Medical Care to Patients with Obesity?

Health care providers can take steps to make sure that their patients 

receive quality care. Health care providers should do the following: 

■ Treat patients with respect. 

■ Have suitable equipment and supplies on hand to improve 

patient access to care. 

■ Support healthy behaviors and self-acceptance even if the 

patient does not wish to lose weight or cannot successfully lose 

weight.

To create a positive office climate, medical and other staff should 

review this fact sheet. 

Create a positive, open, and comfortable office space

■ Provide sturdy, armless chairs and high, firm sofas in 

waiting rooms.

■ Provide sturdy, wide exam tables bolted to the floor to 

prevent tipping.

■ Provide a sturdy stool or step with handles to help patients 

climb onto the exam table.

■ Provide extra-large patient gowns.

■ Install a split toilet seat. Provide a specimen collector with 

a handle.

■ Provide reading materials in the waiting room that focus on

healthy habits, rather than physical looks or being “thin.”

2

Here are some issues 

that may prevent 

patients with obesity 

from seeking help:

■ Being ashamed 

or embarrassed 

about their 

weight

■ Hearing hurtful 

comments that 

the health care 

provider or staff 

may say about 

their weight

■ Being disrespected 

by staff or health 

care providers in 

the past
3

Use medical devices that can correctly assess patients 

with obesity

■ Use large adult blood pressure cuffs or thigh cuffs on patients

with an upper-arm circumference greater than 34 cm.

■ Use extra long needles to draw blood and have large vaginal

specula on hand.

■ Have a weight scale with the capacity to measure patients who 

weigh more than 400 pounds. 

Be respectful when talking about the patient’s weight

■ Weigh patients in a private area and only when 

medically needed.

■ Record weight without comments.

■ Ask patients if they want to discuss their weight or health.

■ Avoid using the term “obesity.” Your patients may prefer such 

terms as “ BMI” or “weight.” Ask your patients what terms they 

would like you to use when discussing their weight.

Track and test for the following health problems linked 

to obesity: 

■ type 2 diabetes

■ hypertension (high blood pressure)

■ sleep apnea (when breathing pauses while sleeping)

■ nonalcoholic steatohepatitis (fatty liver disease)

■ lower extremity edema (swelling of the legs and feet)

■ skin compression (ulcers)

Offer well-care services

■ Allow enough time during office visits to provide well-care 

services.

■ Suggest or provide such services as Pap smears, breast exams, 

mammography, prostate exams, and stool testing.

Here are some issues 

that may prevent a 

health care provider 

from providing the 

best care to patients 

who are obese: 

■ Lack of suitable 

medical tools to 

correctly assess 

and treat patients

■ Lack of training 

in providing the 

physical and 

emotional support 

that patients may 

need

■ Belief that a 

patient’s weight is 

mainly due to lack 

of willpower

■ Challenges 

performing exams, 

such as pelvic 

exams, due to a 

patient’s size
4

Promote healthy behaviors

■ Ask your patients if they would like to talk about weight loss. 

If they want to talk about losing weight, let them know that a 

weight loss of 5 to 7 percent of body weight may lower their 

chance of developing diabetes. Work with your patients to 

establish realistic goals.

■ Start small. Encourage patients to start with simple goals such 

as walking for 10 minutes, three times a day. Once they achieve 

this goal, they can build on it. 

■ Offer patients information and referrals to registered dietitians, 

other health providers, and support groups, as needed.

■ Promote self-acceptance and encourage patients to lead full and 

active lives. 

Health care providers have the power to help improve the lives of 

patients with obesity. Changes that foster respect for the patient and 

a supportive and well-designed space for receiving services are within 

reach of most health care providers. The suggestions outlined in this 

fact sheet offer a solid starting place. Additional resources to help 

achieve these changes are listed at the end of this fact sheet.

Additional Information for Health Care Providers

Davis NJ, Shishodia H, Taqui B, Dumfeh C, Wylie-Rosett J. Resident 

physician attitudes and competence about obesity treatment: need 

for improved education. Medical Education Online. 2008;13:5. 

Available at http://www.med-ed-online.net/index.php/meo/article/

download/4475/4655. Accessed March 2011.

Huizinga MM, Cooper LA, Bleich SN, Clark JM, Beach MC. 

Physician respect for patients with obesity. Journal of General Internal 

Medicine. Nov 2009;24(11):1236–1239. Available at 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771236/?tool=pubme. 

Accessed March 2011.

National Heart, Lung, and Blood Institute, NIH. Body Mass Index 

Tables. http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm. Accessed 

June 2011.

“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 nonjudgmental 

guidance. She is very 

respectful. . . . My 

comfort seems to be 

a goal for her. ”

—A patient
5

National Task Force on the Prevention and Treatment of Obesity. 

Medical care for obese patients: advice for health care professionals. 

American Family Physician. 2002;65(1):81–88. Available at 

http://www.aafp.org/afp/2002/0101/p81.html. Accessed March 2011.

Shay LE, Shobert JL, Seibert D, Thomas LE. Adult weight 

management: translating research and guidelines into practice. Journal 

of the American Academy of Nurse Practitioners. Apr 2009;21(4):197–

206. Available at http://onlinelibrary.wiley.com/doi/10.1111/

j.1745-7599.2008.00383.x/full. Accessed March 2011.

Medical Supplies and Equipment

Amplestuff: Make Your World Fit You (Catalog)

Department WS

P.O. Box 116

Bearsville, NY 12409

Phone: 845–679–3316

Toll-free number: 1–866–486–1655

Email: amplestuff2@aol.com

Internet: http://www.amplestuff.com

Additional Reading from the Weight-control 

Information Network

The following publications are available online at the addresses listed in 

each description and also by calling WIN toll-free at 1–877–946–4627.

Active at Any Size is a brochure that provides ideas and tips on how 

people who are overweight or obese can be physically active. It focuses 

on handling common barriers and setting goals. Available at 

http://www.win.niddk.nih.gov/publications/active.htm.

Bariatric Surgery for Severe Obesity is a fact sheet that discusses 

bariatric surgery as an option for people who are severely obese and 

who cannot lose weight by standard means or who suffer from serious 

health problems linked to obesity. Available at 

http://www.win.niddk.nih.gov/publications/gastric.htm.

Just Enough for You: About Food Portions is a brochure defining the 

difference between a portion—the amount of food a person chooses 

to eat—and a measured serving. It offers tips for judging portion sizes 

and for controlling portions at home and when eating out. Available in 

English and Spanish at http://www.win.niddk.nih.gov/publications.

Changes that 

foster respect for 

the patient and 

a supportive and 

well-designed 

space for receiving 

services are 

within reach of 

most health care 

providers.
Talking With Patients About Weight Loss: Tips for Primary Care 

Professionals is a fact sheet discussing how primary care providers 

are in an ideal position to offer weight-loss guidance to patients 

who are overweight or obese. This fact sheet offers tips that can help 

professionals talk with patients about this subject. Available at 

http://www.win.niddk.nih.gov/publications/talking.htm.

Walking . . . A Step in the Right Direction is a brochure explaining 

how to start a walking program, presenting a sample program, and 

showing stretches for warming up and cooling down. Available in 

English and Spanish at http://www.win.niddk.nih.gov/publications.

Additional Information for Patients

American Association of Diabetes Educators

100 West Monroe Street, Suite 400

Chicago, IL 60603

Phone: 1–800–338–3633

Email: aade@aadenet.org

Internet: http://www.diabeteseducator.org

Locate a certified diabetes educator (C.D.E.).

American Dietetic Association

120 South Riverside Plaza, Suite 2000

Chicago, IL 60606–6995

Phone: 1–800–877–1600

Email: findnrd@eatright.org

Internet: http://www.eatright.org

Locate a registered dietitian (R.D.).

National Diabetes Information Clearinghouse

1 Information Way

Bethesda, MD 20892–3560

Phone: 1–800–860–8747

Email: ndic@info.niddk.nih.gov

Internet: http://www.diabetes.niddk.nih.gov

Find health information and publications on diabetes.

“My doctor never 

judges me on my 

weight and never 

talks down to me 

about it.”

—A patient

6
7

The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight (in pounds). Body Mass Index Table

Body Mass Index Table

Normal Overweight Obese Extreme Obesity

BMI 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54

(inches)

Height Body Weight 

(pounds)

58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 172 177 181 186 191 196 201 205 210 215 220 224 229 234 239 244 248 253 258

59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 198 203 208 212 217 222 227 232 237 242 247 252 257 262 267

60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 184 189 194 199 204 209 215 220 225 230 235 240 245 250 255 261 266 271 276

61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211 217 222 227 232 238 243 248 254 259 264 269 275 280 285

62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 196 202 207 213 218 224 229 235 240 246 251 256 262 267 273 278 284 289 295

63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 203 208 214 220 225 231 237 242 248 254 259 265 270 278 282 287 293 299 304

64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232 238 244 250 256 262 267 273 279 285 291 296 302 308 314

65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240 246 252 258 264 270 276 282 288 294 300 306 312 318 324

66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 223 229 235 241 247 253 260 266 272 278 284 291 297 303 309 315 322 328 334

67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 230 236 242 249 255 261 268 274 280 287 293 299 306 312 319 325 331 338 344

68 125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230 236 243 249 256 262 269 276 282 289 295 302 308 315 322 328 335 341 348 354

69 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236 243 250 257 263 270 277 284 291 297 304 311 318 324 331 338 345 351 358 365

70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278 285 292 299 306 313 320 327 334 341 348 355 362 369 376

71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 257 265 272 279 286 293 301 308 315 322 329 338 343 351 358 365 372 379 386

72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 265 272 279 287 294 302 309 316 324 331 338 346 353 361 368 375 383 390 397

73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302 310 318 325 333 340 348 355 363 371 378 386 393 401 408

74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 280 287 295 303 311 319 326 334 342 350 358 365 373 381 389 396 404 412 420

75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 287 295 303 311 319 327 335 343 351 359 367 375 383 391 399 407 415 423 431

76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328 336 344 353 361 369 377 385 394 402 410 418 426 435 443

Source: Adapted from Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The Evidence Report. NIH Publication No. 98–4083: National Heart, Lung, and Blood Institute; 1998.
Advocacy and Policy Organizations

Council on Size and Weight Discrimination

P.O. Box 305

Mount Marion, NY 12456

Phone: 845–679–1209

Email: info@cswd.org

Internet: http://www.cswd.org

National Association to Advance Fat Acceptance

P.O. Box 4662

Foster City, CA 94404–0662 

Phone: 916–558–6880

Internet: http://www.naafa.org

Obesity Action Coalition

4511 North Himes Avenue, Suite 250

Tampa, FL 33614

Phone: 800–717–3117

Internet: http://www.obesityaction.org

Rudd Center for Food Policy and Obesity

Yale University

309 Edwards Street

New Haven, CT 06520–8369

Phone: 203–432–6700

Internet: http://www.yaleruddcenter.org

The Obesity Society

8630 Fenton Street, Suite 918

Silver Spring, MD 20910

Phone: 301–563–6526

Internet: http://www.obesity.org

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: 

http://www.win.niddk.nih.gov

The Weight-control Information 

Network (WIN) is a national 

information service of the National 

Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK), part 

of the National Institutes of Health 

(NIH). WIN provides the general 

public, health professionals, and the 

media with science-based, up-to-date, 

culturally relevant materials and tips. 

Topics include healthy eating, barriers 

to physical activity, portion control, 

and nutrition myths.

Publications produced by WIN are 

reviewed by both NIDDK scientists 

and outside experts. This fact sheet 

was also reviewed by Rebecca Puhl, 

Ph.D., Rudd Center for Food Policy 

and Obesity, Yale University. 

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 

http://www.win.niddk.nih.gov.

NIH Publication No. 03–5335

February 2003

Updated July 2011

8