Comprehensive Obesity Care

Importance of Diagnosis

Obesity is a complex, multifactorial disease.¹ Diagnosing obesity can be a critical first step in weight management and health outcomes for patients.

How can your patients benefit from obesity diagnosis and comprehensive care? Obesity is a complex multifactorial disease that requires comprehensive care to address the multisystem complications it is associated with, such as, osteoarthritis, hypertension and depression. Early diagnosis of obesity may lead to improvements in weight and obesity-related complications. New communication and care approaches, like the diagnostic term adiposity-based chronic disease, may help address barriers to diagnosis and improve patient outcomes. If you are interested in learning more about the benefits of obesity diagnosis and comprehensive care, follow the link on the screen.

Obesity as a disease

“Obesity is a chronic, progressive, relapsing, and treatable multifactorial neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”

– The Obesity Medicine Association¹

The worldwide prevalence of obesity nearly tripled between 1975 and 2016.²

In 2016 ²:

650 million people ≥18 years of age had obesity
>340 million people 5-19 years of age had obesity or overweight

animated world map of increasing obesity prevalence from 1976 to 2016

Image adapted from Our World in Data.³

Obesity is not simply a “comorbidity” or “risk factor” for other conditions^1,4-6:

Can be caused by a multitude of genetic and environmental factors outside food choice
Shares many of the same pathogenic processes as aging
Is a major cause of cardiovascular disease (CVD), cancer, sleep apnea, type 2 diabetes, and other related metabolic conditions^4-6

Silhouette of man with overweight and icons of affected organs.

Cancer

Colorectal, postmenopausal, breast, endometrial, gastrointestinal, liver

Cardiovascular

Hypertension, heart disease

Central Nervous System (CNS)

Depression, stroke

Endocrine

Metabolic syndrome, type 2 diabetes, dyslipidemia

Gastrointestinal

Metabolic dysfunction-associated steatotic liver disease (MASLD), cholelithiasis, gastroesophageal reflux

Genitourinary

Infertility (male/female), urinary stress incontinence, pregnancy complications

Infections

Sensitivity to influenza and COVID-19

Musculoskeletal

Osteoarthritis

Pulmonary

Obstructive sleep apnea

Renal

Chronic kidney disease

Other

Social stigmatization

Obesity is recognized as a disease by organizations such as the Obesity Medicine Association and the World Obesity Federation.^1,11

Three sets of percentages on whether people recognize Obesity as a disease. — 64% of employers (n=153)
65% of patients with obesity (n=3008)
80% of clinicians (n=606)

Action study participants agreed that obesity is a disease.⁷

Screening and Diagnosing Criteria for Obesity

The diagnosis of obesity can be made through the clinical interpretation of body mass index (BMI), taking into consideration other indicators of adiposity, as well as the presence of obesity-related complications ^8,9

BMI is a screening tool used to assist in the diagnosis of obesity that is interpreted using categories of weight status (in kg/m2)¹⁰:

Overweight: ≥25.0 to <30.0
Class 1 obesity: ≥30.0 to <35.0
Class 2 obesity: ≥35.0 to <40.0
Class 3 obesity: ≥40.0

Additional adiposity measures may be used:

Waist circumference¹¹
Waist-to-height ratio¹¹
Waist-to-hip ratio¹¹
Body composition technologies (eg, bioelectrical impedance analysis)⁸

Factors to Consider in Obesity Diagnosis^8,9,11

BMI and other indicators of obesity, such as waist circumference
Individual differences in body composition (eg, lean mass vs fat mass)
Associated with age, sex, ethnicity, and physical activity
Presence of adiposity-related complications
Weight management journey
Individualized goals

Accepted Screening and Staging Systems

BMI¹⁰
American Association of Clinical Endocrinology (AACE)/American College of Endocrinology (ACE) stages of obesity⁸
Edmonton Obesity Severity Scale⁹

Roger, a hypothetical patient, is visiting his clinician for an annual physical examination.

Roger has a history of weight gain after a foot fracture and experiences frustration and embarrassment at his inability to keep up with his previous physically active hobbies such as hiking and biking.

In the past 2 years, Roger lost weight using a commercial diet plan but regained the weight when he could no longer afford the diet meals.

Male patient talking to female clinician.

At today’s visit, Roger shares his frustration and discomfort with his clinician

Age: 57
Weight: 207 lb
Height: 5 ft 5 in
BMI: 34.5 kg/m2
Waist circumference: 43 in

Roger’s clinician will clinically ASSESS him to determine whether a diagnosis of obesity is appropriate. Based on this diagnosis and his obesity stage, she can better ADVISE him of treatment goals and options.

With a diagnosis of obesity, we can discuss treatment options and make a plan together.

Diagnosing and Treating Patients With Obesity

Early Diagnosis of Obesity May Lead to Improvements in Weight and Other Clinical Outcomes^1,12

Silhouette of overweight male with a tappering triangle to thinner male. Icons of blood drop, person running, and a heart overlay the triangle at intervals

Weight loss of 2%-5% results in improvements in glycemic measures and triglyceride levels^1,12

Weight loss of 5%-10% improves mobility, high-density lipoprotein (HDL) levels, urinary incontinence, and sexual function and reduces healthcare costs^1,12

Weight loss of 10%-15% or more can improve steatohepatitis and sleep apnea^1,12

As compared to patients who did not receive an obesity diagnosis, patients who received a formal, documented obesity diagnosis were more likely to have*:

Initial weight loss of ≥5%
(OR = 1.3; CI: 1.2-1.3)¹³

Initial weight loss of ≥10%
(OR = 1.4; CI: 1.3-1.4)¹³

*In an observational study of 688,878 adults with BMI ≥30.0 kg/m2, 44.9% of patients had a documented obesity diagnosis in a claim or electronic health records (EHR) problem list.

Learn more about comprehensive obesity care.

Includes how to discuss obesity with patients and Roger’s weight loss journey.

Discussing Obesity and Defining Goals

References

Bays H, Golden A, Tondt J. Thirty obesity myths, misunderstandings, and/or oversimplifications: an Obesity Medicine Association (OMA) clinical practice statement (CPS) 2022. Obesity Pillars. 2022;3:100034.
World Health Organisation. Obesity and overweight. World Health Organisation. Accessed October 26, 2023. https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight
Ritchie H, Roser M. Obesity. Our World in Data. Accessed October 26, 2023.https://ourworldindata.org/obesity#
Tsai AG, Bessesen DH. Obesity.Ann Intern Med. 2019;170(5):ITC33-ITC48. doi:10.7326/AITC201903050
Sarma S, Sockalingam S, Dash S. Obesity as a multisystem disease: trends in obesity rates and obesity-related complications. Diabetes Obes Metab. 2021;23(suppl 1):3-16.
Chan W-K, Chuah K-H, Rajaram RB, Lim L-L, Ratnasingam J, Vethakkan SR. Metabolic dysfunction-associated steatotic liver disease (MASLD): a state-of-the-art review. J Obes Metab Syndr. 2023;32(3):197-213.
Kaplan LM, Golden A, Jinnett K, et al. Perceptions of barriers to effective obesity care: results from the National ACTION Study. Obesity (Silver Spring). 2018;26(1):61-69.
Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(7):842-884.
Rueda-Clausen CF, Poddar M, Lear SA, Poirier P, Sharma AM. Canadian adult obesity clinical practice guidelines: assessment of people living with obesity. Obesity Canada. Accessed May 29, 2023.https://obesitycanada.ca/guidelines/assessment
Defining adult overweight & obesity. Centers for Disease Control and Prevention. Accessed November 7, 2023.https://www.cdc.gov/obesity/basics/adult-defining.html
Bray GA, Heisel WE, Afshin A, et al. The science of obesity management: an Endocrine Society scientific statement. Endocr Rev. 2018;39(2):79-132.
Ryan DH, Yockey SR. Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over. Curr Obes Rep. 2017;6(2):187-194.
Ciemins EL, Joshi V, Cuddeback JK, et al. Diagnosing obesity as a first step to weight loss: an observational study. Obesity.2020;28(12):2305-2309.

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Importance of Diagnosis

Obesity as a disease

“Obesity is a chronic, progressive, relapsing, and treatable multifactorial neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”

Obesity is not simply a “comorbidity” or “risk factor” for other conditions^1,4-6:

Screening and Diagnosing Criteria for Obesity

The diagnosis of obesity can be made through the clinical interpretation of body mass index (BMI), taking into consideration other indicators of adiposity, as well as the presence of obesity-related complications ^8,9

Roger, a hypothetical patient, is visiting his clinician for an annual physical examination.

Diagnosing and Treating Patients With Obesity

Early Diagnosis of Obesity May Lead to Improvements in Weight and Other Clinical Outcomes^1,12

References

Please rate your satisfaction with the content on the following statements:

Please rate your satisfaction with the content on the following statements:

Importance of Diagnosis

Obesity as a disease

“Obesity is a chronic, progressive, relapsing, and treatable multifactorial neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”

Obesity is not simply a “comorbidity” or “risk factor” for other conditions1,4-6:

Screening and Diagnosing Criteria for Obesity

The diagnosis of obesity can be made through the clinical interpretation of body mass index (BMI), taking into consideration other indicators of adiposity, as well as the presence of obesity-related complications 8,9

Roger, a hypothetical patient, is visiting his clinician for an annual physical examination.

Diagnosing and Treating Patients With Obesity

Early Diagnosis of Obesity May Lead to Improvements in Weight and Other Clinical Outcomes1,12

Related Resources

Downloadable PDFs

References

Please rate your satisfaction with the content on the following statements:

Please rate your satisfaction with the content on the following statements:

Obesity is not simply a “comorbidity” or “risk factor” for other conditions^1,4-6:

The diagnosis of obesity can be made through the clinical interpretation of body mass index (BMI), taking into consideration other indicators of adiposity, as well as the presence of obesity-related complications ^8,9

Early Diagnosis of Obesity May Lead to Improvements in Weight and Other Clinical Outcomes^1,12