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Clinical Assessment and Management of Adult Obesity

Overweight and obesity are the most common medical problems seen in primary care practice, affecting >68% of adults and 33.0% of children and adolescents in the United States.1,2 Obesity is a risk factor for several of the leading causes of preventable death, including cardiovascular disease, diabetes mellitus, and many types of cancer. Thus, successful treatment and control of obesity should be major imperatives. However, multiple studies have shown that detection and counseling rates among physicians remain low.3–6 Thus, a gap exists between the need to provide obesity care and the actual provision of care. In this article, current recommendations for the medical evaluation of the obese adult patient are reviewed, followed by management approaches to using lifestyle therapy, pharmacotherapy, and surgery.

Few other chronic public health conditions parallel the prevalence of overweight and obesity. They affect two thirds of adults and one third of children and adolescents in the United States.1,2 Minority racial and ethnic groups are especially affected; nearly 76.6% of blacks and 80% of Mexican Americans are overweight or obese.1 Per capita medical expenditures and the cost of both absenteeism and presenteeism (workers being on the job but, because of medical conditions, not fully functioning) attributable to obesity range from $1143 (obese I men) to $6684 (obese III women).7

Clinically, determination of height and weight functions as a simple and inexpensive surrogate measure for percent body fat when the values are entered into the Quetlet index (weight [kg]/height [m2]), commonly referred to as body mass index (BMI).8,9 Categorization of patients by BMI also serves as a useful risk estimate for morbidity and mortality that is supported by multiple population studies.10,11 The relationship is particularly striking for the development of …