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Obesity in Primary Care: Making the Diagnosis

Obesity in Primary Care: Making the Diagnosis

Obesity is a major public health problem with a prevalence in the United States of about 30%. The condition is associated with important chronic diseases, such as type 2 diabetes, hypertension, dyslipidemia, coronary heart disease, stroke, and several cancers, as well as disability and increased mortality.

Screening for All Adults

The US Preventive Services Task Force (USPSTF) recommends screening all adults for obesity and indicates that health care providers have an important role in preventing, identifying, and managing this chronic disease. The USPSTF also recommends that once a diagnosis has been established, physicians should offer or refer patients with a body mass Index (BMI) > 30 kg/m2 to an intensive, interdisciplinary lifestyle intervention program.

However, obesity is a chronic disease that is underdiagnosed in clinical practice. Fewer than 30% of adults with obesity are thought to receive the diagnosis during their primary care visit. Also, probably because of the failure to obtain anthropometric patient data and to clinically identify obesity in patients with this pathology, only a small percentage of obese persons (37%) received any formal obesity counseling during the first visit to their PCP.

Weight Loss Interventions

The USPSTF found adequate evidence to indicate that intensive, multicomponent behavioral interventions for obese adults can lead to an average weight loss of 4 to 7 kg (8.8 to 15.4 lb). These interventions also improve glucose tolerance and other physiologic risk factors for cardiovascular disease.

The questions primary care physicians most often ask about obesity diagnosis are answered on the pages that follow.

Next: Developmental Factors and Comorbidities

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