Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults Risks and Assessment NHLBI Obesity Education Initiative National Heart, Lung, and Blood Institute in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases National Institutes of Health

Alarming Trends in Health of the U.S.

Definitions Body Mass Index (BMI) describes relative weight for height: weight (kg)/height (m2) Overweight = 25–29.9 BMI Obesity = >30 BMI

Assessment of Overweight and Obesity Body Mass Index (BMI): weight (lbs) X 703 height (inches2) Overweight = 25 - 29.9 kg/m2 Obesity = > 30 kg/m2 Waist Circumference High risk: Men >102 cm (40 in) Women >88 cm (35 in) Other risk factors

Age-adjusted prevalence of obesity in Adults ages 20-74 by sex and survey. (NHES, 1960-62; NHANES, 1971-74, 1976-80, 1988-94 and 2003-2006). Source: Health, United States, 2008. NCHS. Note: Obesity is defined as a BMI of 30.0 or higher.

Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1990 1999 2008 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% 7

Distribution of BMI between 1976-1980 and 2005-2006, adults aged 20-74 years, U.S.

NHANES III Prevalence of Hypertension* According to BMI Percent *Defined as mean systolic blood pressure 140 mm Hg, mean diastolic 90 mm Hg, or currently taking antihypertensive medication. Brown C et al. Body Mass Index and the Prevalence of Hypertension and Dyslipidemia. Obes Res. 2000; 8:605-619.

NHANES III Prevalence of High Blood Cholesterol* According to BMI Percent *Defined as >240 mg/dL. Brown C et al. Body Mass Index and the Prevalence of Hypertension and Dyslipidemia. Obes Res. 2000; 8:605-619.

NHANES III Prevalence of Low HDL-Cholesterol* According to BMI Percent *Defined as <35 mg/dL in men and <45 mg/dL in women. Brown C et al. Body Mass Index and the Prevalence of Hypertension and Dyslipidemia. Obes Res. 2000;8:605-619.

Health Benefits of Weight Loss Decreased cardiovascular risk Decreased glucose and insulin levels Decreased blood pressure Decreased LDL and triglycerides, increased HDL Decreased severity of sleep apnea Reduced symptoms of degenerative joint disease Improved gynecological conditions

Care of Overweight/Obese Patients Requires two steps: Assessment Management

Assessment of Overweight and Obesity Body Mass Index Weight (kg)/height (m2) Weight (lb)/height (in2) x 703 Table Waist Circumference High risk: Men >102 cm (40 in.) Women >88 cm (35 in.)

Classification of Overweight and Obesity by BMI

Determine Absolute Risk Status Evaluate: Disease conditions (e.g., CHD, type 2 diabetes, sleep apnea) (+ = very high risk) Other obesity-associated diseases (e.g., gynecological abnormalities, osteoarthritis) Cardiovascular risk factors: smoking, hypertension, high LDL, low HDL, IGT, family hx (>3 = high risk) Other risk factors: Physical inactivity High serum triglycerides (>200 mg/dL)

Obesity-associated Morbidities Asthma Urinary incontinence Gallbladder disease Nonalcoholic FLD Osteoarthritis Psychological disorders Type 2 diabetes Heart disease Hypertension Stroke Cancer Sleep apnea