Nearly half of people with obesity had not received a formal diagnosis1
Obesity remains underdiagnosed and undertreated.1
Only 55% of people with obesity reported receiving a formal diagnosis, and even fewer received follow-up obesity care1
*Either “discussed being overweight” (68%) or “discussed losing weight” (64%) with their health care professional.1
†Among the 71% who have had a conversation with their health care professional about obesity in the past 5 years.1
Diagnose your patients with obesity using the following protocols recommended by AACE/ACE2:
Evaluation
- Medical history
- Physical examination
- Clinical laboratory
- Review of systems, emphasizing obesity-related complications
- Obesity history
- Chart weight vs age
- Lifestyle patterns and preferences
- Previous interventions
Anthropometric diagnosis
- Confirm elevated BMI represents excess adiposity
- Measure waist circumference to evaluate cardiometabolic disease risk
Clinical diagnosis
- Normal weight: BMI <25 kg/m2‡
- Overweight: BMI 25 kg/m2–29.9 kg/m2
- Obesity: BMI ≥30 kg/m2
- Evaluate checklist of obesity-related complications
‡Or BMI <23 kg/m2 in certain ethnicities with waist circumference below regional/ethnic cutoffs.2
BMI, body mass index.
ADVOCACY AND RESOURCES
Reexamining obesity management
This tool explains the risk of weight-related comorbidities for patients with obesity.
METABOLIC ADAPTATION
AACE/ACE guidelines
These guidelines, established by endocrinologists, provide a frame of reference for managing obesity.
OA
OA
CVD Risk
PCOS
Lance
Age: 36
BMI: 35 kg/m2
Weight at an all-time high
At his last checkup, Lance’s weight was at an all-time high of 275 lb, and he had begun to have difficulty walking because of worsening knee pain. To improve his weight, Lance began eating healthier foods and joined a gym.
A diagnosis of osteoarthritis
Despite his new healthy habits, Lance’s knee pain continues, and he is diagnosed with osteoarthritis in his right knee. He is offered therapeutic and surgical options but is concerned about the time required for physical therapy. Lance is not losing weight, and his knee pain is getting worse. He and his doctor agree that his excess weight may be contributing to his worsening osteoarthritis and knee pain.
Weight loss limited to 5%
Because of his knee pain, exercise has been challenging for Lance. His lack of mobility has limited his weight loss to 5% of his body weight. According to his BMI, Lance still has obesity. Although Lance has lost significant weight in the past, he has been unable to maintain that weight loss long-term.
What are the next steps?
If healthier eating habits and exercise aren’t enough to help Lance achieve his desired weight loss, what other options are available to help him manage his weight?
Osteoarthritis tends to progress more quickly and be more severe in people with obesity.3
OA, osteoarthritis.
Simone
Age: 41
BMI: 32 kg/m2
A family history of obesity
Simone has struggled with the cycle of weight loss and regain for most of her life. She is concerned because of her family history of obesity and cardiovascular disease risk factors, including hypertension and dyslipidemia.
Diagnosis confirmed
Simone’s recent checkup showed she was right to be concerned. Like many of her family members, Simone was diagnosed with hypertension, dyslipidemia, and prediabetes, in addition to obesity.
Race to lose weight
Reluctant to take medicines for her newly diagnosed comorbidities, Simone begins an aggressive lifestyle-modification program.
Weight regain
While Simone reached the weight-loss goals she set with her doctor, the weight slowly returned. Now she is continuing her diet and exercise to help manage her prediabetes along with taking several medicines for the management of hypertension and dyslipidemia.
What are the next steps?
What options are available to Simone to help her manage her weight?
Obesity can increase the risk of a CV event.4,5
CV, cardiovascular; CVD, cardiovascular disease.
Maria
Age: 29
BMI: 34 kg/m2
Significant weight gain
Maria gained a significant amount of weight during her last pregnancy and is having trouble losing that weight.
Regularly irregular
Maria’s menstrual cycle has never been regular, and she has noticed her periods have become longer and even more irregular since her weight gain. She consults with her OB/GYN, who orders blood tests and an ultrasound.
A diagnosis of PCOS
Based on the test results, Maria is diagnosed with PCOS. Her OB/GYN recommends lifestyle modifications to help with her weight management. Maria begins making changes in her daily routine for a healthier lifestyle, including diet and exercise.
A weight loss of 10%
8 months later, Maria has not been able to manage her weight and continues to struggle with her PCOS symptoms. She and her OB/GYN agree that diet changes and exercise alone were not enough in her weight-management journey, and together they set a new goal of 10% weight loss.
What are the next steps?
What options are available to Maria to help her manage her weight?
Between 38% to 88% of women with PCOS are overweight or living with obesity.6
OB/GYN, obstetrician/gynecologist; PCOS, polycystic ovary syndrome.
DIAGNOSING OBESITY
Start the conversation on weight management
INITIATING A PLAN
Can pharmacotherapy help patients manage their weight?
References:
1. 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.
2. Garvey WT, Mechanick JI, Brett EM, et al; Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. 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(suppl 3):1-203.
3. Arthritis Foundation. How fat affects osteoarthritis. Accessed May 17, 2024. https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/how-fat-affects-osteoarthritis
4. Khan SS, Ning H, Wilkins JT, et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol. 2018;3(4):280-287.
5. Powell-Wiley TM, Poirier P, Burke LE, et al; American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143(21):e984-e1010.
6. Barber TM, Frank S. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf). 2021;94(4):531-541.
