Medical Care for Obese Patients

article syndicated from NIDDK
updated on 09/01/2006 at 02:09PM

Approximately 30 percent of adults in the United States are obese, up from 15 percent 2 decades ago. As prevalence rates continue to rise, most health care providers can expect to encounter obese patients in their practices. This article offers practical tips for overcoming the challenges unique to providing optimal care to patients who are obese, independent of weight loss treatment.

Obesity and Body Mass Index

Body mass index (BMI) closely correlates with body fat and can help predict the development of health problems related to excess weight. BMI is calculated by dividing weight in kilograms by height in meters squared (or weight in pounds by height in inches squared and multiplied by 703), or by using the chart below.

The National Institutes of Health (NIH) identifies obesity as a BMI of 30 kg/m2 or greater. Obesity is further broken down to Class I (BMI of 30-34.9 kg/m2), Class II (BMI of 35-39.9 kg/m2), and Class III (BMI of 40 kg/m2 or greater), also called extreme obesity.

Challenges in Treating Obese Patients

Patients who are obese may delay seeking medical care. They may also be less likely to receive certain preventive care services, such as Pap smears, breast examinations, and pelvic examinations. Insufficient medical care is probably the result of both patient and physician factors.

Providing Optimal Medical Care to Obese Patients

“My doctor talks about nutrition and what to eat for my type, but not about dieting. She encourages exercise, but doesn't push. I have been able to make beneficial changes in my diet under her non-judgmental guidance. She is very respectful... my comfort seems to be a goal for her.”
—A patient

“My doctor never judges me on my weight, and never talks down to me about it.”
—A patient

Health care providers can take steps to overcome barriers to ensure optimal medical care of patients who are obese. Optimal care begins with educating staff about treating patients with respect. Having appropriate equipment and supplies on hand further increases patient access to care. Weighing patients privately and only when necessary may help overcome their reluctance to seek out medical services. Offering preventive services in addition to monitoring and treating ongoing medical conditions helps ensure that obese patients receive the same level of care as non-obese patients. Finally, providers should encourage healthy behaviors and self-acceptance even in the absence of weight loss.

Using the following checklist can improve patient care in your office. To create a positive office environment, review the checklist with your medical and administrative staff.

Create an accessible and comfortable office environment.

Provide sturdy, armless chairs and high, firm sofas in waiting rooms.
Provide sturdy, wide examination tables that are bolted to the floor to prevent tipping.
Provide extra-large examination gowns.
Install a split lavatory seat and provide a specimen collector with a handle.

Use medical equipment that can accurately assess patients who are obese.

Use large adult blood pressure cuffs or thigh cuffs on patients with an upper-arm circumference greater than 34 cm.
Have extra-long phlebotomy needles, tourniquets, and large vaginal speculae on hand.
Have a weight scale with adequate capacity (greater than 350 pounds) for obese patients.

Reduce patient fears about weight.

Weigh patients only when medically appropriate.
Weigh patients in a private area.
Record weight without comments.
Ask patients if they wish to discuss their weight or health.
Avoid using the term obesity. Your patients may be more comfortable with terms such as ”difficulties with weight“ or ”being overweight.“

Monitor obesity-related medical conditions and risk factors.

Conduct tests to assess type 2 diabetes, dyslipidemia, hypertension, sleep apnea, ischemic heart disease, and nonalcoholic steatohepatitis.
Consider concerns of the extremely obese patient that may be overlooked such as lower extremity edema, thromboembolic disease, respiratory insufficiency (Pickwickian syndrome), skin compression (ulcers), and fungal infections.

Offer preventive care services.

Allow adequate time during office visits for preventive care services.
Recommend or provide preventive care services that are not impeded by the size of the patient, such as Pap smears, breast examinations, mammography, prostate examinations, and stool testing.

Encourage healthy behaviors.

Discuss weight loss—as little as 5 to 10 percent of body weight—as a treatment for weight-related medical conditions.
Emphasize healthy behaviors to prevent further weight gain, whether or not the patient is able or willing to lose weight.
Encourage physical activity to improve cardiovascular health.
Seek out professional resources to assist your patients and provide referrals to registered dietitians, certified diabetes educators, exercise physiologists, weight management programs, and support groups, as appropriate.
Promote self-acceptance and encourage patients to lead a full and active life.

Providing optimal medical care to patients who are obese may be challenging. Changes that foster a supportive and accessible environment for the patient, however, are within reach of most health care providers and can go far to overcome both patient and provider barriers to care.

Patient Barriers to Adequate Medical Care and Preventive Services

Self-consciousness about weight
Fears of disparaging, negative, or inappropriate comments from physicians and medical staff
Weight gain or failure to lose weight since last medical appointment
Past negative experiences with or disrespectful treatment from physicians and medical staff

Health Care Provider Barriers to Adequate Medical Care and Preventive Services

Lack of appropriate medical equipment to accurately assess and treat patients who are obese
Lack of training in accommodating the physical and emotional needs of persons who are obese
Perception that patients’ obesity is mainly due to lack of willpower
Difficulty performing examinations, such as pelvic exams, due to the patient’s size
Focus on treating ongoing medical conditions, to the exclusion of preventive care services

Article syndicated from National Institute of Diabetes and & Digestive & Kidney Diseases (NIDDK):
http://www.niddk.nih.gov/health/nutrit/pubs/medcare/medcare2.htm
NIH Publication No. 03-5335 - February 2003