ui ASSESSMENT OF OVERWEIGHT AND OBESITY h an The Heart Foundation a Te H o t u M na wa W Kg (st/lb) This resource is inappropriate for use with: l children or adolescents under the age of 18 years l very muscular people l pregnant women l those who are very short (less than 150cm) or very tall (greater than 190 cm) Kg/m2 32 120 (18.2) 30 CALCULATIONS BODY MASS INDEX (BMI) 110 (17.4) Metric conversion formula = Weight (kg) / height (m)2 Example of BMI calculation: A person who weighs 78 kilograms and is 177 centimetres tall has a BMI of 25: Weight (78kg) / height (1.77m x 1.77m) = 24.9 100 (15.10) 25 90 (14.2) 80 (12.8) Overweight 18.5 70 (11.0) 60 (9.6) Healthy BODY MASS INDEX IN KILOGRAMS PER METRE SQUARED WEIGHT IN KILOGRAMS (STONES & POUNDS) — IN LIGHT CLOTHING WITHOUT SHOES 26 Obesity Non-metric conversion formula = [weight (pounds) / height (inches)2] x 704.5 Example of BMI calculation: A person who weighs 165 pounds and is 68 inches (or 5’8”) tall has a BMI of 25.1 {weight (165 pounds) / height (68 inches x 68 inches)} x 704.5 = 25.1 CLASSIFICATION OF OVERWEIGHT AND OBESITY RISK OF TYPE 2 DIABETES AND CARDIOVASCULAR DISEASE BMI (kg/m2) Underweight Healthy Overweight Obesity 50 (7.12) 40 (6.4) <18.5 18.5 - 25 25 - 30 >30 Waist Circumference (cm) Men £ 102cm Women £ 88cm > 102cm > 88cm — — Increased High — Increased High Very High Table adapted from: Preventing and Managing the Global Rpidemic of Obesity Report of the World Health Organisation Consultation of Obesity. WHO, Geneva, June 1997. Underweight NOTES 30 (4.10) l For Maori and Pacific Islands people the upper range for healthy weight and obesity should be extended to 26kg/m2 and 32kg/m2 respectively. 140cm (4’7”) 150cm (4’11”) 160cm (5’3”) 170cm (5’7”) 180cm (5’11”) HEIGHT IN CENTIMETRES (FEET & INCHES) — WITHOUT SHOES 190cm (6’3”) l For Asion populations, BMI definitions should be adjusted downwards. l The health risk from obesity may not be as strong in people over 75 years. This chart is a guideline only and clinical judgement may be needed for some individuals. BACKGROUND INFORMATION FOR THE HEALTH PROFESSIONAL TREATMENT ALGORITHM* 1. The person’s risk status should be assessed by determining the degree of overweight or obesity based on BMI. the degree of abdominal obesity based on waist circumference, and the presence of concomitant risk factors or co-morbidities. Patient Encounter 2. An increased waist circumference is independently associated with increased health risk including people with a BMI less than 25kg/m². Hx of ³ 25 BMI? 3. If the BMI is above 35kg/m² the waist circumference does not add significantly to the risk estimation. No Yes BMI measured in past 2 years? 4. Waist circumference cut-off points can generally be applied to all adult ethnic groups unless the person is very short (less than 150cm). 5. The relationship between BMI and health risk weakens with increasing age, especially over 75 years. This is partly explained by confounding factors (such as occult diseases, selected survival and smoking). • Measure weight, height and waist circumference • Calculate BMI BMI ³ 25 OR waist circumference >88cm (F) >102cm (M) 6. At any given percentage of body fat, BMI is one or two units higher in Polynesians than in New Zealand Europeans and these differences increase with increasing BMI. Yes Assess risk factors No Hx BMI ³ 25? Yes Clinician and patient devise goals and treatment strategy for weight loss and risk factor control No Yes Yes Does patient want to lose weight? No Brief reinforcement/ educate on weight management 7. Asian ethnicity is associated with a smaller body frame and therefore BMI cut-offs should be adjusted downwards, however, equivalent levels have not been determined. BMI ³ 30 OR {BMI 25 to 29.9 OR waist circumference >88cm (F) >102cm (M)} AND ³ 2 risk factors Advise to maintain weight/address other risk factors Periodic Weight Check Yes Progress being made/goal achieved? No No Maintenance counseling: • Dietary therapy • Behaviour therapy • Physical activity Assess reasons for failure to lose weight Instructions for Measuring Waist Circumference To define the level at which waist circumference is measured, a bony landmark is first located. The measuring tape is placed in a horizontal plane around the abdomen at a level just above the uppermost lateral border of the iliac crest. The plane of the tape is parallel to the floor and the tape is snugg, but does not compress the skin. The measurement is made at a normal minimal expiration. Examination Treatment * This algorithm applies only to the assessment for overweight and obesity and subsequent decisions based on that assessment. It does not reflect any initial overall assessment for other conditions and diseases that the clinician may wish to do. ADVANTAGES OF WEIGHT LOSS • Lowering of elevated blood pressure in overweight and obese persons. • Lowering of total cholesterol, LDL-cholesterol, and triglyceride, raising of low HDL-cholesterol levels in overweight and obese persons with dyslipidaemia. • Lowering of elevated blood glucose levels in overweight and obese persons with type 2 diabetes.
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