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Chapter 5: The Physical Exam

Asking patients to “step on the scale” is often part of a routine physical examination; however, clinicians should be considerate of the timing, approach, and rationale for taking weights. Additionally, weight measurements should be done in conjunction with other assessments of health related to a patient’s size.   

Rethinking Procedures for Taking Weight

To reduce patients’ fears about the clinic visit, review clinic procedures for weighing patients. Encourage a practice of weighing patients only when needed. Locate the scales in a private area that allows information to be kept confidential. Patients should be asked their permission to have their weight taken. ‘Do I have your permission to weigh you today?’ Be sure to record weight without comment. 

Assessing Weight-Related Health Risk

Determining when to counsel about weight is a first step. Important data include:
  • Weight history
  • Body mass index
  • Waist circumference
  • Current weight-related conditions
  • Presence of eating disorders
The National Heart, Lung, and Blood Institute recommends weight loss therapy for these patients:
  • Those with a BMI of 30 or higher
  • Women with waist circumference of 35 inches of greater
  • Men with a waist circumference of 40 inches or greater
  • Those with a BMI of 25 or higher AND two or more weight-related health issues. 
 
Screening tests are needed to rule out specific obesity-related conditions (see "Weight-Related Medical Conditions and Risk Factors by Organ System"). Patients should have fasting lipid profile and fasting blood glucose level.
 

Weight-Related Medical Conditions and Risk Factors by Organ System [1]

 

Cardiovascular
  • Hypertension
  • Coronary Artery Disease
  • Congestive Heart Failure
  • Cor-Pulmonale
  • Varicose Veins
  • Pulmonary Embolism
Endocrine
  • Metabolic Syndrome
  • Type 2 Diabetes Mellitus
  • Dyslipidemia
  • Polycystic Ovary Syndrome
  • Menstrual Disorders/Infertility
 

Gastrointestinal

  • Gastroesophageal Reflux Disease
  • Non-alcoholic Fatty Liver Disease
  • Gallstones
  • Hernias
  • Colon Cancer
Genitourinary
  • Stress Urinary Incontinence
  • Obesity-related glomerulopathy
  • Male Hypogonadism
  • Breast and Uterine Cancer
  • Complications of pregnancy
 
Skin
  • Striae
  • Lymphedema
  • Cellulitis
  • Intertrigo
  • Acanthosis Nigricans
  • Status Pigmentation of Legs
Respiratory
  • Dyspnea
  • Asthma
  • Obstructive Sleep Apnea
  • Hypoventilation Syndrome
  • Pickwickian Syndrome
 
Neurologic
  • Cerebrovascular Accident
  • Idiopathic Intracranial Hypertension
  • Meralgia Paresthetica
 
Musculoskeletal
  • Gout and Hyperuricemia
  • Osteoarthritis of Hips and Knees
  • Immobility
  • Low Back Pain
 

 

References

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